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Lozano-Jaramillo DA, Millan-Arreola E, Esquer-Cota OO, Lozano-Garcia JM, Valenzuela-Espinoza MA. Soft-Tissue Anaplastic Lymphoma Kinase-Positive Anaplastic Large Cell Lymphoma in a Child Unmasked by COVID-19. J Hematol 2023; 12:37-41. [PMID: 36895288 PMCID: PMC9990711 DOI: 10.14740/jh1081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Accepted: 01/26/2023] [Indexed: 03/11/2023] Open
Abstract
Anaplastic large cell lymphoma (ALCL) is children's most common mature T-cell neoplasm. The majority is positive for anaplastic lymphoma kinase (ALK). Initial presentation as a soft-tissue pelvic mass without nodal involvement is rare and can be easily misdiagnosed. We report a case of a 12-year-old male presenting with pain and movement restriction in the right extremity. Computed tomography (CT) scan revealed a solitary pelvic mass. Initial biopsy examination concluded rhabdomyosarcoma. After developing pediatric multisystemic inflammatory syndrome due to coronavirus disease 2019 (COVID-19), central and peripheral lymph node enlargement appeared. New cervical adenopathy and pelvic mass biopsies were performed. Immunohistochemistry concluded an ALK-positive ALCL with a small-cell pattern. The patient was treated with brentuximab-based chemotherapy and eventually improved. Differential diagnosis of pelvic masses in children and adolescents must include ALCL. An inflammatory trigger may promote the appearance of a typical nodal disease, previously absent. Attention is warranted during histopathological examination to avoid diagnostic errors.
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Affiliation(s)
- Diego Alberto Lozano-Jaramillo
- Centro de Investigacion Valle Bibb Fundacion, Tijuana, Baja California, Mexico.,Centro Oncologico Pediatrico de Baja California, Tijuana, Baja California, Mexico
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2
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Restivo GA, Mussolin L, D’Angelo P, Zin A, Pigazzi M, Carraro E, D’Amore ESG, Pillon M, Farruggia P. Extranodal Biphenotypic Non-Hodgkin Lymphoma of the Popliteal Cavity: A Case Report and Review of Literature. Diagnostics (Basel) 2022; 12:diagnostics12071649. [PMID: 35885553 PMCID: PMC9323538 DOI: 10.3390/diagnostics12071649] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2022] [Revised: 06/24/2022] [Accepted: 07/05/2022] [Indexed: 11/20/2022] Open
Abstract
Primary soft-tissue lymphoma (PSTL) is a rare extranodal non-Hodgkin lymphoma, characterized by a mass growing within soft-tissue, which is connective tissue, adipose tissue, and skeletal muscle. Here, we describe a case of biphenotypic lymphoblastic lymphoma arising from soft tissue of the popliteal fossa in an 11-year-old boy. A pediatric review about PSTL revealed that anaplastic large cell lymphoma is the most common histological type and a biphenotypic lymphoblastic lymphoma has not yet been reported in childhood. Lymphoma should always be considered in patients presenting with a soft-tissue mass, and a comprehensive immunohistochemical evaluation, including B-cell, T-cell, and myeloid markers, is needed to make a correct diagnosis and establish the most suitable treatment.
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Affiliation(s)
- Giulia A. Restivo
- Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties “G. D’Alessandro”, University of Palermo, 90127 Palermo, Italy
- Correspondence:
| | - Lara Mussolin
- Clinic of Pediatric Hemato-Oncology, Department of Women’s and Children’s Health, University of Padova, 35128 Padova, Italy; (L.M.); (M.P.); (E.C.); (M.P.)
- Institute of Pediatric Research-Fondazione Città della Speranza, 35127 Padova, Italy;
| | - Paolo D’Angelo
- Department of Pediatric Hemato-Oncology, ARNAS Ospedali Civico, G. Di Cristina, 90127 Palermo, Italy; (P.D.); (P.F.)
| | - Angelica Zin
- Institute of Pediatric Research-Fondazione Città della Speranza, 35127 Padova, Italy;
| | - Martina Pigazzi
- Clinic of Pediatric Hemato-Oncology, Department of Women’s and Children’s Health, University of Padova, 35128 Padova, Italy; (L.M.); (M.P.); (E.C.); (M.P.)
| | - Elisa Carraro
- Clinic of Pediatric Hemato-Oncology, Department of Women’s and Children’s Health, University of Padova, 35128 Padova, Italy; (L.M.); (M.P.); (E.C.); (M.P.)
| | | | - Marta Pillon
- Clinic of Pediatric Hemato-Oncology, Department of Women’s and Children’s Health, University of Padova, 35128 Padova, Italy; (L.M.); (M.P.); (E.C.); (M.P.)
| | - Piero Farruggia
- Department of Pediatric Hemato-Oncology, ARNAS Ospedali Civico, G. Di Cristina, 90127 Palermo, Italy; (P.D.); (P.F.)
