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Cefai E, Montanaro G, Mercieca C. Anaplastic bone lymphoma presenting as isolated back pain. BMJ Case Rep 2023; 16:e254516. [PMID: 37491120 PMCID: PMC10373682 DOI: 10.1136/bcr-2022-254516] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/27/2023] Open
Abstract
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.
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Affiliation(s)
- Erika Cefai
- Rheumatology, Mater Dei Hospital, Msida, Malta
- Medicine, Mater Dei Hospital, Msida, Malta
| | | | - Cecilia Mercieca
- Rheumatology, Mater Dei Hospital, Msida, Malta
- Medicine, Mater Dei Hospital, Msida, Malta
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Primary ALK-negative anaplastic large cell lymphoma with extensive bone involvement mimicking multiple myeloma and metastatic carcinoma. Int J Hematol 2019; 110:1-2. [PMID: 31093934 DOI: 10.1007/s12185-019-02657-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2019] [Revised: 05/08/2019] [Accepted: 05/08/2019] [Indexed: 10/26/2022]
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3
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Primary Bone Anaplastic Large Cell Lymphoma Masquerading as Ewing Sarcoma: Diagnosis by Anchored Multiplex PCR. J Pediatr Hematol Oncol 2018; 40:e103-e107. [PMID: 28452858 DOI: 10.1097/mph.0000000000000839] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
A 3-year-old boy presented with pathologic fracture of the left proximal femur. Magnetic resonance imaging revealed an aggressive expansile bony mass associated with cortical destruction and surrounding myositis. Computed tomography-guided biopsy revealed a monomorphic small round blue cell tumor by histology. CD99 immunoreactivity and low-level EWSR1 gene translocation by break-apart fluorescent in situ hybridization initially favored a diagnosis of Ewing sarcoma and chemotherapy commenced. Subsequent molecular evaluation by an anchored multiplex polymerase chain reaction-based assay (Archer FusionPlex Sarcoma Panel) revealed a nucleophosmin-anaplastic lymphoma kinase (NPM-ALK) gene fusion. The diagnosis was then amended to primary bone ALK-positive anaplastic large cell lymphoma and the chemotherapy regimen was modified accordingly. This report illustrates the value of this molecular assay in establishing the correct diagnosis of a very rare malignancy masquerading as another tumor type.
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Kim KH, Jung YH, Han CW, Woo IS, Son JH. A case of Primary Bone Anaplastic Large Cell Lymphoma. AMERICAN JOURNAL OF CASE REPORTS 2016; 17:734-738. [PMID: 27729639 PMCID: PMC5063430 DOI: 10.12659/ajcr.898743] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Patient: Female, 52 Final Diagnosis: Primary bone anaplastic large cell lymphoma Symptoms: Bone pain Medication: — Clinical Procedure: — Specialty: Oncology
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Affiliation(s)
- Kyung Hyun Kim
- Division of Medical Oncology, Department of Internal Medicine, Yeouido St. Mary's Hospital, College of Medicine, The Catholic University of Kore, Seoul, South Korea
| | - Yun Hwa Jung
- Division of Medical Oncology, Department of Internal Medicine, Yeouido St. Mary's Hospital, College of Medicine, The Catholic University of Kore, Seoul, South Korea
| | - Chi Wha Han
- Division of Medical Oncology, Department of Internal Medicine, Cheju Halla General Hospital, Jeju, South Korea
| | - In Sook Woo
- Division of Medical Oncology, Department of Internal Medicine, Yeouido St. Mary's Hospital, College of Medicine, The Catholic University of Korea,Seoul, South Korea
| | - Jong Ho Son
- Division of Medical Oncology, Department of Internal Medicine, Yeouido St. Mary's Hospital, College of Medicine, The Catholic University of Korea,Seoul, South Korea
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CAO YIYUAN, ZHANG HANFEI, QU YANJUAN, LIAO MEIYAN. Primary alveolar soft part sarcoma of the right femur and primary lymphoma of the left femur: A case report and literature review. Oncol Lett 2016; 11:89-94. [PMID: 26870173 PMCID: PMC4727093 DOI: 10.3892/ol.2015.3906] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2015] [Accepted: 09/24/2015] [Indexed: 11/18/2022] Open
Abstract
Alveolar soft part sarcoma (ASPS) is a rare soft tissue tumor, particularly in bone, which usually affects young patients. Primary lymphoma of bone (PLB) is a rare form of non-Hodgkins lymphoma that occurs primarily in bone. In the present report, the case of a 42-year-old woman affected by ASPS and PLB in the left and right femur, respectively, is presented. The radiological features of digital radiography, computed tomography and magnetic resonance imaging examination are discussed, and compared with previous findings reported in the literature. To the best of our knowledge, the present study is the first case of ASPS and PLB occurring concomitantly in a patient.
