Intravascular B cell lymphoma is a rare subtype of diffuse large B cell lymphoma. Proliferation of lymphoma cells in small blood vessels causes occlusion. Four cases are presented. Cases 1 (62 years male) and 2 (40 years female) had decreased perianal sensation, leg weakness and faecal incontinence. Case 1 also had increased anal sphincter tone and case 2, urinary retention. Case 3 (69 years male) had urinary retention, constipation and a left leg flaccid monoparesis. All three cases had raised CSF protein (0.62–1.42 g/l) and areas of abnormal increased signal in the deep white matter on MRI. Cases 2 and 3 had abnormal increased signal in the distal thoracic cord: conus on MRI. Cases 2–4 had raised serum lactate dehydrogenase (477–1215 IU/l). At postmortem, atypical B lymphocytes were found in blood vessels of the spinal cords and brains of cases 1–3. Case 4 (49 years male) had a prolonged seizure with postictal agitation. CT head showed two hypodense areas in the right parietal and occipital lobes (Abstract 176 figure 1A). These had resolved on a later MRI but there was a new left frontal lesion (Abstract 176 figure 1B,C). He became aggressive with delusions, visual and auditory hallucinations and MRI spectroscopy showed temporal and frontal lobe involvement (Abstract 176 figure 1E–H). Right temporal pole biopsy showed atypical B lymphocytes within cerebral blood vessels (Abstract 176 figure 2). He was treated with CHOP chemotherapy. His hallucinations ceased, his paranoia decreased and a CT head demonstrated lesion resolution.
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