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]

A clinicopathologic study of 13 cases of primary lymphoma in soft tissue and review of literature

Primary lymphoma in soft tissue is very rare. In order to understand the clinicopathological features of primary lymphoma in soft tissue, we found 13 cases (0.3%) of primary lymphoma in soft tissue by reviewing 4303 lymphomas diagnosed in our institution from 2010 to 2019. Tumors were found in the following sites: 8 in lower extremity (2 in leg, 1 in calf, 1 in knee and 4 in buttock), 1 in upper extremity (left shoulder) and 4 in the trunk (3 in waist and 1 in thoracolumbar). The most common histologic type was DLBCL (7/13, 54.8%). 6 cases of which had follow-up information. 25 patients were also selected by screening the English literature search (from Jan 2010 to December 2019) including 1102 studies. Compared to the results of literature review, our results are similar with them. The tumor sites were as follows: 10 in lower extremity, 4 in upper extremity, 9 in the trunk and 2 in masticatory muscle. The most common histological type was also DLBCL (n=11/25, 44%). Overall survival analysis of all 31 patients including our 6 cases with primary lymphoma in soft tissue showed no significant difference between different histological type (Log Rank P=0.120, Breslow P=0.157). The differential diagnosis includes malignant melanoma, rhabdomyosarcoma and metastatic carcinoma in soft tissue.

ALK-positive anaplastic large cell lymphoma of skeletal muscle masquerading as soft tissue sarcoma

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.

Primary bone anaplastic lymphoma kinase positive anaplastic large-cell lymphoma: A case report and review of the literature

BACKGROUND

Primary bone lymphoma (PBL) is an uncommon extranodal disease that represents approximately 1%-3% of lymphomas. Anaplastic lymphoma kinase (ALK) positive anaplastic large-cell lymphoma (ALCL) is an extremely rare type of PBL. The aim of this report is describe the symptoms, diagnosis, and treatment of primary bone ALK-positive ALCL.

CASE SUMMARY

A 66-year-old man presented to our hospital with neck and shoulder pain and intermittent fever that lasted for 1 mo. After extensive evaluation, positron emission tomography-computed tomography (CT) examination showed multiple osteolytic bone lesions without other sites lesions. CT-guided biopsy of the T10 vertebral body was performed, and the pathology results showed that neoplastic cells were positive for ALK-1, CD30, and CD3. A diagnosis of primary bone ALK positive ALCL was ultimately made. The patient was in partial response after four cycle soft cyclophosphamide, doxorubicin, vincristine, and prednisone chemotherapy, and we planned to repeat the biopsy and radiological examination after completion of the fifth cycle of therapy.

CONCLUSION

Primary bone ALK positive ALCL is a rare disease and physicians should keep in mind that ALCL can present with isolated osseous involvement without nodal involvement, and lymphoma should be considered in the differential diagnosis of primary bone lesions.

Aggressive Disease Course of Multiple Myeloma with Concomitant ALK-Negative Anaplastic Large Cell Lymphoma: A Case Report with an Unusual Presentation

ALK-negative anaplastic large cell lymphoma is a rare T-cell neoplasm with an aggressive course requiring prompt diagnostic work-up and treatment. Few cases of concomitant multiple myeloma and T-cell neoplasm are described in the literature, mainly regarding primary cutaneous anaplastic large cell lymphoma. We present the case of a 65-year-old man, simultaneously diagnosed with ALK-negative anaplastic large cell lymphoma with extranodal localization in the gastrocnemius muscle (stage 1AE) and IgG lambda multiple myeloma (ISS 2, Durie-Salmon stage 3A). Both diseases required therapeutic intervention due to the high proliferative index of lymphoma and the presence of bone lesions attributable to myeloma. The therapeutic program initially included chemotherapy (cyclophosphamide, doxorubicin, vincristine, etoposide, and prednisone; CHOEP), radiotherapy on the leg, bortezomib, and then consolidation with autologous hematopoietic stem cell transplantation. Despite being on bortezomib treatment and waiting for transplantation, the patient experienced an early myeloma progression that turned out to be refractory to second-line lenalidomide-based treatment. To our knowledge, this is the first case of concurrent diagnosis of extranodal ALK-negative anaplastic large cell lymphoma of the muscle and multiple myeloma. Simultaneous onset can be challenging for clinicians as both diseases may have an aggressive course requiring multiple treatments with increased risk of toxicity and complicated management.

Non-Hodgkin lymphoma of multiple extranodal involvement seen on MRI, FDG PET-CT scans: A case report

RATIONALE

Anaplastic large cell lymphoma (ALCL) is a rare type of non-Hodgkin lymphoma (NHL). The most common extranodal sites of ALCL are skin, subcutaneous tissue, bone, lung, and gastrointestinal organs. This study reports a case of ALCL with multiple extranodal involvement, especially the whole body skeletal muscles, with the aim to share the imaging features of the ALCL including magnetic resonance imaging (MRI) and 18F-fluorodeoxyglucose positron emission tomography-computed tomography (18F-FDG PET-CT).

PATIENT CONCERNS

A 54-year-old female patient presented with two-month history of bilateral shoulder pain, which had exacerbated for 6 days prior to admission. MRI scans revealed multiple hyperintense on T2-weighted image (T2WI) and marked inhomogenous diffuse or rim enhancement masses in shoulder muscles. The probable diagnoses must include metastatic carcinoma in the skeletal muscle, purulent abscess, soft-tissue sarcoma and lymphoma. For our patient, however, she did not have a history of cancer or hyperleukocytosis. 18F-FDG PET-CT was made for further evaluation and identified whether there is another related lesion. PET-CT image showed widespread FDG uptake lesions, including cervical/retroperitoneal lymphnodes, subcutaneous tissue, hepar and multiple groups of whole body muscles.

DIAGNOSES

An ultrasound-guided tissue biopsy was performed on the left cervical lymphnodes. Histological and immunohistochemical examination showed ALK- ALCL.

INTERVENTIONS

Clinicians planned to give our patient systemic chemotherapy.

OUTCOMES

Our patient died of multiple organ failure four weeks after her first visit to our hospital.

LESSONS

This disease should be considered when patient presented diffuse muscle swelling in particular when a history of cancer and hyperleukocytosis was not supported. The presence of soft tissue masses in skeletal muscles on MRI scans, as well as multiple marked focal tracer uptake on PET-CT and immunohistochemical analysis of the mass, may help the recognition of ALCL and the state of illness evaluation, allowing for the appropriate treatment strategy to be initiated.