Hematopathology Diagnoses Too Easy to Miss!
Malignant Lymphomas that Can Go Totally Unrecognized
Marsha Kinney, James Cook and Steven Swerdlow
Intravascular lymphoma is easily overlooked due to the subtle involvement of blood vessels. Awareness
of this entity and routine use and careful interpretation of CD20 immunostaining helps avoid this
Intravascular Large B-cell Lymphoma (Synonyms: angiotropic lymphoma,
malignant angioendotheliomatosis, intravascular lymphomatosis, and angioendotheliomatosis proliferans
This 63 year-old male presented with progressive dyspnea
over 4 months, dry cough, low-grade fever and chills, and 19-pound weight loss. Past medical history was
significant for single vessel atherosclerotic cardiovascular disease, hyperlipidemia, hypertension, and
peptic ulcer disease. Chest x-ray revealed a retrocardiac infiltrate. Patient had recent exposure to
birds and puppies at a neighbor's house. Patient was treated with antibiotics for two weeks without
Patient was admitted to the hospital. CT examination revealed an alveolar infiltrate more pronounced
in the bases than in the apices. There was no adenopathy by physical examination or CT. Pulmonary
function tests revealed airflow obstruction. CBC was normal except for anemia (HCT = 30.3%). LDH was
1825 IU/L with a mildly elevated AST (124 IU/L) and a normal total billirubin and ALT. Haptoglobin was
normal and reticulocyte count was 3.3%. Bronchoscopy with transbronchial biopsy of the right lower lobe
Sections of the transbronchial biopsy show small fragments of
lung tissue. The alveolar capillaries are distended by large non-cleaved lymphocytes with folded,
irregular nucleoli with dispersed chromatin and prominent nucleoli. Similar large, non-cohesive cells
are present in small, dilated submucosal vessels. The bronchial epithelial cells are normal.
Paraffin immunoperoxidase stains show the large
lymphocytes are CD45+, CD20+, and BCL-2+. Only a small number of scattered CD3+ T-cells are present.
The tumor cells are negative for CD5, CD10, and CD43. There is a suggestion of weak kappa light chain
expression in the cytoplasm of some of the large lymphocytes.
Treatment and Follow -up:
negative by routine
received CHOP combination
was free of
disease at last
follow -up four
This case was kindly contributed by Thomas S. Neuhauser,
M.D., McKee Medical Center, Loveland, Colorado.
Background and Clinical Features:
Intravascular large cell lymphoma (IVL) is an unusual large cell
lymphoma originally described in 1959 by Pfleger and Tappeiner as an endothelial cell
In the early to mid 1980's several groups reported its lymphoid rather than
Non-cohesive large lymphocytes with somewhat irregular nuclei with
dispersed chromatin and prominent nucleoli are present in the lumen of small vessels (arteries, veins,
and predominantly capillaries) and may be surrounded by a meshwork of fibrin and platelets. Small foci
of tumor outside of the vessel or previous lymphoma have been reported in small numbers of
cases.  Rare cases with small non-cleaved, non-Burkitt morphology have been described. 
The tumor infiltrate is subtle, and many cases have been diagnosed at post mortem examination.
Patients with IVL are older (median age 70 years, range 34-90 years; male to female ratio:
and present with generalized findings such as fever, weight loss, and
malaise and signs and symptoms related to occlusion of small vessels in various organs, most frequently
the central nervous system and skin. Although conventional imaging studies are often negative, autopsy
shows disseminated disease with tumor in multiple organs, so the disease presentation can be protean.
Skin lesions occur in approximately 40% of cases and include tender erythematous nodules, tumors,
plaques, telangectasia, cellulitis and lymphedema.
