Systemic and primary cutaneous anaplastic large cell lymphoma: Clinical features, morphological spectrum, and immunohistochemical profile

Primary cutaneous anaplastic large-cell lymphoma resembling infratemporal space infection: a case report

BACKGROUND

Primary cutaneous anaplastic large-cell lymphoma (PC-ALCL) is a rare T-cell lymphoma belonging to the CD30 + T-cell lymphoproliferative disorders. The case of PC-ALCL in the temporal region is exceedingly rare. Herein, we report a case of PC-ALCL involving the temporal region mimicking infratemporal space infection.

CASE PRESENTATION

A 78-year-old woman presented to maxillofacial surgery service with a 6-month history of swelling and pain in the left side of her face. Laboratory investigations found an elevated C-reactive protein (CRP). Imaging findings showed enlarged lymph nodes and extensive thickening of subcutaneous tissue of the left temples. Based on these findings, the infratemporal space infection was suspected initially. The patient underwent incision and drainage, and we unexpectedly found no pus in the lesion area. Incisional biopsy showed necrosis and extensive involvement of the left temples by a diffuse infiltrate containing large, atypical cells. The tumor cells were positive for CD30, CD3, Ki67. They were negative for ALK (SP8), CD5, CD8, CD20 and PAX5. After considering these findings, a diagnosis of PC-ALCL was rendered. The patient was admitted to the lymphoma department for systemic chemotherapy and no relapse occurred during a follow-up period of six months.

CONCLUSIONS

This report suggests that if there are suspicious intraoperative manifestations, carrying out a biopsy simultaneously, using Hematoxylin and eosin (HE) staining, and a comprehensive Immunohistochemistry (IHC) panel are essential to diagnosing PC-ALCL to prevent misdiagnosis.

Anaplastic bone lymphoma presenting as isolated back pain

A previously healthy man in his late 20s presented with a 4-week history of insidious back pain and raised inflammatory markers. Various specialists were involved in his care including general physicians, orthopaedic surgeons and rheumatologists. After numerous investigations including imaging and two bone biopsies, an unexpected diagnosis of anaplastic large cell lymphoma emerged. This case illustrates the importance of investigating back pain with red flags thoroughly using different imaging modalities and where indicated a bone biopsy.

A case of primary cutaneous anaplastic large cell lymphoma on eyelid

Primary cutaneous anaplastic large cell lymphoma is a kind of cluster of differentiation 30+ primary cutaneous lymphoproliferative disorders with a relatively good prognosis in the absence of high-stage disease. Primary cutaneous anaplastic large cell lymphoma shows a higher frequency in males and commonly affects the head and neck. Palpebral involvement is very rare. We present a 42-year-old lady patient with primary cutaneous anaplastic large cell lymphoma involving the eyelid which was initially misdiagnosed as stye. The patient underwent a total excision of the lesion and showed complete regression of the lesion after surgery without any other treatment. There was no evidence of local or systemic disease during follow-up after nine months.

Immunohistochemistry in Dermatopathology and its Relevance in Clinical Practice

Immunohistochemistry (IHC) is an important diagnostic tool in histopathology. Dermatopathology is a rapidly developing subspecialty of histopathology. Although IHC is not widely used in routine dermatopathology practice, its application is gradually increasing. IHC is used to differentiate two conditions with similar morphology, to confirm a diagnosis as well as to assess prognosis. It is more commonly used for neoplastic conditions like melanocytic, hematolymphoid, and spindle cell tumors, although uses can be very wide. Although IHC can aid in diagnosis, sometimes interpretation can be difficult as there may be overlapping findings. Thus, IHC should not be interpreted in isolation and should be done in the context of clinical and histological findings. In this review, we have discussed the uses of various immunohistochemical markers in dermatopathology in the light of current literature and their clinical relevance.