Conclusion
Intravascular B-cell lymphoma has traditionally been associated with an
aggressive course and poor outcomes. Recent efforts to increase
awareness and improved insight into the disease have led to increased
identification of this disorder. However, it remains an elusive
diagnosis due to heterogeneity in presentation. The development of
IVLBCL in two of our patients on active immunosuppression could point
towards an underlying disease mechanism similar to that seen in the
development of post-transplant lymphoproliferative disorder. Traditional
preliminary diagnostic modalities such as imaging are usually
inconclusive, given the paucity of lymphomatous aggregates. A bone
marrow biopsy, random skin biopsies, or a focal organ biopsy in
appropriate cases is required for diagnosis. Nevertheless, a timely
diagnosis requires a high clinical suspicion. Early initiation of
aggressive anthracycline-based therapy with rituximab is associated with
improved outcomes. Novel treatment approaches such as end-organ
resection, if the disease is limited to a single organ such as thyroid
or kidney, can potentially induce remission without the need for
systemic therapy.