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Hickeson M, Abikhzer G. Review of Physiologic and Pathophysiologic Sources of Fluorodeoxyglucose Uptake in the Chest Wall on PET. PET Clin 2011; 6:339-64. [PMID: 27156728 DOI: 10.1016/j.cpet.2011.04.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
The chest wall can be defined as the osseous and soft tissue structures that form the outer framework of the thorax and move during breathing. Topics discussed in this article include physiologic uptake of fluorodeoxyglucose, benign diseases of the chest wall, and malignant tumors of the chest wall.
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Affiliation(s)
- Marc Hickeson
- Division of Nuclear Medicine, McGill University Health Centre, Royal Victoria Hospital, 687 Pine Avenue West, M2.11, Montreal, Quebec H3A 1A1, Canada
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Gustafson S, Medeiros LJ, Kalhor N, Bueso-Ramos CE. Anaplastic large cell lymphoma: another entity in the differential diagnosis of small round blue cell tumors. Ann Diagn Pathol 2010; 13:413-27. [PMID: 19917480 DOI: 10.1016/j.anndiagpath.2009.09.002] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2009] [Accepted: 09/03/2009] [Indexed: 10/20/2022]
Abstract
We saw in consultation a biopsy specimen from a 6-year old girl with anaplastic lymphoma kinase (ALK)-positive anaplastic large cell lymphoma (ALCL). The tumor arose in soft tissue of the neck, and diagnostic tissue was obtained by core needle biopsy. Histologically, the neoplasm was cellular without pattern. Immunohistochemical workup with a large panel of antibodies at another institution showed immunoreactivity for NB84 and neuron specific enolase (dim). Antibodies specific for CD3, CD20, and CD45/LCA were negative; CD30 or ALK were not assessed. Electron microscopy showed cytoplasmic structures thought to be neurosecretory granules. The neoplasm was interpreted initially as a neuroblastoma. At the time of our review, we considered the possibility of ALCL. Immunohistochemical analysis for CD30 showed bright, uniform expression and ALK was positive in a nuclear and cytoplasmic pattern, confirming the diagnosis of ALK+ ALCL. The purpose of this review is to discuss ALK+ ALCL and many of the other entities included under the rubric of small round blue cell tumor, with a focus on tumors that occur in children.
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Affiliation(s)
- Steven Gustafson
- Department of Hematopathology, The University of Texas M. D. Anderson Cancer Center, Houston, TX 77030, USA
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Primary bone lymphoma: report of a case with multifocal skeletal involvement. Biomed Imaging Interv J 2007; 3:e52. [PMID: 21614300 PMCID: PMC3097684 DOI: 10.2349/biij.3.4.e52] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2007] [Revised: 11/05/2007] [Accepted: 11/27/2007] [Indexed: 11/24/2022] Open
Abstract
Primary bone lymphoma is an uncommon tumour accounting for approximately 4-5% of extra nodal lymphoma and less than 1% of all Non-Hodgkin’s lymphoma. The radiographic appearance of primary bone lymphoma is variable. As lesions frequently resemble other disease processes namely chronic osteomyelitis and metastases, further imaging evaluation and histopathological examination allow early identification for appropriate treatment. The authors present a case of anaplastic large cell lymphoma of bone presenting with multifocal osseus involvement.
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Mounasamy V, Berns S, Azouz EM, Giusti V, Knapp DR. Anaplastic large cell lymphoma presenting as an epiphyseal lytic lesion--a case report with clinico-pathologic correlation. Skeletal Radiol 2006; 35:619-23. [PMID: 16534639 DOI: 10.1007/s00256-006-0087-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2005] [Revised: 12/28/2005] [Accepted: 01/04/2006] [Indexed: 02/02/2023]
Abstract
Anaplastic large cell lymphoma (ALCL) is predominantly a systemic disease with nodal involvement, but extranodal involvement can occur either as the primary presentation or during the disease course. Primary epiphyseal involvement is extremely rare with lymphomas. This case report illustrates an 8-year old boy who first presented with pain over the right upper extremity, which was initially treated as epiphyseal osteomyelitis. A few weeks later, he presented with abdominal pain and an abdominal wall mass, which on biopsy proved to be an anaplastic large-cell lymphoma.
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Affiliation(s)
- Varatharaj Mounasamy
- Nemour's Children's Clinic and Orlando Regional Medical Center, Orlando, FL, USA.
