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Kosei Matsue - One of the best experts on this subject based on the ideXlab platform.
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random skin biopsy and bone marrow biopsy for diagnosis of Intravascular large b cell Lymphoma
Annals of Hematology, 2011Co-Authors: Kosei Matsue, Noboru Asada, Masayuki Yamakura, Shun Ichi Kimura, Jun Odawara, Takayoshi Aoki, Kan Ichi Iwama, Hideaki Fujiwara, Masami TakeuchiAbstract:Intravascular Lymphoma (IVL) is a rare type of extranodal Lymphoma in which the Lymphoma cells proliferate exclusively in the lumina of small vessels. The diagnosis of IVL requires histological confirmation. Although random skin biopsy from healthy-appearing skin in patients with suspected IVL appeared to be useful, the sensitivity of this method for the diagnosis of IVL remains unknown. We performed a random skin biopsy from 12 consecutive cases of IVL diagnosed at our institution over the past 4 years and evaluate its relevance of clinical and laboratory characteristics, presence or absence of skin lesions, and bone marrow involvement. All 12 patients were diagnosed antemortem by either random skin biopsy or bone marrow biopsy and treated with rituximab-containing chemotherapy. Random skin biopsy was performed in all 12 patients, and the results were positive in ten patients (83.3%). Erythematous skin lesions were seen in 3 of 12 patients, but biopsy was positive for Lymphoma lesion in two patients. Bone marrow invasion was seen in 11 of the 12 patients (91.6%) by bone marrow smear and/or flow cytometric analysis, but was detected in only half of the patients by trephine biopsy. We concluded that random skin biopsy from normal-appearing skin is highly sensitive in the diagnosis of IVL comparable to bone marrow trephine biopsy. It should be performed irrespective of the presence or absence of skin lesions in patients who were suspicious of IVL.
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a clinicopathological study of 13 cases of Intravascular Lymphoma experience in a single institution over a 9 yr period
European Journal of Haematology, 2008Co-Authors: Kosei Matsue, Noboru Asada, Masami Takeuchi, Masayuki Yamakura, Shun Ichi Kimura, Jun Odawara, Takatoshi AokiAbstract:Intravascular Lymphoma (IVL) is a rare type of extranodal Lymphoma in which the Lymphoma cells proliferate exclusively in lumina of small vessels. Here, we report a clinicopathological study of 13 cases IVL diagnosed at our institution between March 1999 and July 2007, and evaluated the clinical characteristics, usefulness of random skin biopsy and response to chemotherapy containing rituximab. Three of 13 patients were diagnosed at autopsy. The most common clinical features were unexplained fever, neurological deterioration, respiratory failure, and poor performance status. Thrombocytopenia, high serum lactate dehydrogenase and soluble interleukin2 receptor levels were the most common laboratory abnormalities. Adrenal tumor was detected in four cases and pituitary involvement was seen in all three autopsied cases and in two surviving patient by brain magnetic resonance imaging. Bone marrow invasion was seen in all 13 cases by bone marrow smear, and it was subtle in trephine biopsy. Immunohistochemical analyses revealed that CD5 was positive in one-third of the cases. Most of the cases were positive for MUM1/IRF, Bcl-2 and negative for CD10 and BCL-6 indicating the postgerminal center cell origin of this peculiar type of Lymphoma. On random skin biopsy, the most recent seven patients were diagnosed promptly and chemotherapy containing rituximab was successfully administered. Patients with IVL exhibit the characteristic clinical and immunophenotypic features cited above and the use of random skin biopsy facilitates prompt diagnosis. Early commencement of chemotherapy containing rituximab appears promising for this peculiar Lymphoma. As the recent seven patients were diagnosed by random skin biopsy over the past 13 months, the incidence of IVL is thought to be much higher than generally accepted.