Neurologic conditions include
cerebral infarcts with secondary neurologic deficits, dementia, non-localizing defects, polyneuropathy
and myopathy including myalgia and muscle weakness. CSF is only rarely involved. Lymph nodes are
usually spared (present in 11% of cases). The adrenal glands are another common disease site, and
prostate enlargement, kidney disease with nephrotic syndrome, and lytic bone lesions have been
described. Hepatosplenic involvement (26%) was recently described in a large cooperative study and was
associated with bone marrow disease.  Two recent case reports describe IVL in the
IVL is only rarely associated with immunodeficiency
and has been reported in three AIDs patients and one renal transplant patient.
Over 200 cases of IVL have been reported  but primary or predominant pulmonary
involvement, as seen in this case, has been described only in about 20 cases.
complaints include dyspnea, cough, and fever. Chest x-ray and CT scan show reticular or reticulonodular
densities suggesting interstitial lung disease. Pulmonary function tests reveal decreased diffusion
capacity due to vascular obstruction by malignant cells. Patients can develop pulmonary hypertension and
right heart failure and pulmonary angiitis.
Transbronchial biopsy is
A cutaneous variant limited to the skin has been described.  Disease limited to the skin
strongly correlates with female gender, normal white blood cell and platelet counts, and younger age
(median of 59 years). Fewer patients had B symptoms. Patients with solitary lesions have a favorable
prognosis with long-term survival; a worse outcome was seen with multiple lesions.
Patients also present with FUO, anemia, thrombocytopenia, and less often leukopenia, autoimmune
hemolytic anemia, and diffuse intravascular coagulation. A bone marrow sample may be the first tissue
obtained for diagnosis. 
Bone marrow involvement is reported in 10%-32% of cases.
The low detection rate may be due to lack of immunostaining in many cases. A small number
of histologically and immunophenotypically negative marrows have shown 100% involvement when sensitive
PCR studies have been performed.  Lymphoma cells are generally present in small groups or
single file in sinuses, but in some cases, tumor cells markedly distend the sinuses. Despite the
intravascular location, peripheral blood involvement has been reported only in a small number of cases;
tumor cells vary from rare to up to 12% of the white blood cells.  Clumps of tumor cells
have been rarely reported in routine peripheral blood smears and those made from the needle point after
A monoclonal serum immunoglobulin has been reported in 14%.
An Asian variant of IVL has been described (average age 66 years, males 62%) and is characterized by a
hemophagocytic syndrome, pancytopenia, hepatosplenomegaly, and rare mass formation.
addition, marrow invasion, fever, and elevated bilirubin and LDH levels are significantly more often
present than in typical IVL. Rare leukemic presentation is described.  Neurologic
abnormalities and skin lesions are significantly less frequent with tumor cells more often infiltrating
vessels and/or sinusoids of the liver, marrow, lung, kidney, and other organs. A small number of cases
have been reported in the West supporting the concept of a specific variant.
Hemophagocytosis negative IVL cases in patients from Japan and other Eastern countries have similar
features to classical IVL arising in patients in Western countries. 
In up to one-third of IVL cases, there is a history of antecedent lymphoma (reviewed in reference 8)
such as follicular lymphoma, MALT-type lymphoma, and cases of large cell lymphoma including primary
cutaneous large cell lymphoma of the leg.
It has been suggested IVL may represent
an unusual transformation of low grade lymphoma; clonality studies to determine if the two lymphomas are
related are limited.  A small number of patients have antecedent or concomitant
carcinoma.  IVL is rarely reported co-existing with vascular lesions--hemangiomas in the skin
 and within the lesions of Kaposi's sarcoma in an AIDS
Large tumor cells with vesicular nuclei, prominent nucleoli, and variable cytoplasm are
present in vascular lumina. Mitotic figures can be seen. Fibrin thrombi can be present. Concomitant
extravascular infiltrates have been described. 
In a review of 82 IVL cases reported by Ko et al.,
1997  and 86 cases by Estalilla et al,1999,
 85%-91% were B-cell and 9%-15% were
T-cell.  A small subset of T-cell cases are CD30+ and have anaplastic large cell lymphoma
A few cases of NK cell origin have recently been described.
ost cases (89%-100%) express BCL-2 and 0%-20% express CD43; there is variability in the expression
of CD5 and CD10 with 50%-60% being CD5-CD10- and approximately 20%-50% expressing either CD5 or CD10 on
paraffin embedded tissue.