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Hsu PK, Hsu HS, Li AFY, Wang LS, Huang BS, Huang MH, Hsu WH. Non-Hodgkin’s Lymphoma Presenting as a Large Chest Wall Mass. Ann Thorac Surg 2006; 81:1214-8. [PMID: 16564245 DOI: 10.1016/j.athoracsur.2005.11.044] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2005] [Revised: 11/10/2005] [Accepted: 11/21/2005] [Indexed: 10/24/2022]
Abstract
BACKGROUND Malignant lymphoma presenting as a solitary chest wall mass is not frequently seen. Only a few case reports have been found in the English literature. The treatment for primary chest wall lymphoma remains unclear. METHODS From 1991 to 2004, of 157 patients with initial presentation of isolated chest wall mass, non-Hodgkin's lymphoma was diagnosed in 7 of them. Patients with tumors arising from axillary lymph nodes or mediastinal lymphadenopathy with chest wall extension were excluded in the study. The clinical manifestation, management, and outcome of these patients were reviewed. RESULTS There were 1 female and 6 male patients with a mean age of 66.5 years. The mean largest diameter of the mass was 10.3 cm. Four of these 7 patients had the chest wall lymphoma as the only site of disease. The other 3 patients had other organ involvement including lung, bone, or liver. The pathologic diagnoses were malignant lymphoma in 2 patients and diffuse large B-cell lymphoma in 5 patients. Three patients with chest wall lymphoma as the only site of disease had tumor excision followed by adjuvant chemotherapy. No recurrence or metastasis was noted for these 3 patients. The mean follow-up period was 102 months. The other patient with chest wall lymphoma as the only site of disease, who had chemotherapy as the initial treatment, remained free of disease for 6 months after treatment. The other 3 patients with other organ involvement who were managed with chemotherapy with or without radiotherapy died of disease after a mean survival of 20 months. CONCLUSIONS Malignant lymphoma presenting as a large chest wall mass is not common. Although the primary treatment of choice for lymphoma with or without chest wall involvement is chemotherapy, surgery followed by adjuvant chemotherapy can provide satisfactory outcome for some patients in whom the chest wall lymphoma was the only site of disease.
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Affiliation(s)
- Po-Kuei Hsu
- Division of Thoracic Surgery, Department of Surgery, Taipei Veterans General Hospital, National Yang-Ming University School of Medicine, Taipei, Taiwan
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Huebner-Chan D, Fernandes B, Yang G, Lim MS. An immunophenotypic and molecular study of primary large B-cell lymphoma of bone. Mod Pathol 2001; 14:1000-7. [PMID: 11598170 DOI: 10.1038/modpathol.3880425] [Citation(s) in RCA: 37] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Primary non-Hodgkin's lymphomas of bone (PNHLB) is a rare form of extranodal lymphoma. Many studies have reported the clinical, radiologic, and histopathologic characteristics of PNHLB; however, their molecular features have not been well studied. In this report, we present the immunophenotypic and molecular characteristics of 20 primary large B-cell lymphoma (PLBCL) of bone from 20 adults. Most demonstrated centroblastic morphology, with the majority exhibiting nuclear multilobation. One case (5%) demonstrated anaplastic features with strong CD30 expression but was ALK-1 negative. BCL-6 expression was seen in 6 of 20 cases, and strong p53 protein expression was seen in 11 of 20 (55%) cases. The majority of cases analyzed (13/18 = 72%) demonstrated a clonal B-cell process by IgH gene rearrangement studies. Of the five cases that did not demonstrate a clonal population, two expressed BCL-6 protein. No cases demonstrated a bcl-2/JH rearrangement, but BCL-2 protein expression was seen in 11 of 20 (55%) cases. In summary, primary lymphoma of bone is largely a non-Hodgkin's lymphoma of large B-cell type. Our studies demonstrate that p53 and BCL-2 expression may play a role in the pathogenesis of PLCBL of bone. In addition, a subset of the cases are of putative germinal center B-cell origin based on the expression of BCL-6 protein and may be genetically distinct from follicle center lymphomas. The results provide evidence for molecular heterogeneity within primary large B-cell lymphomas of bone.