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3
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Gupta D, Vishwajeet V, Ramzan M, Elhence PA. ALK-positive anaplastic large cell lymphoma of skeletal muscle masquerading as soft tissue sarcoma. BMJ Case Rep 2022; 15:e245685. [PMID: 35131778 PMCID: PMC8823051 DOI: 10.1136/bcr-2021-245685] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/06/2022] [Indexed: 11/04/2022] Open
Abstract
Anaplastic large cell lymphoma (ALCL) is a subtype of T cell non-Hodgkin's lymphoma and can present as an extranodal disease. Primary ALCL of skeletal muscle is rare. We report a case of ALK-positive ALCL involving the left thigh and anterior chest wall in a 12-year-old male child. The fine needle aspiration cytology from the lesion showed cellular smears with singly scattered and occasional clusters of large pleomorphic atypical cells. A diagnosis of poorly differentiated malignant neoplasm was rendered. On core biopsy, the histomorphological features posed a diagnostic challenge with a myriad of morphological mimickers. The diagnosis was established by excluding specific entities by relevant immunostains and confirming the diagnosis by strong expression of CD30 and ALK on immunohistochemistry. Fluorescence in-situ hybridisation confirmed the characteristic t(2:5) translocation. Presentation of ALCL with skeletal muscle involvement is uncommon, and the diagnosis relies on broadening the diagnostic possibilities and judicious use of immunohistochemical markers.
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Affiliation(s)
- Deepika Gupta
- Department of Pathology and Lab Medicine, All India Institute of Medical Sciences, Jodhpur, India
| | - Vikarn Vishwajeet
- Department of Pathology and Lab Medicine, All India Institute of Medical Sciences, Jodhpur, India
| | - Mohammed Ramzan
- Department of Paediatrics, All India Institute of Medical Sciences, Jodhpur, India
| | - Poonam Abhay Elhence
- Department of Pathology and Lab Medicine, All India Institute of Medical Sciences, Jodhpur, India
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4
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Takamatsu S, Murakami K, Takaya H, Tobiume T, Nakai H, Suzuki A, Mandai M, Matsumura N. Malignant psoas syndrome associated with gynecological malignancy: Three case reports and a review of the literature. Mol Clin Oncol 2018; 9:82-86. [PMID: 29977543 DOI: 10.3892/mco.2018.1635] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2018] [Accepted: 05/21/2018] [Indexed: 11/05/2022] Open
Abstract
Malignant psoas syndrome (MPS) is a rare and unique cancer-associated syndrome caused by the malignant involvement of the psoas major muscle, and is characterized by ipsilateral lumbosacral plexopathy and painful hip flexion. The pain in MPS is often distressing and intractable, and there is no established effective treatment approach. Herein, the present study reports on three cases of MPS associated with gynecological malignancies, wherein symptom improvement was observed following chemotherapy or radiotherapy. Among 39 cases documented in the literature, female genital tract malignancies were the most frequent causes of MPS; however, the condition may be under-diagnosed, owing to the lack of general recognition. Considering the development of recent high-precision radiation therapy, palliative radiotherapy may serve an important role in the management of MPS. For physicians treating gynecological cancers, early detection of MPS is clinically important as this may allow patients to receive possible therapies and improve their quality of life in end-stage cancer. Further prospective studies should be performed to evaluate effective therapeutic approaches for MPS.
