Random skin biopsy for diagnosis of intravascular large B-cell lymphoma in a patient with hypoxemia and normal lung imaging

IVLBCL: intravascular large B-cell lymphoma I ntravascular large B-cell lymphoma (IVLBCL) is a very rare type of non-Hodgkin lymphoma in which tumor cells proliferate within the lumina of small blood vessels, particularly within capillaries, causing clinical symptoms. The clinical presentation of IVLBCL differs among geographic areas. For example, Asians more commonly present with fever, hepatosplenomegaly, thrombocytopenia, bone marrow involvement, and hemophagocytic syndrome and only rarely with central nervous system involvement or cutaneous lesions, which are more often seen in western populations. IVLBCL presenting as hypoxemia with no abnormal findings on chest computed tomography is rare, and only a few cases have been reported in which the disease was diagnosed by pulmonary microvascular cytology, open lung biopsy, or random transbronchial lung biopsy. There are a few reports suggesting the usefulness of the random or blind skin biopsy from normal-appearing skin for diagnosis of intravascular lymphoma.