Approximately 20%-25% express BCL-6.
Co-expression of CD5 and BCL-6 and of CD5 and CD10 has been reported in a small number of cases.
The immunophenotype of variant Asian cases with hemophagocytosis may have more frequent CD5
expression (29%-67%) as compared to IVL in the West;
no clinical differences were
observed between CD5+ and CD5- cases in a Japanese study.  Overall, the immunophenotypic
findings in all cases of IVL demonstrate heterogeneity in the cell of origin. Although the presence of
CD5 suggests transformation from CLL/SLL or mantle cell lymphoma in some cases, CD23 and cyclin D1 have
been negative in the small number of cases tested.
with expression of histiocyte antigens  or co-expression of myeloperoxidase and CD20 have
been reported.  Tumor cells may express prostatic acid phosphatase (PSA) and elevated PSA
levels have been reported in a small number of males and females. 
Treatment and Prognosis:
Early studies showed a high mortality (>80%)
with survivals ranging from 2 - 48 months.  More recent studies report a good response to
It appears that IVL has a relatively good prognosis when diagnosed
early and treated with multiagent chemotherapy (cyclophosphamide, doxorubicin, vincristine, prednisone),
Rituximab, or stem cell transplant.
Molecular, cytogenetic, and pathogenetic features:
Molecular analysis of
the immunoglobulin heavy chain gene variable region using direct sequence analysis of the
complementary-determining region 2 (CDR2) and framework region 3 (FR3) has shown that 5/6 cases of IVL
originated in post-germinal center B-cells based on the presence of somatic mutation in VH genes; three
of the IVL with hypermutated genes were CD5+ providing further evidence
against a mantle cell origin of IVL, as mantle cell lymphoma develops in pre-germinal center B-cells in
the majority of cases.  BCL-2 rearrangements have been negative
in the small number of cases tested even though CD10 or BCL-6 expression has been reported in 44% of
Cytogenetic data is limited. Review of cytogenetic studies in 6 cases found an accumulation of
structural aberrations in chromosomes 1, 6, and 18, especially 1p (67% of cases) and trisomy 18 (67% of
cases).  A translocation, t(1;3)(p22;p21), has also been reported.
There is little support for a viral etiology. EBV is only rarely detected in IVL by EBER in-situ hybridization.
A small number of EBV+ cases have been
reported in patients from the Far East.
Two cases were T-cell and the third case was a
B-cell IVL in a patient with AIDs and Kaposi's sarcoma.
It has been postulated that the peculiar intravascular growth pattern of IVL may be due to abnormal
homing receptors on the tumor cells or endothelial cells preventing tumor cells from migrating into the
tissue, but a well-defined concept has not emerged. Alterations of the CD11a/CD18 complex (LFA-1), which
mediates cell-to-cell adhesion on lymphocytes and binds to ICAM-1 (CD54) on endothelial cells, and lack
of CD29 (beta-1 integrin subunit) and CD54 on tumor cells, have been described.
CD44 expression appears normal.
Vascular invasion is common in many tumors but
disseminated intravascular anaplastic neoplasms with occult primary tumors are rare. The differential
diagnosis includes metastatic tumor (carcinoma, melanoma) and vascular tumors including reactive
angioendotheliomatosis and angiosarcoma. Carcinoma and melanoma are excluded by the lack of keratin and
S-100, HMB-45, and Mart1 expression, respectively.