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use of random skin biopsy for diagnosis of Intravascular large b cell Lymphoma
Mayo Clinic Proceedings, 2007Co-Authors: Noboru Asada, Masami Takeuchi, Masayuki Yamakura, Shun Ichi Kimura, Jun Odawara, Takatoshi Aoki, Reiko Seki, Atsushi Tanaka, Kosei MatsueAbstract:Intravascular Lymphoma (IVL) is a rare type of extranodal Lymphoma with an aggressive clinical course characterized by proliferation of large Lymphoma cells within the lumina of the small vessels. Because of its varied clinical symptoms and the absence of lymphadenopathy, diagnosis of IVL is extremely difficult and requires histological confirmation. We report here 6 consecutive patients with IVL, admitted to Kameda General Hospital, Kamogawa-shi, Japan, from June 7, 2006, to February 28, 2007, whose IVL was diagnosed by random skin biopsy of healthy-appearing skin. Three patients presented with progressive neurological deterioration and 2 others with hypoxemia with interstitial infiltration on chest radiography. One patient presented with confusion and severe hypoxia without apparent interstitial infiltration. Two patients showed localized skin involvement. Irrespective of the presence of skin lesions, almost all skin biopsy specimens showed obliteration of small vessels of subcutaneous fat tissues by Lymphoma cells, allowing a prompt diagnosis of IVL. Early institution of rituximab-based chemotherapy induced favorable responses in all patients treated. Because diagnosis based on tissue other than skin is usually difficult in patients with suspected IVL, random skin biopsy should be considered even in patients with no evident skin lesions.
Geraldine S Pinkus - One of the best experts on this subject based on the ideXlab platform.
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Intravascular cytotoxic t cell Lymphoma a case report and review of the literature
Journal of The American Academy of Dermatology, 2008Co-Authors: Briana C Gleason, Geraldine S Pinkus, Nooshin K Brinster, Scott R Granter, Neal I Lindeman, Danielle M MillerAbstract:Intravascular Lymphoma (IVL) is a rare subtype of extranodal diffuse large B-cell Lymphoma in the World Health Organization classification. Although the majority of cases are of B-cell lineage, cases of IVL with a T-cell phenotype and, rarely, histiocytic and natural killer (NK)-cell phenotypes have been reported. We report a case of T-cell IVL with a cytotoxic phenotype. A 62-year-old male presented with erythematous patches and plaques on the lower extremities, and a biopsy revealed IVL with an activated cytotoxic phenotype (CD56 + , perforin+, granzyme B+, TIA-1+, CD3ɛ + , CD20 − , CD4 − , CD8 − , CD5 − , and T-cell receptor [TCR] βF1 - ), consistent with either NK-cell or T-cell origin. TCR gene analysis showed a monoclonal T-cell population, supporting the diagnosis of a T-cell IVL. Although the patient's skin lesions were refractory to combination chemotherapy and salvage chemotherapy regimens, there has been no evidence of disease progression in 24 months of follow-up.
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first reported cases of Intravascular large cell Lymphoma of the nk cell type clinical histologic immunophenotypic and molecular features
American Journal of Clinical Pathology, 2005Co-Authors: J W Said, Elizabeth D Ames, Chen Chen, Valerie Mcwhorter, Peter P Chen, Violette Ghali, Geraldine S PinkusAbstract:Most cases of Intravascular large cell Lymphoma are of B-cell phenotype, with a few cases of T-cell lineage and rare cases with histiocytic features described. A definitive natural killer (NK) cell variant has not been recognized. This report is the first to describe the clinical, histologic, immunophenotypic, and molecular features of 2 cases of Intravascular Lymphoma with an NK cell phenotype (CD3e+, CD2+, CD7+, CD56+, T-cell intracytoplasmic antigen-1+ (TIA-1), perforin+, granzyme B+, CD20-, CD4-, CD5-, CD8-, T-cell receptor [TCR] βF1-). Molecular studies for TCR gene rearrangements revealed a germline configuration. A 41-year-old man had erythematous plaque-like subcutaneous lesions of the lower extremities in which biopsy revealed Epstein-Barr virus-positive Intravascular Lymphoma. Following chemotherapy and stem cell transplantation, he was alive with no evidence of disease at 1 year. A 47-year-old woman had myalgias, arthralgias, weakness, fever, altered mental status, and pancytopenia. Bone marrow biopsy demonstrated Intravascular Lymphoma. Therapy was initiated; however, her condition deteriorated rapidly, and she died. Autopsy revealed involvement of multiple organs, including brain, kidneys, ovaries, and bone marrow. These cases represent the first documented examples of an NK cell variant of Intravascular Lymphoma.
