一例血管内大 B 细胞淋巴瘤尸检病例,显示其迅速转变为栓塞性脑卒中,主要脑动脉闭塞。

IF 1.3 4区 医学 Q4 CLINICAL NEUROLOGY
Neuropathology Pub Date : 2024-04-01 Epub Date: 2023-08-10 DOI:10.1111/neup.12940
So Tando, Tadashi Kimura, Ryo Mizuhara, Natsuko Yuki, Akira Yoshioka, Hisashi Takahashi, Rei Yasuda, Kyoko Itoh
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引用次数: 0

摘要

血管内大 B 细胞淋巴瘤可因淋巴瘤细胞导致的小血管闭塞而诱发中枢神经系统表现,包括中风。然而,大血管受累的情况却很少见。在这里,我们展示了一例不寻常的尸检病例,一名88岁的老人从典型的血管内淋巴瘤小血管闭塞引起的多发性中风迅速转变为主要脑动脉闭塞引起的进行性栓塞性中风。磁共振血管造影显示了与这些多发性进行性中风相关的主要大脑动脉,包括右侧大脑后动脉、左侧大脑前动脉和右侧大脑中动脉,但可探测性很差。腹部随机皮肤活检确诊为血管内大 B 细胞淋巴瘤。尽管接受了强化治疗,但患者在住院106天后死亡。尸检显示,大脑大动脉所辖区域广泛液化坏死,小血管内的血管内淋巴瘤细胞导致多处小梗死。此外,大脑大动脉还出现了多处血栓栓塞,并伴有部分组织和血管内淋巴瘤细胞簇。值得注意的是,这些细胞沿着基底动脉的血管壁聚集附着,可能会引起附近血管的局灶性高凝状态。这种聚集可能会在其他主要脑动脉中广泛传播。此外,基底动脉中的血管内淋巴瘤细胞团肿瘤坏死因子α呈阳性,脾静脉中也观察到类似的组织病理学结果。然而,这种涉及这些细胞的罕见现象的发病机制仍然不明。从临床角度来看,我们应该考虑血管内淋巴瘤细胞可能引发类似的进行性栓塞中风。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
An autopsy case of intravascular large B-cell lymphoma showing a rapid transition to embolic strokes with occlusion of the major cerebral arteries.

Intravascular large B-cell lymphoma can induce central nervous system manifestations, including strokes, due to small-vessel occlusion caused by lymphoma cells. However, involvement in large-sized vessels is rare. Here, we present an unusual autopsy case of an 88-year-old man showing a rapid transition from multiple strokes due to small vessel occlusion, typical of intravascular lymphoma, to progressive embolic strokes caused by the occlusion of major cerebral arteries. Magnetic resonance angiography demonstrated the major cerebral arteries associated with those multiple progressive strokes, including the right posterior cerebral artery, left anterior cerebral artery, and right middle cerebral artery, but the detectability was poor. A random skin biopsy at the abdomen confirmed the diagnosis of intravascular large B-cell lymphoma. The patient died 106 days after hospitalization despite intensive treatment. An autopsy revealed broad liquefactive necrosis in the area governed by the major cerebral arteries and multiple small infarctions caused by intravascular lymphoma cells in the small-sized vessels. In addition, the major cerebral arteries showed multiple thromboembolism with partial organization and clusters of intravascular lymphoma cells. Notably, those cells were shown aggregated and attached along the vascular wall of the basilar artery, which might have caused focal hypercoagulation in the near vessels. This aggregation might have disseminated widely in the other major cerebral arteries. Moreover, the cluster of intravascular lymphoma cells in the basilar artery was positive for tumor necrosis factor α, and similar histopathology findings were observed in the splenic veins. However, the pathogenesis of this rare phenomenon involving these cells remains unknown. From a clinical perspective, we should consider the possibility that intravascular lymphoma cells may provoke similar progressive embolic strokes.

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来源期刊
Neuropathology
Neuropathology 医学-病理学
CiteScore
4.10
自引率
4.30%
发文量
105
审稿时长
6-12 weeks
期刊介绍: Neuropathology is an international journal sponsored by the Japanese Society of Neuropathology and publishes peer-reviewed original papers dealing with all aspects of human and experimental neuropathology and related fields of research. The Journal aims to promote the international exchange of results and encourages authors from all countries to submit papers in the following categories: Original Articles, Case Reports, Short Communications, Occasional Reviews, Editorials and Letters to the Editor. All articles are peer-reviewed by at least two researchers expert in the field of the submitted paper.
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