Intravascular large cell lymphoma

A 19-year-old female presented at our hospital with a 1-year history of a 5-cm indurated nontender lesion on the left shoulder. Two months later, a similar lesion appeared in the left mammary region, accompanied by necrosis and fever. At admission to our department, she presented disseminated lesions in the left submandibular region, the sternal area and the posterior part of the upper and lower extremities. The lesions were indurated erythematous-violaceous plaques affecting the adipose tissue, some with ulcerations and necrotic crusting (Fig. 1). The first histopathological report was thrombosis of the capillary vessels and focal vasculitis (Fig. 2). A biopsy from a lesion on the left thigh showed dilated vessels with large atypical intravascular cells with hyperchromatic nuclei and numerous atypical mytoses in the dermis and subcutaneous tissue. Some of these cells were immersed in fibrin thrombi or in the perivascular connective tissue (Fig. 3). An immunohistochemical study was positive for the common leukocytic antigen and for the B-cell phenotype. The diagnosis was large B-cell lymphoma. The patient persisted with a high fever, dry cough, pericardial effusion complicated by an abscess and left pleural effusion. She died before systemic workings for lymphoma could be carried out, and before chemotherapy could be attempted.