Benign reactive angioendotheliomatosis is a rare disorder occurring in the setting of a
hypersensitivity reaction or systemic infection, most commonly bacterial endocarditis, or with
cryoglobulinemia.  Clinically, patients have multiple erythematous nodules and indurated
plaques on the trunk, limbs, face, or ear lobes. Ulceration and blister formation, though uncommon, can
occur. Lesions consist of endothelial and myoepithelial cell proliferations and stain with factor
VIII-related antigen, Ulex europaeus, and antibodies against smooth muscle cells (desmin, muscle specific
Cases of intravascular disseminated angiosarcoma are rare.  Tumor cells are irregular with
slightly spindled morphology and hyperchromatic nuclei with scant cytoplasm. Occasional intravascular
papillary structures can be seen. Tumor cells show variable expression of factor VIII-related antigen,
CD31, CD34, and Ulex europaeus.
A small number of diffuse large B-cell lymphomas show prominent involvement of lymph node sinuses.
These include microvillus lymphomas,
ALK+ B-cell lymphoma,
and a subset of diffuse large B-cell lymphoma (DLBCL) that express CD30.
lymphomas have a variable cytologic spectrum with large transformed lymphocytes, immunoblasts,
plasmacytoid lymphocytes, anaplastic large cells and cannot be distinguished on a morphologic basis.
CD30+ B-cell lymphoma is included in the DLBCL category in the WHO classification. Diagnosis of these
lymphomas requires immunophenotypic and ultrastructural analyses. See Table 1.
Table 1. Differential Antigen Expression in Large B-cell Lymphomas with Sinus Growth
|Antigen ||CD30+ Diffuse Large B-cell Lymphoma ||Microvillous Lymphoma ||ALK+ B-cell Lymphoma|
|CD30 ||+ ||- ||-|
|CD20 ||+ ||+ ||-|
|EMA ||-/+ ||- ||+|
|Cytoplasmic Ig ||- ||+ ||+|
|ALK ||- ||- ||+|
|CD56 ||- ||+/- ||NT|
|CD57 ||NT ||NT ||+ (weak)|
|EBV ||-/+ ||NT ||-|
|CD4 ||- ||- ||+|
Ig = immunoglobulin + = 50% - 100% +/- = 25% -
49% -/+ = 5- 24% - = < 5% NT = not tested
To make a diagnosis of intravascular lymphoma with a T-cell phenotype, other T cell lymphomas have to
be excluded. Anaplastic large cell lymphoma (ALCL) can occur at extranodal sites and have vascular
involvement;  a diffuse growth of cohesive appearing tumor cells is usually present in ALCL
and markers such as CD30, EMA, TIA-1, and ALK-1 should be expressed. Some cases of hepatosplenic T-cell
lymphoma show intravascular growth outside the liver, spleen, and marrow and should be considered in the
diagnosis of T-cell IVL. Correlation with clinical history (prominent liver and spleen involvement),
TIA-1 and frequent CD56 expression, and the presence of isochromosome (7q) would favor hepatosplenic
IVL in the lung resembles an inflammatory interstitial pneumonia. The tumor cells can be somewhat
inconspicuous in a background of mild interstitial inflammation and proliferation of type II alveolar
pneumocytes. Recognition of large intravascular lymphocytes and staining for CD20 lead to the
Finally, pathologists should be aware that intravascular menstrual endometrium can rarely be seen in
hysterectomy specimens and mimic IVL.  Histologically, there is a variable mixture of
small-spindled stromal cells and large cuboidal epithelial cells that mark with vimentin in the former
and low molecular weight cytokeratin and EMA in the latter. Reactive accumulations of intravascular
large T-cells have been described in vessels within an endometrial polyp. 
- Pfleger L, Tappeiner J. [On the recognition of systematized endotheliomatosis of the cutaneous blood vessels (reticuloendotheliosis?]. Hautarzt 10: 359-363, 1959.
- Ponzoni M, Ferreri AJ. Intravascular lymphoma: a neoplasm of 'homeless' lymphocytes? Hematol Oncol 24: 105-112, 2006.
- Zuckerman D, Seliem R, Hochberg E. Intravascular lymphoma: the oncologist's "great imitator". Oncologist 11: 496-502, 2006.