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Affiliation(s)
- Shiro Takamatsu
- Department of Obstetrics and Gynecology, Kindai University Faculty of Medicine, Osakasayama, Osaka 589-8511, Japan
| | - Kosuke Murakami
- Department of Obstetrics and Gynecology, Kindai University Faculty of Medicine, Osakasayama, Osaka 589-8511, Japan
| | - Hisamitsu Takaya
- Department of Obstetrics and Gynecology, Kindai University Faculty of Medicine, Osakasayama, Osaka 589-8511, Japan
| | - Takako Tobiume
- Department of Obstetrics and Gynecology, Kindai University Faculty of Medicine, Osakasayama, Osaka 589-8511, Japan
| | - Hidekatsu Nakai
- Department of Obstetrics and Gynecology, Kindai University Faculty of Medicine, Osakasayama, Osaka 589-8511, Japan
| | - Ayako Suzuki
- Department of Obstetrics and Gynecology, Kindai University Faculty of Medicine, Osakasayama, Osaka 589-8511, Japan
| | - Masaki Mandai
- Department of Gynecology and Obstetrics, Kyoto University Graduate School of Medicine, Kyoto, Osaka 606-8507, Japan
| | - Noriomi Matsumura
- Department of Obstetrics and Gynecology, Kindai University Faculty of Medicine, Osakasayama, Osaka 589-8511, Japan
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5
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Binici DNR, Karaman A, Timur O, Tasar PNT, Sanibas AV. Primary skeletal muscle lymphoma: A case report. Mol Clin Oncol 2017; 8:80-82. [PMID: 29387400 DOI: 10.3892/mco.2017.1483] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2016] [Accepted: 03/29/2017] [Indexed: 12/27/2022] Open
Abstract
Primary lymphomas of the bone or skeletal muscle are rare. Three mechanisms of lymphomatous involvement of the muscle have been described, namely direct invasion from adjacent involved lymph nodes or bone, metastatic spread and, least commonly, primary muscle lymphoma. We herein present a rare case of primary mucle non-Hodgkin lymphoma with a description if the associated clinicopathological findings and a review of the relevant literature. A 41-year-old female patient was referred to our hospital with a painful mass in the right lower extremity. Following resection and histopathological examination, a diffuse large B-cell lymphoma originating from the muscle with cutaneous and subcutanenous infiltration was diagnosed. The patient received chemotherapy with six cycles of cyclophosphamide, hydroxydaunomycin, oncovin and prednisone (CHOP regimen) and a complete radiological response was achieved after six cycles of treatment.
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Affiliation(s)
- Dogan Nasi R Binici
- Department of Internal Medicine, Erzurum Regional Training and Research Hospital, Erzurum 25040, Turkey
| | - Ali Karaman
- Department of Medical Genetics, Zeynep Kamil Women's and Children's Diseases Education and Research Hospital, Istanbul 34668, Turkey
| | - Ozge Timur
- Department of Internal Medicine, Erzurum Regional Training and Research Hospital, Erzurum 25040, Turkey
| | - Pi Nar Tosun Tasar
- Erzurum Department of Geriatrics, Regional Training and Research Hospital, Erzurum 25040, Turkey
| | - Ahmet Veli Sanibas
- Department of Internal Medicine, Erzurum Regional Training and Research Hospital, Erzurum 25040, Turkey
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6
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McKay TA, Bishop S, McKay MJ. Primary psoas sarcoma causing malignant psoas syndrome: favourable response to radiotherapy. ANNALS OF TRANSLATIONAL MEDICINE 2017; 5:105. [PMID: 28361070 DOI: 10.21037/atm.2017.03.08] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Malignant psoas syndrome (MPS) is an uncommon condition first described by Stevens et al. MPS is caused by malignant infiltration of the psoas muscle and adjacent nerves and is characterised by (fixed) flexion deformity of the ipsilateral hip and proximal lumbosacral plexopathy. It has previously been described in relation to metastatic carcinoma, melanoma and liposarcoma, as well as non-Hodgkins lymphoma. We present the case of a 68-year-old woman with a sarcoma arising in the left psoas muscle at the level of L4 who presented with symptoms of MPS. To the authors' knowledge this is the first case of MPS arising from a primary sarcoma of the iliopsoas compartment. The patient underwent presurgical radiotherapy, with a significant improvement in pain control without an increase in analgesic medications. We discuss the aetiology of MPS and the role of radiotherapy in the treatment of this rare syndrome.
