Anaplastic large cell lymphoma: The evolution continues

Primary pulmonary anaplastic large cell lymphoma: case report and literature review

Primary anaplastic large cell lymphoma (ALCL) is a rare pulmonary malignancy. Due to its nonspecific clinical and radiologic manifestations, the disease presents a great challenge to pulmonologists. Appropriate invasive biopsy and immunohistochemistry are important for its diagnosis. Here, we report an ALCL case of a 27-year-old Chinese woman who presented to our hospital complaining of coughing for 10+ days and breath holding for 4-5 days after the event. Positive signs on physical examination were dull percussion sounds and decreased right lung breath sounds. Chest CT scans revealed central carcinoma and atelectasis of the right lung, pleural effusion, and lung mass. Pathology consultation showed a right main bronchial ALCL that involved the parabronchial lymph nodes but not the bronchial tangent. The patient discontinued treatment after right pneumonectomy and died two months later. Postoperative lung biopsy showed anaplastic tumor cells with large and multiple nuclei. The ALCL was characterized by the expression of T cell antigens, CD30 and ALK, as indicated by immunohistochemistry. We also reviewed the atypical cases of ALCL that were previously published. The results indicated that primary pulmonary ALCL is an extremely rare and easily misdiagnosed disease with non-specific clinical and imaging manifestations. Its diagnosis is based on biopsy and immunohistochemistry, and its prognosis is poor.

ALK-Positive Anaplastic Large Cell Lymphoma: A Diagnostic Dilemma for the Otolaryngologist in a Resource Poor Setting

Anaplastic large cell lymphoma is a rare subtype of non-Hodgkin's lymphoma. The morphological diversity with which its anaplastic cells confer make the diagnosis of this hematological entity extremely challenging to the pathologist in a resource poor setting. We present a case of a 35-year-old male with a nasopharyngeal mass and cervical lymphadenopathy and the adversities faced by out otolaryngology department with obtaining the diagnosis of ALK-positive anaplastic large cell lymphoma.

Diagnostic Challenges of Anaplastic Large Cell Lymphoma in a Resource-Limited Setting: A Case Report and Literature Review

Anaplastic large cell lymphoma (ALCL) is a rare variety of non-Hodgkin's lymphoma with diverse morphologic variants. Due to the similarity of the different variants with other lymphoma entities, misdiagnosis may be inevitable when immunohistochemical and cytogenetic techniques are not available and histology alone is employed. We report a case of a 43-year-old woman with a seven-month history of neck swelling which was complicated by ulceration of the mass and pathological fracture of the right clavicle after two months delay in arriving at a correct diagnosis. Several attempts to arrive at definitive diagnosis using histology alone gave divergent reports which all misdiagnosed the case until it was sent to a facility outside the country. Our report highlights the limitations and challenges of histology in making a definitive diagnosis of ALCL and the overt importance of immunohistochemical and cytogenetic techniques which are largely unavailable in resource-constrained environment typical of tertiary centers in Nigeria and most sub-Saharan Africa countries.

Change in the diagnosis from classical Hodgkin's lymphoma to anaplastic large cell lymphoma by (18)F flourodeoxyglucose positron emission tomography/computed tomography: Importance of recognising disease pattern on imaging and immunohistochemistry

Anaplastic large cell lymphoma (ALCL) is a rare type of nonHodgkin's lymphoma (NHL), but one of the most common subtypes of T-cell lymphoma. It is an aggressive T-cell lymphoma, and some ALCL may mimic less aggressive classical HL histopathlogically. It may be misdiagnosed unless careful immunohistochemical examination is performed. As the prognosis and management of these two lymphomas vary significantly, it is important to make a correct diagnosis. We describe a case who was diagnosed as classical HL by histopathological examination of cervical lymph node, in whom ¹⁸F-flouro deoxyglucose positron emission tomography/computed tomography appearances were unusual for HL and warranted review of histopathology that revealed anaplastic lymphoma kinase-1 negative anaplastic large T-cell lymphoma, Hodgkin-like variant, thereby changing the management.