- Nakamura S, Ponzoni M, Campo E, Intravascular large B-cell lymphoma. in WHO Classification of Tumours of Haematopoietic and Lymphoid Tissues. Swerdlow SH, Campo E, Harris NL, et al., [Eds.] IARC: Lyon. 2008, 252-253.
- Ansell J, Bhawan J, Cohen S, et al. Histiocytic lymphoma and malignant angioendotheliomatosis: one disease or two? Cancer 50: 1506-1512, 1982.
- Carroll TJ, Jr., Schelper RL, Goeken JA, et al. Neoplastic angioendotheliomatosis: immunopathologic and morphologic evidence for intravascular malignant lymphomatosis. Am J Clin Pathol 85: 169-175, 1986.
- Mori S, Itoyama S, Mohri N, et al. Cellular characteristics of neoplastic angioendotheliosis. An immunohistological marker study of 6 cases. Virchows Arch A Pathol Anat Histopathol 407: 167-175, 1985.
- Sheibani K, Battifora H, Winberg CD, et al. Further evidence that "malignant angioendotheliomatosis" is an angiotropic large-cell lymphoma. N Engl J Med 314: 943-948, 1986.
- Yegappan S, Coupland R, Arber DA, et al. Angiotropic lymphoma: an immunophenotypically and clinically heterogeneous lymphoma. Mod Pathol 14: 1147-1156, 2001.
- Gabor EP, Sherwood T, Mercola KE. Intravascular lymphomatosis presenting as adult respiratory distress syndrome. Am J Hematol 56: 155-160, 1997.
- Malicki DM, Suh YK, Fuller GN, et al. Angiotropic (intravascular) large cell lymphoma of T-cell phenotype presenting as acute appendicitis in a patient with acquired immunodeficiency syndrome. Arch Pathol Lab Med 123: 335-337, 1999.
- Ferreri AJ, Campo E, Seymour JF, et al. Intravascular lymphoma: clinical presentation, natural history, management and prognostic factors in a series of 38 cases, with special emphasis on the 'cutaneous variant'. Br J Haematol 127: 173-183, 2004.
- Roglin J, Boer A. Skin manifestations of intravascular lymphoma mimic inflammatory diseases of the skin. Br J Dermatol 157: 16-25, 2007.
- Barnett CR, Seo S, Husain S, et al. Intravascular B-cell lymphoma: the role of skin biopsy. Am J Dermatopathol 30: 295-299, 2008.
- Kutzner H, Jaffe ES, Intravascular large B-cell lymphoma. in World Health Organization Classification of Turmours. Pathology and Genetics of Skin Tumours. LeBoit PE, Burg G, Weedon D, et al., [Eds.] IARC Press: Lyon. 2006, 200-201.
- Sur M, Ross C, Moens F, et al. Intravascular large B-cell lymphoma of the uterus: a diagnostic challenge. Int J Gynecol Pathol 24: 201-203, 2005.
- Yamada N, Uchida R, Fuchida S, et al. CD5+ Epstein-Barr virus-positive intravascular large B-cell lymphoma in the uterus co-existing with huge myoma. Am J Hematol 78: 221-224, 2005.
- Dunphy CH. Primary cutaneous angiotropic large-cell lymphoma in a patient with acquired immunodeficiency syndrome. Arch Pathol Lab Med 119: 757-759, 1995.
- Ghorbani RP, Shokouh-Amiri H, Gaber LW. Intragraft angiotropic large-cell lymphoma of T cell-type in a long-term renal allograft recipient. Mod Pathol 9: 671-676, 1996.
- Hsiao CH, Su IJ, Hsieh SW, et al. Epstein-Barr virus-associated intravascular lymphomatosis within Kaposi's sarcoma in an AIDS patient. Am J Surg Pathol 23: 482-487, 1999.
- Delsol G, Lamant L, Mariame B, et al. A new subtype of large B-cell lymphoma expressing the ALK kinase and lacking the 2; 5 translocation. Blood 89: 1483-1490, 1997.