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first reported cases of Intravascular large cell Lymphoma of the nk cell type
American Journal of Clinical Pathology, 2005Co-Authors: J W Said, Elizabeth D Ames, Chen Chen, Valerie Mcwhorter, Peter P Chen, Violette Ghali, Geraldine S PinkusAbstract:Most cases of Intravascular large cell Lymphoma are of B-cell phenotype, with a few cases of T-cell lineage and rare cases with histiocytic features described. A definitive natural killer (NK) cell variant has not been recognized. This report is the first to describe the clinical, histologic, immunophenotypic, and molecular features of 2 cases of Intravascular Lymphoma with an NK cell phenotype (CD3ɛ+, CD2+, CD7+, CD56+, T-cell intracytoplasmic antigen-1+ (TIA-1), perforin+, granzyme B+, CD20–, CD4–, CD5–, CD8–, T-cell receptor [TCR] βF1–). Molecular studies for TCR gene rearrangements revealed a germline configuration. A 41-year-old man had erythematous plaque-like subcutaneous lesions of the lower extremities in which biopsy revealed Epstein-Barr virus–positive Intravascular Lymphoma. Following chemotherapy and stem cell transplantation, he was alive with no evidence of disease at 1 year. A 47-year-old woman had myalgias, arthralgias, weakness, fever, altered mental status, and pancytopenia. Bone marrow biopsy demonstrated Intravascular Lymphoma. Therapy was initiated; however, her condition deteriorated rapidly, and she died. Autopsy revealed involvement of multiple organs, including brain, kidneys, ovaries, and bone marrow. These cases represent the first documented examples of an NK cell variant of Intravascular Lymphoma.
Masami Takeuchi - One of the best experts on this subject based on the ideXlab platform.
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random skin biopsy and bone marrow biopsy for diagnosis of Intravascular large b cell Lymphoma
Annals of Hematology, 2011Co-Authors: Kosei Matsue, Noboru Asada, Masayuki Yamakura, Shun Ichi Kimura, Jun Odawara, Takayoshi Aoki, Kan Ichi Iwama, Hideaki Fujiwara, Masami TakeuchiAbstract:Intravascular Lymphoma (IVL) is a rare type of extranodal Lymphoma in which the Lymphoma cells proliferate exclusively in the lumina of small vessels. The diagnosis of IVL requires histological confirmation. Although random skin biopsy from healthy-appearing skin in patients with suspected IVL appeared to be useful, the sensitivity of this method for the diagnosis of IVL remains unknown. We performed a random skin biopsy from 12 consecutive cases of IVL diagnosed at our institution over the past 4 years and evaluate its relevance of clinical and laboratory characteristics, presence or absence of skin lesions, and bone marrow involvement. All 12 patients were diagnosed antemortem by either random skin biopsy or bone marrow biopsy and treated with rituximab-containing chemotherapy. Random skin biopsy was performed in all 12 patients, and the results were positive in ten patients (83.3%). Erythematous skin lesions were seen in 3 of 12 patients, but biopsy was positive for Lymphoma lesion in two patients. Bone marrow invasion was seen in 11 of the 12 patients (91.6%) by bone marrow smear and/or flow cytometric analysis, but was detected in only half of the patients by trephine biopsy. We concluded that random skin biopsy from normal-appearing skin is highly sensitive in the diagnosis of IVL comparable to bone marrow trephine biopsy. It should be performed irrespective of the presence or absence of skin lesions in patients who were suspicious of IVL.
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a clinicopathological study of 13 cases of Intravascular Lymphoma experience in a single institution over a 9 yr period
European Journal of Haematology, 2008Co-Authors: Kosei Matsue, Noboru Asada, Masami Takeuchi, Masayuki Yamakura, Shun Ichi Kimura, Jun Odawara, Takatoshi AokiAbstract:Intravascular Lymphoma (IVL) is a rare type of extranodal Lymphoma in which the Lymphoma cells proliferate exclusively in lumina of small vessels. Here, we report a clinicopathological study of 13 cases IVL diagnosed at our institution between March 1999 and July 2007, and evaluated the clinical characteristics, usefulness of random skin biopsy and response to chemotherapy containing rituximab. Three of 13 patients were diagnosed at autopsy. The most common clinical features were unexplained fever, neurological deterioration, respiratory failure, and poor performance status. Thrombocytopenia, high serum lactate dehydrogenase and soluble interleukin2 receptor levels were the most common laboratory abnormalities. Adrenal tumor was detected in four cases and pituitary involvement was seen in all three autopsied cases and in two surviving patient by brain magnetic resonance imaging. Bone marrow invasion was seen in all 13 cases by bone marrow smear, and it was subtle in trephine biopsy. Immunohistochemical analyses revealed that CD5 was positive in one-third of the cases. Most of the cases were positive for MUM1/IRF, Bcl-2 and negative for CD10 and BCL-6 indicating the postgerminal center cell origin of this peculiar type of Lymphoma. On random skin biopsy, the most recent seven patients were diagnosed promptly and chemotherapy containing rituximab was successfully administered. Patients with IVL exhibit the characteristic clinical and immunophenotypic features cited above and the use of random skin biopsy facilitates prompt diagnosis. Early commencement of chemotherapy containing rituximab appears promising for this peculiar Lymphoma. As the recent seven patients were diagnosed by random skin biopsy over the past 13 months, the incidence of IVL is thought to be much higher than generally accepted.
