Background
Intravascular large B cell lymphoma (IVLBCL) is difficult to diagnose and is exceedingly rare with an incidence of less than 1 in 1,000,000. Known as a great imitator, symptoms can include anything from fever, sensory and motor deficits, vertigo, vision loss, poor circumscribed violaceous plaques, or any variety of organ-specific symptoms. Diagnostic uncertainty and late presentation certainly play a role in the poor prognosis of patients diagnosed with IVLBCL, particularly in those with CNS involvement. 
Case Presentation
We describe a case of IVLBCL in a 56-year-old male which was identified after recurrent strokes. Symptoms included vertigo, hearing loss and tinnitus in the right ear, emesis, diaphoresis, and right facial paresthesia. Vasculitis, hypercoagulability, and cardiology workup for thromboembolism including echocardiogram and Holter test was negative. Despite these negative results, he continued to present with worsening symptoms and MRIs continued to demonstrate new, diffuse cerebral infarcts. Right partial nephrectomy was performed after the patient was stabilized due to a CT scan revealing a right renal mass. Pathology demonstrated renal oncocytoma and IVLBCL cells that were CD20+, PAX5+, CD10 trace+, BCL-6+, BCL-2+, MUM-1+, and negative for BCL-1 and CD34. Ki-67 staining was 100%. Chemotherapy was initiated with R-HyperCVAD (4 odd cycles included high doses of cyclophosphamide, vincristine, doxorubicin, and dexamethasone while 4 even cycles had high doses of methotrexate and cytarabine). Rituximab and two doses of intrathecal chemotherapy, one dose each of methotrexate and cytarabine, were utilized in both cycles. The patient achieved complete remission after termination of treatment and has remained in remission for 5 years after diagnosis.
Discussion
This case represents the first known report of R-HyperCVAD with intrathecal methotrexate and cytarabine for the treatment of IVLBCL with neurologic symptoms. R-HyperCVAD with intrathecal methotrexate has previously been described to achieve complete remission in IVLBCL for at least 2 years, but that case demonstrated no neurological symptoms with only a T2-hyperdense pontine lesion. R-CHOP is largely considered the treatment of choice in IVLBCL, however low doses of chemotherapy in this regimen do not pass through the blood brain barrier. R-HyperCVAD, on the other hand, provides ample CNS penetration that led to its use in this case due to the recurrent stroke symptoms. Our case demonstrates resolution of IVLBCL and its associated CNS symptoms for 5 years after diagnosis following treatment with R-HyperCVAD combined with intrathecal methotrexate and cytarabine. 


Intravascular Large B-Cell Lymphoma Masquerading as Stroke Successfully Treated with R-Hyper-CVAD

 Hematology / Oncology / Pathology

poster

Welcome to the **largest national, multi-specialty research** event featuring research from nearly 700 medical students, residents, fellows, and international medical graduates.

Use the buttons below or navigation menu to access the event.
 


[![](https://assets.underline.io/uploads/markdown_image/1/image/3e33a8c754cc49610b30950617d813e7.png)](https://underline.io/events/434/sessions?searchGroup=all)
 
[![](https://assets.underline.io/uploads/markdown_image/1/image/551404d429c4e274f9a54cbdd7081918.png)](https://underline.io/events/434/posters?searchGroup=all)
 
[![](https://assets.underline.io/uploads/markdown_image/1/image/677d92f566b880cebd36905fc738fc10.png)](https://underline.io/events/434/lounge)
 
[![](https://assets.underline.io/uploads/markdown_image/1/image/c7392833c7261c3874c5b43fa2f4df19.png)](https://underline.io/events/434/help-desk)
 

#### Event Details

The 2023 American Medical Association Research Challenge includes a poster symposium hall and a semifinals hall with the top scored research. **Log in at any time throughout the event to:**

* **View posters and presentations** on a variety of topics and specialties
* **Score posters in the semifinals** to help decide the top five finalists (AMA member exclusive opportunity)
* **Connect with participants** and provide feedback to help advance their research
* **Attend education sessions** with physician experts on key research topics

At the conclusion of this event, the AMA will announce the top five finalists who will advance to the AMA Research Challenge finals, present their research to an elite panel of judges, and compete to win a $10,000 grand prize sponsored by Laurel Road. 

### Grand Prize Sponsor

AMA would like to thank Laurel Road for sponsoring a $10,000 grand prize for the winner of the AMA Research Challenge. Laurel Road is not involved in the judging or scoring process to select the winner. The winner will be announced on February 4, 2024 during the AMA Research Challenge finals. Payment of the grand prize will be directly from Laurel Road. See the AMA Research Challenge Official Rules for terms and conditions.

![](https://assets.underline.io/uploads/markdown_image/1/image/611e331d4a0eba0920f240cfc04b4d77.png)

**There is no registration fee for this event! **

Register to explore research in a variety of topics. AMA members get exclusive access to score posters in the semifinals.

**Please use this link [here](https://www.ama-assn.org/about/events/ama-research-challenge) to register for free.**

Registration Is Required

AMA Research Challenge 2023

Join the AMA Research Challenge poster symposium and semifinals to explore top research posters, score posters in the semifinals (an AMA member exclusive opportunity) and attend education sessions with experienced physicians to learn tips to advance your research and career. 

Christopher Popiolek

1

SHORT BIO

Presentations

Intravascular Large B-Cell Lymphoma Masquerading as Stroke Successfully Treated with R-Hyper-CVAD

Stay up to date with the latest Underline news!

PRESENTATIONS

CONFERENCES

COMPANY

RESOURCES