- Curtis JL, Warnock ML, Conrad DJ, et al. Intravascular (angiotropic) large-cell lymphoma ('malignant angioendotheliomatosis') with small vessel pulmonary vascular obstruction and hypercalcemia. West J Med 155: 72-76, 1991.
- Evert M, Lehringer-Polzin M, Mobius W, et al. Angiotropic large-cell lymphoma presenting as pulmonary small vessel occlusive disease. Hum Pathol 31: 879-882, 2000.
- Goh SG, Chuah KL, Tan PH. Intravascular lymphomatosis of the lung and liver following eyelid lymphoma in a Chinese man and review of primary pulmonary intravascular lymphomatosis. Pathology 34: 82-85, 2002.
- Kamesaki H, Matsui Y, Ohno Y, et al. Angiotropic lymphoma with histologic features of neoplastic angioendotheliomatosis presenting with predominant respiratory and hematologic manifestations. Report of a case and review of the literature [corrected]. Am J Clin Pathol 94: 768-772, 1990.
- Ko YH, Han JH, Go JH, et al. Intravascular lymphomatosis: a clinicopathological study of two cases presenting as an interstitial lung disease. Histopathology 31: 555-562, 1997.
- Kreiss Y, Schwartz E, Kaminski N, et al. Unique pulmonary presentation of intravascular large cell lymphoma. Respir Med 92: 1087-1089, 1998.
- Okawa Y, Usui N, Uno S, et al. [Intravascular large B cell lymphoma with migratory local high density shadow by chest CT and diagnosed by transbronchial lung biopsy]. Rinsho Ketsueki 43: 567-572, 2002.
- Snyder LS, Harmon KR, Estensen RD. Intravascular lymphomatosis (malignant angioendotheliomatosis) presenting as pulmonary hypertension. Chest 96: 1199-1200, 1989.
- Takamura K, Nasuhara Y, Mishina T, et al. Intravascular lymphomatosis diagnosed by transbronchial lung biopsy. Eur Respir J 10: 955-957, 1997.
- Yousem SA, Colby TV. Intravascular lymphomatosis presenting in the lung. Cancer 65: 349-353, 1990.
- Estalilla OC, Koo CH, Brynes RK, et al. Intravascular large B-cell lymphoma. A report of five cases initially diagnosed by bone marrow biopsy. Am J Clin Pathol 112: 248-255, 1999.
- Tucker TJ, Bardales RH, Miranda RN. Intravascular lymphomatosis with bone marrow involvement. Arch Pathol Lab Med 123: 952-956, 1999.
- Wick MR, Mills SE, Scheithauer BW, et al. Reassessment of malignant "angioendotheliomatosis". Evidence in favor of its reclassification as "intravascular lymphomatosis". Am J Surg Pathol 10: 112-123, 1986.
- DiGiuseppe JA, Hartmann DP, Freter C, et al. Molecular detection of bone marrow involvement in intravascular lymphomatosis. Mod Pathol 10: 33-37, 1997.
- Cobcroft R. Images in haematology. Diagnosis of angiotropic large B-cell lymphoma from a peripheral blood film. Br J Haematol 104: 429, 1999.
- Yoshida S, Nagafuji K. Peripheral blood smear in a case of intravascular lymphoma. Eur J Haematol 81: 327, 2008.
- Murase T, Tomita Y, Nakamura S. [Clinicopathologic features of intravascular large B-cell lymphoma in Japan: review of the special reference to the Asian variant]. Rinsho Ketsueki 43: 5-11, 2002.
- Murase T, Nakamura S, Kawauchi K, et al. An Asian variant of intravascular large B-cell lymphoma: clinical, pathological and cytogenetic approaches to diffuse large B-cell lymphoma associated with haemophagocytic syndrome. Br J Haematol 111: 826-834, 2000.
- Shimazaki C, Inaba T, Okano A, et al. Clinical characteristics of B-cell lymphoma-associated hemophagocytic syndrome (B-LAHS): comparison of CD5+ with CD5- B-LAHS. Intern Med 40: 878-882, 2001.
