😱A clinical case of lymphoma-induced nightmares.
A 56-year-old woman presented to a neurologist with multiple neurological symptoms — nightmares, unusual headaches, and dizziness. She also developed a fever and abdominal pain.
✅Examination. Body temperature: 38.6°C, pale skin. No enlarged lymph nodes or spleen were found. Neurological examination revealed confusion.
✅Complete Blood Count: ❗Hemoglobin – 79 g/L; (moderate anemia) Leukocytes — 4.43 × 109 /L; (normal) Neutrophils — 2.9 × 109 /L; (normal) Platelets — 215 × 10^9 /L. (normal)
✅In the image below: a) Brain MRI. Two hyperintense lesions in the right parietal lobe: one subcortical and the other periventricular (black arrows).
b-h Bone marrow aspiration. May-Grünwald-Giemsa stain, ×200. b) Hypercellularity with a predominance of large mononuclear cells. c–d) Large malignant cells (30–70 µm) with round or lobulated nuclei and basophilic cytoplasm; e) Lymphoma cell with pseudopodia formation; g) Blasts; h) Phagocytosis of neutrophils by macrophages.
🔬Microscopic examination of the blood smear revealed a leucoerythroblastic reaction with 1–2% blast-like cells. The bone marrow aspirate was hypercellular and contained 40.5% large undifferentiated cells.
✅Laboratory tests revealed abnormally high levels of ferritin 3225 µg/L, triglycerides 294 mg/dL, LDH 1501 IU/L, soluble CD25 (39.09 ng/mL, normal <7.5), and β2-microglobulin 5.1 (normal 0.97 - 2.64 mg/L).
🧬Karyotype in the 2nd photo in the carousel (very complex chromosomal aberrations!)
💡Immunophenotyping. Revealed a high population of mature monoclonal B-lymphocytes with forward and side scatter. The cells were positive for CD19, CD45, CD20, CD38, HLA-DR, immunoglobulin kappa light chain, and CD5, with no CD10 expression.
⚠The 56-year-old woman was diagnosed with intravascular large B-cell lymphoma with hemophagocytic lymphohistiocytosis.
💊Treatment. The patient achieved complete remission after 2 courses of carmustine, cytarabine, and methotrexate, followed by 1 cycle of R-CHOP (rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisone). She later underwent autologous stem cell transplantation (auto-SCT). She remains in complete remission 17 months after diagnosis.
👉Source: Prats-Martín, C., Franco-Macías, E., Morales-Camacho, R. M., Pérez, O., Vargas, M. T., de la Cruz Vicente, F., Pérez-Simón, J. A. (2016). Intravascular lymphoma: look through the small vessels. Annals of Hematology, 96(3), 517–519.
