Case Report
Copyright ©The Author(s) 2020. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Oncol. Aug 24, 2020; 11(8): 673-678
Published online Aug 24, 2020. doi: 10.5306/wjco.v11.i8.673
Intravascular lymphoma with hypopituitarism: A case report
Teiko Kawahigashi, Shinichi Teshima, Eri Tanaka
Teiko Kawahigashi, Department of General Internal Medicine, Shonan Kamakura General Hospital, Kanagawa 247-8533, Japan
Shinichi Teshima, Department of Histopathology, Shonan Kamakura General Hospital, Kanagawa 247-8533, Japan
Eri Tanaka, Department of Hematology, Shonan Kamakura General Hospital, Kanagawa 247-8533, Japan
Author contributions: Kawahigashi T made substantial contributions to the conception of the case and wrote the initial draft of the manuscript; Teshima S contributed to the acquisition and interpretation of the patient’s findings and data; Tanaka E was involved in drafting the manuscript, revising it critically for important intellectual content, and provided final approval for the version to be published; all authors meet the criteria for authorship and have read the manuscript and have approved this submission.
Informed consent statement: Written informed consent was obtained from the patient for publication of this case report and any accompanying images.
Conflict-of-interest statement: The authors have no conflicts-of-interest to disclose.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Teiko Kawahigashi, MD, Doctor, Department of General Internal Medicine, Shonan Kamakura General Hospital, 1370-1 Okamoto, Kanagawa 247-8533, Japan. teikokawahigashi@gmail.com
Received: January 20, 2020
Peer-review started: January 20, 2020
First decision: April 3, 2020
Revised: May 7, 2020
Accepted: June 27, 2020
Article in press: June 27, 2020
Published online: August 24, 2020
Processing time: 213 Days and 19.5 Hours
Abstract
BACKGROUND

Intravascular lymphoma (IVL) is a rare subtype of lymphoma involving the growth of lymphoma cells within the vessel lumina without lymphadenopathy. Because of various modes of presentation and its rarity, IVL is often diagnosed postmortem. Herein, we report a case of intravascular B-cell lymphoma with hypopituitarism, an extremely rare complication, that was successfully treated with chemotherapy.

CASE SUMMARY

An 80-year-old Japanese woman presented with a 7-mo history of a tingling sensation in the lower limbs. She also presented with various other symptoms such as pancytopenia, high fever daily, and unconsciousness with hypoglycemia. Although the doctor who previously treated her diagnosed hypoglycemia as being due to hypopituitarism, the cause of the other symptoms remained uncertain despite a 7-mo evaluation period. We performed bone marrow aspiration to evaluate pancytopenia and found that she had hemophagocytic lymphohistiocytosis (HLH). On the basis of a random skin biopsy for assessing the cause of HLH, she was diagnosed with intravascular B-cell lymphoma. HLH and hypopituitarism were considered secondary to IVL. All her clinical findings matched the presentations of IVL. She was immediately treated with chemotherapy and achieved complete response. She was relapse free two years after treatment.

CONCLUSION

IVL should be included in the differential diagnosis of hypopituitarism, which although life-threatening, is treatable through prompt diagnosis and appropriate chemotherapy.

Keywords: Intravascular lymphoma; Random skin biopsy; Hypopituitarism; General internal medicine; Tingling; Pancytopenia; Case report

Core tip: When encountering cases showing a variety of symptoms that cannot be reasonably explained, general physicians should consider intravascular lymphoma (IVL) and its useful diagnostic tool, i.e., random skin biopsy. Additionally, the mechanisms underlying lymphoma-associated hypopituitarism associated with IVL have not yet been elucidated, thereby necessitating further case studies and laboratory-based research.