- Shimizu I, Ichikawa N, Yotsumoto M, et al. Asian variant of intravascular lymphoma: aspects of diagnosis and the role of rituximab. Intern Med 46: 1381-1386, 2007.
- Xanthopoulos V, Galanopoulos AG, Paterakis G, et al. Intravascular B-cell lymphoma with leukemic presentation: case report and literature review. Eur J Haematol 80: 177-181, 2008.
- Dufau JP, Le Tourneau A, Molina T, et al. Intravascular large B-cell lymphoma with bone marrow involvement at presentation and haemophagocytic syndrome: two Western cases in favour of a specific variant. Histopathology 37: 509-512, 2000.
- Ferreri AJ, Dognini GP, Campo E, et al. Variations in clinical presentation, frequency of hemophagocytosis and clinical behavior of intravascular lymphoma diagnosed in different geographical regions. Haematologica 92: 486-492, 2007.
- Kamath NV, Gilliam AC, Nihal M, et al. Primary cutaneous large B-cell lymphoma of the leg relapsing as cutaneous intravascular large B-cell lymphoma. Arch Dermatol 137: 1657-1658, 2001.
- Rubin MA, Cossman J, Freter CE, et al. Intravascular large cell lymphoma coexisting within hemangiomas of the skin. Am J Surg Pathol 21: 860-864, 1997.
- Takahashi E, Kajimoto K, Fukatsu T, et al. Intravascular large T-cell lymphoma: a case report of CD30-positive and ALK-negative anaplastic type with cytotoxic molecule expression. Virchows Arch 447: 1000-1006, 2005.
- Wu H, Said JW, Ames ED, et al. First reported cases of intravascular large cell lymphoma of the NK cell type: clinical, histologic, immunophenotypic, and molecular features. Am J Clin Pathol 123: 603-611, 2005.
- Kuo TT, Chen MJ, Kuo MC. Cutaneous intravascular NK-cell lymphoma: report of a rare variant associated with Epstein-Barr virus. Am J Surg Pathol 30: 1197-1201, 2006.
- Khalidi HS, Brynes RK, Browne P, et al. Intravascular large B-cell lymphoma: the CD5 antigen is expressed by a subset of cases. Mod Pathol 11: 983-988, 1998.
- Ponzoni M, Arrigoni G, Gould VE, et al. Lack of CD 29 (beta1 integrin) and CD 54 (ICAM-1) adhesion molecules in intravascular lymphomatosis. Hum Pathol 31: 220-226, 2000.
- Snowden JA, Angel CA, Winfield DA, et al. Angiotropic lymphoma: report of a case with histiocytic features. J Clin Pathol 50: 67-70, 1997.
- Conlin PA, Orden MB, Hough TR, et al. Myeloperoxidase-positive intravascular large B-cell lymphoma. Arch Pathol Lab Med 125: 948-950, 2001.
- Seki K, Miyakoshi S, Lee GH, et al. Prostatic acid phosphatase is a possible tumor marker for intravascular large B-cell lymphoma. Am J Surg Pathol 28: 1384-1388, 2004.
- Gupta AK, Lipa M, Haberman HF. Proliferating angioendotheliomatosis. Case with long survival and review of literature. Arch Dermatol 122: 314-319, 1986.
- Calamia KT, Miller A, Shuster EA, et al. Intravascular lymphomatosis. A report of ten patients with central nervous system involvement and a review of the disease process. Adv Exp Med Biol 455: 249-265, 1999.
- Yamaguchi M, Kimura M, Watanabe Y, et al. Successful autologous peripheral blood stem cell transplantation for relapsed intravascular lymphomatosis. Bone Marrow Transplant 27: 89-91, 2001.
- Koizumi M, Nishimura M, Yokota A, et al. Successful treatment of intravascular malignant lymphomatosis with high-dose chemotherapy and autologous peripheral blood stem cell transplantation. Bone Marrow Transplant 27: 1101-1103, 2001.
