Intravascular Large B Cell Lymphoma Presenting as a Thyroid Mass

Excerpt

The patient is a 68-year-old male who was in his usual state of good health when he had an episode of vertigo lasting about 15 min. The patient was evaluated by a neurologist who performed imaging studies which were negative. Symptoms progressed, and the patient experienced an episode of profound generalized weakness. On admission, his white blood cell count was noted to be 23,000/μL (4,000–11,000/μL normal range) with 85 % neutrophils (45.0–75.0 % normal range); no clear etiology was established and he was discharged on antibiotics. An extensive infectious disease workup was negative, and flow cytometry performed on the cerebrospinal fluid was nondiagnostic. Neurologic symptoms progressed and the patient experienced episodes of nausea and vomiting. Imaging studies were unrevealing in terms of the neurologic symptoms, but were remarkable for incidental thyroid nodules. A thyroid ultrasound showed a left-sided nodule; positron emission tomography/computer tomography revealed focal fluorodeoxyglucose uptake. …