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Washington University Experience | NEOPLASMS (HEMATOLYMPHOID) | Lymphoma, Intravascular | 2A0 Case 2 History
Case 2 History ---- The patient was a 68 year old woman with a medical history remarkable only for osteoporosis. In February, she noted a decreased energy level, fatigability, and a 15 pound weight loss over the last several months. A bone marrow biopsy showed myeloblastoid changes, hypocellular marrow, and hypersegmented neutrophils without evidence of malignancy. This was not thought consistent with myelodysplastic syndrome, but suggested anemia of chronic disease. She subsequently developed multiple compression fractures. She was admitted to BJH for further workup. An MRI of her brain showed moderate to severe white matter changes. The patient's mental status slightly improved while in the hospital and she was discharged to a rehabilitation facility on 6/13. While in rehabilitation, lumbar puncture showed elevated ACE levels (6.0). She was started on high dose Prednisone and experienced significant cognitive improvement. Later, while at an OSH she patient became septic, presumably from a urinary tract infection, and on 7/12, she became hypotensive, unresponsive and died on 7/13. ---- At autopsy the weight of the unfixed brain was 1350g. The white matter shows multiple irregular tan-white, soft lesions. Leptomeningeal and intraparenchymal vessels, mostly of small caliber, contain clusters of intraluminal large, atypical lymphoid cells with vesicular nuclei, and mitotic activity. These cells were reactive for CD45 (leukocyte common antigen, LCA) indicating their hematolymphoid origin. They are also reactive for L26, a B cell marker, and are non-reactive for CD3 and UCHL-1, T cell markers. Thus, this is a large cell lymphoma of B cell origin that is intravascularly located and that does not show bone marrow, brain parenchymal involvement or systemic mass lesions.