- Ponzoni M, Ferreri AJ, Campo E, et al. Definition, diagnosis, and management of intravascular large B-cell lymphoma: proposals and perspectives from an international consensus meeting. J Clin Oncol 25: 3168-3173, 2007.
- Kanda M, Suzumiya J, Ohshima K, et al. Intravascular large cell lymphoma: clinicopathological, immuno-histochemical and molecular genetic studies. Leuk Lymphoma 34: 569-580, 1999.
- Sleater JP, Segal GH, Scott MD, et al. Intravascular (angiotropic) large cell lymphoma: determination of monoclonality by polymerase chain reaction on paraffin-embedded tissues. Mod Pathol 7: 593-598, 1994.
- Tsukadaira A, Okubo Y, Ogasawara H, et al. Chromosomal aberrations in intravascular lymphomatosis. Am J Clin Oncol 25: 178-181, 2002.
- Molina A, Lombard C, Donlon T, et al. Immunohistochemical and cytogenetic studies indicate that malignant angioendotheliomatosis is a primary intravascular (angiotropic) lymphoma. Cancer 66: 474-479, 1990.
- Au WY, Shek TW, Kwong YL. Epstein-Barr virus-related intravascular lymphomatosis. Am J Surg Pathol 24: 309-310, 2000.
- Jalkanen S, Aho R, Kallajoki M, et al. Lymphocyte homing receptors and adhesion molecules in intravascular malignant lymphomatosis. Int J Cancer 44: 777-782, 1989.
- Ferry JA, Harris NL, Picker LJ, et al. Intravascular lymphomatosis (malignant angioendotheliomatosis). A B-cell neoplasm expressing surface homing receptors. Mod Pathol 1: 444-452, 1988.
- Lazova R, Slater C, Scott G. Reactive angioendotheliomatosis. Case report and review of the literature. Am J Dermatopathol 18: 63-69, 1996.
- Lin BT, Weiss LM, Battifora H. Intravascularly disseminated angiosarcoma: true neoplastic angioendotheliomatosis? Report of two cases. Am J Surg Pathol 21: 1138-1143, 1997.
- Kinney MC, Glick AD, Stein H, et al. Comparison of anaplastic large cell Ki-1 lymphomas and microvillous lymphomas in their immunologic and ultrastructural features. Am J Surg Pathol 14: 1047-1060, 1990.
- Hammer RD, Vnencak-Jones CL, Manning SS, et al. Microvillous lymphomas are B-cell neoplasms that frequently express CD56. Mod Pathol 11: 239-246, 1998.
- Lai R, Medeiros LJ, Dabbagh L, et al. Sinusoidal CD30-positive large B-cell lymphoma: a morphologic mimic of anaplastic large cell lymphoma. Mod Pathol 13: 223-228, 2000.
- Haralambieva E, Pulford KA, Lamant L, et al. Anaplastic large-cell lymphomas of B-cell phenotype are anaplastic lymphoma kinase (ALK) negative and belong to the spectrum of diffuse large B-cell lymphomas. Br J Haematol 109: 584-591, 2000.
- Suarez-Vilela D, Izquierdo-Garcia FM, Ramos-Ortega F. Intravascular lymphomatosis in T-hepatosplenic lymphoma. Am J Clin Pathol 117: 662-663, 2002.
- Vega F, Medeiros LJ, Bueso-Ramos C, et al. Hepatosplenic gamma/delta T-cell lymphoma in bone marrow. A sinusoidal neoplasm with blastic cytologic features. Am J Clin Pathol 116: 410-419, 2001.
- Banks ER, Mills SE, Frierson HF, Jr. Uterine intravascular menstrual endometrium simulating malignancy. Am J Surg Pathol 15: 407-412, 1991.
- Bryant A, Lawton H, Al-Talib R, et al. Intravascular proliferation of reactive lymphoid blasts mimicking intravascular lymphoma--a diagnostic pitfall. Histopathology 51: 401-402, 2007.