1. CPC #5 Pathology

5. CD3

7. CD20

9. Ki-67

11. Diagnosis Intravascular Large B-Cell Lymphoma

12. Intravascular Large B Cell Lymphoma Extranodal Diffuse Large B Cell Lymphoma characterized by lymphoma cells confined to lumen of small vessels Affects adults Symptoms arise from occlusion of capillaries Absence of homing recptors on neoplastic cells –CD29 (B1-integrin) –CD54 (ICAM-1)

13. Intravascular Lymphoma: Presentation Skin-plaques and nodules CNS-dementia, focal neurologic deficits –DDX: Vasculitis Fever of Unknown Origin

14. Intravascular Lymphoma: Prognosis Thought to have poor prognosis –Delay in diagnosis –Poor response to chemotherapy –Cutaneous-only cases (almost always females) may be a better prognosis DiGiuseppe JA, Nelson WG, Seifter E, Boitnott JK, Mann RB. J Clin Oncol 1994;12: 2573-9. –Aggressive combination chemotherapy can yield long term survival

15. Follow-Up on This Case On 12/29/2008 the patient was transferred to begin chemotherapy for intravascular lymphoma. CHOP therapy was initiated and her altered mental status resolved rather quickly. As of 10/20/2009 the patient is status post 6 cycles of R- CHOP, the last being in 05/09. Her course has been complicated by a sacral decubitus ulcer with associated osteomyelitis for which she was treated with 6 course of vancomycin and cefepime which was completed on 09/10/09. She also has indwelling foley catheter with chronic contamination of C-candida glabrata.