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Affiliation(s)
| | - Sarah Bishop
- Illawarra Cancer Care Centre, Wollongong, NSW, Australia
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7
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Anaplastic large cell lymphoma with primary involvement of the skeletal muscle: A case report. Oncol Lett 2015; 9:2815-2818. [PMID: 26137153 DOI: 10.3892/ol.2015.3087] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2014] [Accepted: 03/04/2015] [Indexed: 01/12/2023] Open
Abstract
The present study reported the case of a patient with primary anaplastic large cell lymphoma (ALCL) occurring in the left major psoas. A 24-year-old male patient presented with one-month history of left lower back pain, which had been exacerbated for 10 days prior to admission. Magnetic resonance imaging (MRI) scans revealed an enlarged major psoas muscle that protruded into the inguinal region. The presence of an intense soft tissue mass on MRI scans, as well as the results of fine-needle aspiration biopsy and immunohistochemical analysis of the mass, may help establish an early diagnosis, allowing for the appropriate treatment strategy to be initiated.
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8
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Das DK, Pathan SK, Al-Qaddomi SA, Al-Ghawas M, El-Sonbaty MR, Ali AE. Anaplastic large cell lymphoma of the chest wall with cytoplasmic globules and variability in nuclear morphology including a teddy bear-shaped nucleus. Diagn Cytopathol 2015; 43:559-62. [PMID: 25693724 DOI: 10.1002/dc.23260] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2014] [Revised: 01/07/2015] [Accepted: 01/31/2015] [Indexed: 11/08/2022]
Affiliation(s)
- Dilip K Das
- Department of Pathology, Faculty of Medicine, Kuwait University, Kuwait, Kuwait.,Cytology Unit, Mubarak Al-Kabeer Hospital, Kuwait, Kuwait
| | | | | | - Mae Al-Ghawas
- Department of Medicine, Al-Adan Hospital, Kuwait, Kuwait
| | | | - Abdullah E Ali
- Histopathology Laboratory, Hussain Makki Al-Juma Center for Specialized Surgery, Kuwait, Kuwait
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9
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Derenzini E, Casadei B, Pellegrini C, Argnani L, Pileri S, Zinzani PL. Non-Hodgkin Lymphomas Presenting as Soft Tissue Masses: A Single Center Experience and Meta-Analysis of the Published Series. CLINICAL LYMPHOMA MYELOMA & LEUKEMIA 2013; 13:258-65. [DOI: 10.1016/j.clml.2012.10.003] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/19/2012] [Revised: 09/30/2012] [Accepted: 10/01/2012] [Indexed: 11/16/2022]
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10
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Kounami S, Yoshikawa N. Primary skeletal muscle anaplastic large cell lymphoma, positive for anaplastic lymphoma kinase, exhibiting multiple skeletal muscle lesions. Int J Hematol 2012; 95:597-8. [PMID: 22610540 DOI: 10.1007/s12185-012-1098-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2012] [Revised: 05/08/2012] [Accepted: 05/11/2012] [Indexed: 10/28/2022]
Affiliation(s)
- Shinji Kounami
- Department of Pediatrics, Wakayama Medical University, 811-1 Kimiidera, Wakayama 641-8509, Japan.
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11
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Gaiser T, Geissinger E, Schattenberg T, Scharf HP, Dürken M, Dinter D, Rosenwald A, Marx A. Case report: A unique pediatric case of a primary CD8 expressing ALK-1 positive anaplastic large cell lymphoma of skeletal muscle. Diagn Pathol 2012; 7:38. [PMID: 22497840 PMCID: PMC3359216 DOI: 10.1186/1746-1596-7-38] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2012] [Accepted: 04/12/2012] [Indexed: 11/20/2022] Open
Abstract
Primary involvement of skeletal muscle is a very rare event in ALK-1 positive anaplastic large cell lymphoma (ALCL). We describe a case of a 10-year old boy presenting with a three week history of pain and a palpable firm swelling at the dorsal aspect of the left thigh. Histological examination of the lesion revealed a tumoral and diffuse polymorphic infiltration of the muscle by large lymphoid cells. Tumor cells displayed eccentric, lobulated "horse shoe" or "kidney-shape" nuclei. The cells showed immunohistochemical positivity for CD30, ALK-1, CD2, CD3, CD7, CD8, and Perforin. Fluorescence in situ hybridization analysis revealed a characteristic rearrangement of the ALK-1 gene in 2p23 leading to the diagnosis of ALK-1 positive ALCL. Chemotherapy according to the ALCL-99-NHL-BFM protocol was initiated and resulted in a complete remission after two cycles. This case illustrates the unusual presentation of a pediatric ALCL in soft tissue with a good response to chemotherapy.
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Affiliation(s)
- Timo Gaiser
- Institute of Pathology, Medical Faculty Mannheim, University of Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167 Mannheim, Germany.
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