Peripheral blood smear in a case of intravascular lymphoma

A 72-year-old woman developed fever, progressive fati-

gue, memory disturbance, and weakness of lower extrem-

ities in October 2007. She was admitted to our hospital

in December 2007 after she showed progressive worsen-

ing of symptoms. Physical examination revealed marked

facial and pedal edema and absence of hepatospleno-

megaly.

Laboratory results included hemoglobin, 11.9 g ⁄dL;white blood cell count, 7.9 · 109 ⁄L; platelet count,

100 · 109 ⁄L; lactate dehydrogenase, 1254 U ⁄L (normal,

119 to 229); and soluble interleukin-2 receptor,

5873 U ⁄mL (normal, 190–650). Coagulation study

revealed the presence of disseminated intravascular

coagulation.

Peripheral blood examination revealed a cluster of

large lymphoid cells with prominent nucleoli (Fig. 1).

Immunohistochemical study demonstrated that the

abnormal cells were positive for CD45 and CD20 and

negative for CD3. Bone marrow aspiration and biopsy

revealed no evidence of abnormal lymphoid cell infiltra-

tion. Whole-body computed tomography showed no

lymphadenopathies. She was diagnosed with intravascular

lymphoma and treated with rituximab and cyclo-

phosphamide ⁄doxorubicin ⁄vincristine ⁄prednisone. Fol-

lowing treatment, her condition improved markedly.

Intravascular lymphoma is a rare lymphoid malignancy

that is difficult to be diagnosed in some cases. Careful

examination of peripheral blood smear is essential in such

cases.

Shuro Yoshida, Koji NagafujiMedicine and Biosystemic Science, Kyushu University

Graduate School of Medical Sciences, Fukuoka, Japan

Correspondence Koji Nagafuji, Medicine and Biosys-

temic Science, Kyushu University Graduate School of

Medical Sciences, 3-1-1 Maidashi, Higashi-ku, Fukuoka

812-8582, Japan.

Tel: 81 92 642 5230; Fax: 81 92 642 5247;

e-mail: nagafuji@intmed1.med.kyushu-u.ac.jp

Figure 1 Peripheral blood smear of the patient at presentation.

Peripheral blood examination revealed a cluster of large lymphoid cells

with prominent nucleoli.

doi:10.1111/j.1600-0609.2008.01125.x European Journal of Haematology ISSN 0902-4441

CLINICAL PICTURE

ª 2008 The Authors

Journal compilation 81 (327) ª 2008 Blackwell Munksgaard 327