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use of random skin biopsy for diagnosis of Intravascular large b cell Lymphoma
Mayo Clinic Proceedings, 2007Co-Authors: Noboru Asada, Masami Takeuchi, Masayuki Yamakura, Shun Ichi Kimura, Jun Odawara, Takatoshi Aoki, Reiko Seki, Atsushi Tanaka, Kosei MatsueAbstract:Intravascular Lymphoma (IVL) is a rare type of extranodal Lymphoma with an aggressive clinical course characterized by proliferation of large Lymphoma cells within the lumina of the small vessels. Because of its varied clinical symptoms and the absence of lymphadenopathy, diagnosis of IVL is extremely difficult and requires histological confirmation. We report here 6 consecutive patients with IVL, admitted to Kameda General Hospital, Kamogawa-shi, Japan, from June 7, 2006, to February 28, 2007, whose IVL was diagnosed by random skin biopsy of healthy-appearing skin. Three patients presented with progressive neurological deterioration and 2 others with hypoxemia with interstitial infiltration on chest radiography. One patient presented with confusion and severe hypoxia without apparent interstitial infiltration. Two patients showed localized skin involvement. Irrespective of the presence of skin lesions, almost all skin biopsy specimens showed obliteration of small vessels of subcutaneous fat tissues by Lymphoma cells, allowing a prompt diagnosis of IVL. Early institution of rituximab-based chemotherapy induced favorable responses in all patients treated. Because diagnosis based on tissue other than skin is usually difficult in patients with suspected IVL, random skin biopsy should be considered even in patients with no evident skin lesions.
Noboru Asada - One of the best experts on this subject based on the ideXlab platform.
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random skin biopsy and bone marrow biopsy for diagnosis of Intravascular large b cell Lymphoma
Annals of Hematology, 2011Co-Authors: Kosei Matsue, Noboru Asada, Masayuki Yamakura, Shun Ichi Kimura, Jun Odawara, Takayoshi Aoki, Kan Ichi Iwama, Hideaki Fujiwara, Masami TakeuchiAbstract:Intravascular Lymphoma (IVL) is a rare type of extranodal Lymphoma in which the Lymphoma cells proliferate exclusively in the lumina of small vessels. The diagnosis of IVL requires histological confirmation. Although random skin biopsy from healthy-appearing skin in patients with suspected IVL appeared to be useful, the sensitivity of this method for the diagnosis of IVL remains unknown. We performed a random skin biopsy from 12 consecutive cases of IVL diagnosed at our institution over the past 4 years and evaluate its relevance of clinical and laboratory characteristics, presence or absence of skin lesions, and bone marrow involvement. All 12 patients were diagnosed antemortem by either random skin biopsy or bone marrow biopsy and treated with rituximab-containing chemotherapy. Random skin biopsy was performed in all 12 patients, and the results were positive in ten patients (83.3%). Erythematous skin lesions were seen in 3 of 12 patients, but biopsy was positive for Lymphoma lesion in two patients. Bone marrow invasion was seen in 11 of the 12 patients (91.6%) by bone marrow smear and/or flow cytometric analysis, but was detected in only half of the patients by trephine biopsy. We concluded that random skin biopsy from normal-appearing skin is highly sensitive in the diagnosis of IVL comparable to bone marrow trephine biopsy. It should be performed irrespective of the presence or absence of skin lesions in patients who were suspicious of IVL.
