2021-07 / February 15
Contributors: Lakshmi Agarwal, Sanjay Gandhi, Manmohan Agrawala

A man in his 60s presented with a history of voiding symptoms. Digital rectal examination revealed enlargement of the prostate and his prostate specific antigen level was 4.31 ng/ml. Transurethral resection of the patient’s prostate was performed.


1. What is the correct diagnosis?

a. Small cell carcinoma

b. Metastatic carcinoma

c. Prostatic adenocarcinoma

d. Non Hodgkin lymphoma

e. Intravascular large B cell lymphoma

1. Intravascular large B cell lymphoma

Intravascular large B cell lymphoma (IVLBCL) is a very rare distinct entity of diffuse large B cell lymphoma (DLBCL). It is also known as intravascular lymphomatosis or angiotropic lymphoma. It is a high grade lymphoma arising from the peripheral mature B cells. It is characterised by presence of lymphoma cells within the lumina of small to medium sized blood vessels. The etiology of this tumour is unknown. Sections revealed large lymphoid cells within the lumina of blood vessels. These cells form cohesive clusters admixed with fibrin. The cells resemble centroblasts. The surrounding stroma, acinar and glandular structures were benign. Immunohistochemistry staining was done. The malignant cells were found to be positive for CD45, CD20 and negative for cytokeratin and CD3. Ki-67 proliferation index was 60%. The CD34 staining was positive in endothelial cells, highlighting the intravascular nature of the malignant cells. On the basis of the above findings the final diagnosis of intravascular large B cell lymphoma of prostate was rendered. PET scan was done and tumor was found to be confined within the prostate.

1. Pusch G, Feher G, Szomor A, Kover F, Gomori E, Illes Z. Intravascular lymphoma presenting with neurological signs but diagnosed by prostate biopsy: suspicion as a key to early diagnosis. Eur J Neurol 2009;16:39-41.

2. Quintini G, Barbera V, Franco V, Florena AM, Spadola V, Mariani G. Uncommon presentations of non-Hodgkin’s lymphoma: case 1. Intravascular large B-cell lymphoma: diagnosis on prostate biopsy. J Clin Oncol 2003;21:564-565.

3. Xu M, Yang Q, Li M, Geng W, Huang W, Chen Y. Prostate involvement by intravascular large B-cell lymphoma: a case report with literature review. Int J Surg Pathol 2011;19:544-547.

4. Yin XR, Liu H, Chen HQ. Intravascular lymphomatosis of the prostate gland. Zhonghua Bing Li Xue Za Zhi 2005;34:189-90.

Lakshmi Agarwal
Government Medical College Kota
Pushpadi Cancer Care Centre
Kota, Rajasthan

Sanjay Gandhi
Histoplus Diagnostics
Ahmedabad, Gujarat

Manmohan Agrawala
Pushpadi Cancer Care Centre
Kota, Rajasthan


Prostate, lymphoma, intravascular