Abstract
Background: We report a case of angiotropic lymphoma with cluster formation in the bone marrow and peripheral blood smears.
Case: A 67-years-old housewife began to suffer from vertigo, followed by neurological signs such as hemianopia, hemiparesis and dementia. CT examination revealed rapid progression of multifocal cerebral infarctions. Serum LDH and CRP were increased. The bone marrow smear contained aggregates of atypical finely vacuolated large cells which appeared to indicate a non-hematologic malignancy. However, a B cell origin was revealed by immunocytochemical analysis. CD 44 was also detected. Similar neoplastic cell clusters were detected in the peripheral blood smear transiently only when the brain damage had rapidly progressed. Although histologic examination of brain was not performed, the lesion was diagnosed as angiotropic lymphoma because of the unique cytologic appearance and typical clinical course. CD 44 seems to have role in tumor cell aggregation.
Conclusion: Our experience suggests angiotropic lymphoma cells could be released into the blood flow in the rapidly progressive phase though they are usually absent in the peripheral blood smear because of their tight adhesion to endothelial cells. Accordingly cytologic examination of peripheral blood in the rapidly progressive phase seems to be useful for diagnosis.