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a clinicopathological study of 13 cases of Intravascular Lymphoma experience in a single institution over a 9 yr period
European Journal of Haematology, 2008Co-Authors: Kosei Matsue, Noboru Asada, Masami Takeuchi, Masayuki Yamakura, Shun Ichi Kimura, Jun Odawara, Takatoshi AokiAbstract:Intravascular Lymphoma (IVL) is a rare type of extranodal Lymphoma in which the Lymphoma cells proliferate exclusively in lumina of small vessels. Here, we report a clinicopathological study of 13 cases IVL diagnosed at our institution between March 1999 and July 2007, and evaluated the clinical characteristics, usefulness of random skin biopsy and response to chemotherapy containing rituximab. Three of 13 patients were diagnosed at autopsy. The most common clinical features were unexplained fever, neurological deterioration, respiratory failure, and poor performance status. Thrombocytopenia, high serum lactate dehydrogenase and soluble interleukin2 receptor levels were the most common laboratory abnormalities. Adrenal tumor was detected in four cases and pituitary involvement was seen in all three autopsied cases and in two surviving patient by brain magnetic resonance imaging. Bone marrow invasion was seen in all 13 cases by bone marrow smear, and it was subtle in trephine biopsy. Immunohistochemical analyses revealed that CD5 was positive in one-third of the cases. Most of the cases were positive for MUM1/IRF, Bcl-2 and negative for CD10 and BCL-6 indicating the postgerminal center cell origin of this peculiar type of Lymphoma. On random skin biopsy, the most recent seven patients were diagnosed promptly and chemotherapy containing rituximab was successfully administered. Patients with IVL exhibit the characteristic clinical and immunophenotypic features cited above and the use of random skin biopsy facilitates prompt diagnosis. Early commencement of chemotherapy containing rituximab appears promising for this peculiar Lymphoma. As the recent seven patients were diagnosed by random skin biopsy over the past 13 months, the incidence of IVL is thought to be much higher than generally accepted.
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use of random skin biopsy for diagnosis of Intravascular large b cell Lymphoma
Mayo Clinic Proceedings, 2007Co-Authors: Noboru Asada, Masami Takeuchi, Masayuki Yamakura, Shun Ichi Kimura, Jun Odawara, Takatoshi Aoki, Reiko Seki, Atsushi Tanaka, Kosei MatsueAbstract:Intravascular Lymphoma (IVL) is a rare type of extranodal Lymphoma with an aggressive clinical course characterized by proliferation of large Lymphoma cells within the lumina of the small vessels. Because of its varied clinical symptoms and the absence of lymphadenopathy, diagnosis of IVL is extremely difficult and requires histological confirmation. We report here 6 consecutive patients with IVL, admitted to Kameda General Hospital, Kamogawa-shi, Japan, from June 7, 2006, to February 28, 2007, whose IVL was diagnosed by random skin biopsy of healthy-appearing skin. Three patients presented with progressive neurological deterioration and 2 others with hypoxemia with interstitial infiltration on chest radiography. One patient presented with confusion and severe hypoxia without apparent interstitial infiltration. Two patients showed localized skin involvement. Irrespective of the presence of skin lesions, almost all skin biopsy specimens showed obliteration of small vessels of subcutaneous fat tissues by Lymphoma cells, allowing a prompt diagnosis of IVL. Early institution of rituximab-based chemotherapy induced favorable responses in all patients treated. Because diagnosis based on tissue other than skin is usually difficult in patients with suspected IVL, random skin biopsy should be considered even in patients with no evident skin lesions.
Shun Ichi Kimura - One of the best experts on this subject based on the ideXlab platform.
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random skin biopsy and bone marrow biopsy for diagnosis of Intravascular large b cell Lymphoma
Annals of Hematology, 2011Co-Authors: Kosei Matsue, Noboru Asada, Masayuki Yamakura, Shun Ichi Kimura, Jun Odawara, Takayoshi Aoki, Kan Ichi Iwama, Hideaki Fujiwara, Masami TakeuchiAbstract:Intravascular Lymphoma (IVL) is a rare type of extranodal Lymphoma in which the Lymphoma cells proliferate exclusively in the lumina of small vessels. The diagnosis of IVL requires histological confirmation. Although random skin biopsy from healthy-appearing skin in patients with suspected IVL appeared to be useful, the sensitivity of this method for the diagnosis of IVL remains unknown. We performed a random skin biopsy from 12 consecutive cases of IVL diagnosed at our institution over the past 4 years and evaluate its relevance of clinical and laboratory characteristics, presence or absence of skin lesions, and bone marrow involvement. All 12 patients were diagnosed antemortem by either random skin biopsy or bone marrow biopsy and treated with rituximab-containing chemotherapy. Random skin biopsy was performed in all 12 patients, and the results were positive in ten patients (83.3%). Erythematous skin lesions were seen in 3 of 12 patients, but biopsy was positive for Lymphoma lesion in two patients. Bone marrow invasion was seen in 11 of the 12 patients (91.6%) by bone marrow smear and/or flow cytometric analysis, but was detected in only half of the patients by trephine biopsy. We concluded that random skin biopsy from normal-appearing skin is highly sensitive in the diagnosis of IVL comparable to bone marrow trephine biopsy. It should be performed irrespective of the presence or absence of skin lesions in patients who were suspicious of IVL.
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a clinicopathological study of 13 cases of Intravascular Lymphoma experience in a single institution over a 9 yr period
European Journal of Haematology, 2008Co-Authors: Kosei Matsue, Noboru Asada, Masami Takeuchi, Masayuki Yamakura, Shun Ichi Kimura, Jun Odawara, Takatoshi AokiAbstract:Intravascular Lymphoma (IVL) is a rare type of extranodal Lymphoma in which the Lymphoma cells proliferate exclusively in lumina of small vessels. Here, we report a clinicopathological study of 13 cases IVL diagnosed at our institution between March 1999 and July 2007, and evaluated the clinical characteristics, usefulness of random skin biopsy and response to chemotherapy containing rituximab. Three of 13 patients were diagnosed at autopsy. The most common clinical features were unexplained fever, neurological deterioration, respiratory failure, and poor performance status. Thrombocytopenia, high serum lactate dehydrogenase and soluble interleukin2 receptor levels were the most common laboratory abnormalities. Adrenal tumor was detected in four cases and pituitary involvement was seen in all three autopsied cases and in two surviving patient by brain magnetic resonance imaging. Bone marrow invasion was seen in all 13 cases by bone marrow smear, and it was subtle in trephine biopsy. Immunohistochemical analyses revealed that CD5 was positive in one-third of the cases. Most of the cases were positive for MUM1/IRF, Bcl-2 and negative for CD10 and BCL-6 indicating the postgerminal center cell origin of this peculiar type of Lymphoma. On random skin biopsy, the most recent seven patients were diagnosed promptly and chemotherapy containing rituximab was successfully administered. Patients with IVL exhibit the characteristic clinical and immunophenotypic features cited above and the use of random skin biopsy facilitates prompt diagnosis. Early commencement of chemotherapy containing rituximab appears promising for this peculiar Lymphoma. As the recent seven patients were diagnosed by random skin biopsy over the past 13 months, the incidence of IVL is thought to be much higher than generally accepted.
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use of random skin biopsy for diagnosis of Intravascular large b cell Lymphoma
Mayo Clinic Proceedings, 2007Co-Authors: Noboru Asada, Masami Takeuchi, Masayuki Yamakura, Shun Ichi Kimura, Jun Odawara, Takatoshi Aoki, Reiko Seki, Atsushi Tanaka, Kosei MatsueAbstract:Intravascular Lymphoma (IVL) is a rare type of extranodal Lymphoma with an aggressive clinical course characterized by proliferation of large Lymphoma cells within the lumina of the small vessels. Because of its varied clinical symptoms and the absence of lymphadenopathy, diagnosis of IVL is extremely difficult and requires histological confirmation. We report here 6 consecutive patients with IVL, admitted to Kameda General Hospital, Kamogawa-shi, Japan, from June 7, 2006, to February 28, 2007, whose IVL was diagnosed by random skin biopsy of healthy-appearing skin. Three patients presented with progressive neurological deterioration and 2 others with hypoxemia with interstitial infiltration on chest radiography. One patient presented with confusion and severe hypoxia without apparent interstitial infiltration. Two patients showed localized skin involvement. Irrespective of the presence of skin lesions, almost all skin biopsy specimens showed obliteration of small vessels of subcutaneous fat tissues by Lymphoma cells, allowing a prompt diagnosis of IVL. Early institution of rituximab-based chemotherapy induced favorable responses in all patients treated. Because diagnosis based on tissue other than skin is usually difficult in patients with suspected IVL, random skin biopsy should be considered even in patients with no evident skin lesions.