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MESH Headings
- Adult
- Aged
- Aged, 80 and over
- Antigens, CD20/analysis
- Bone Neoplasms/genetics
- Bone Neoplasms/metabolism
- Bone Neoplasms/pathology
- DNA, Neoplasm/genetics
- DNA-Binding Proteins/analysis
- Female
- Gene Rearrangement
- Humans
- Immunoglobulin Heavy Chains/genetics
- Immunohistochemistry
- Ki-1 Antigen/analysis
- Ki-67 Antigen/analysis
- Lymphoma, B-Cell/genetics
- Lymphoma, B-Cell/metabolism
- Lymphoma, B-Cell/pathology
- Lymphoma, Large B-Cell, Diffuse/genetics
- Lymphoma, Large B-Cell, Diffuse/metabolism
- Lymphoma, Large B-Cell, Diffuse/pathology
- Male
- Middle Aged
- Polymerase Chain Reaction
- Proto-Oncogene Proteins/analysis
- Proto-Oncogene Proteins c-bcl-2/analysis
- Proto-Oncogene Proteins c-bcl-2/genetics
- Proto-Oncogene Proteins c-bcl-6
- Transcription Factors/analysis
- Tumor Suppressor Protein p53/analysis
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Affiliation(s)
- D Huebner-Chan
- Department of Pathology, Kaiser Permanente Medical Center, Anaheim, California, USA
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MESH Headings
- Anaplastic Lymphoma Kinase
- Cell Nucleus/metabolism
- Cell Transformation, Neoplastic
- Chromosomes, Human, Pair 2
- Chromosomes, Human, Pair 5
- Cytoplasm/metabolism
- Humans
- Immunophenotyping
- Ki-1 Antigen/analysis
- Lymphoma, Large-Cell, Anaplastic/genetics
- Lymphoma, Large-Cell, Anaplastic/immunology
- Lymphoma, Large-Cell, Anaplastic/pathology
- Nuclear Proteins/genetics
- Nucleophosmin
- Protein-Tyrosine Kinases/genetics
- Receptor Protein-Tyrosine Kinases
- Translocation, Genetic
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Affiliation(s)
- B Falini
- Institute of Haematology, Policlinico Monteluce, University of Perugia, Perugia, Italy.
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Tsuda T, Matsunami M, Nakayama K, Hara J, Sakaguchi R, Katayama N, Okamoto Y, Ota K. Autologous peripheral stem-cell transplantation after intensive chemotherapy in a case of CD30 (Ki-1)-positive anaplastic large-cell lymphoma. J Int Med Res 2001; 29:425-31. [PMID: 11725830 DOI: 10.1177/147323000102900507] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Simultaneous treatment with peripheral blood stem-cell (PBSC) transplantation and intensive chemotherapy was evaluated in a case of non-Hodgkin's lymphoma (NHL) with poor prognosis. A 59-year-old male diagnosed with a high-grade, anaplastic large-cell (Ki-1) NHL, involving fractures in the left hip, underwent computed tomography and gallium scintigram surveillance. The patient received chemotherapy with epirubicin hydrochloride, cyclophosphamide, vincristine and prednisolone, and the fractured hip bone was repaired following the first course of chemotherapy. After the second and third courses of chemotherapy, PBSCs were harvested and cryopreserved. The patient then received a further course of chemotherapy and PBSC transplantation was conducted using infused cells consisting of 9.63 x 10(6)/kg CD34 cells and 2.24 x 10(5)/kg granulocyte macrophage colony-forming units. Recovery of platelet and white blood cell counts occurred 10 and 8 days, respectively, after PBSC infusion and the patient remains well.
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Affiliation(s)
- T Tsuda
- Department of Blood Transfusion Medicine and Clinical Hematology, Wakayama Medical University, Japan
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Abstract
The anaplastic lymphoma kinase (ALK) gene fuses to the nucleophosmin (NPM) gene as a result of a (2;5) translocation associated with a subtype of human lymphoma (initially designated anaplastic large cell lymphoma [ALCL] or Ki-1/CD30-positive lymphoma). The immunocytochemical detection of NPM-ALK (and proteins encoded by other ALK fusion genes) has allowed the definition of a tumor entity, "ALK-positive lymphoma" (which shows only partial overlap with pathologists' diagnosis of ALCL), to be defined and is invaluable in distinguishing this disease from ALK-negative large cell lymphomas. Eight variant ALK fusion proteins have been identified. Some are expressed only in ALCL, some are found only in the nonhematopoietic neoplasm inflammatory myofibroblastic tumor (IMT), and some are present in both types of malignancy. The ALK gene is silent in adult tissues except for restricted sites within the nervous system (consequently, patients with ALK-positive lymphoma produce antibodies to the ALK protein) but is expressed in some neuroblastomas and rhabdomyosarcomas. Biochemical studies suggest an anti-apoptotic function of NPM-ALK, and this may contribute to oncogenesis. Although ALK-positive lymphomas have a generally good prognosis, new therapeutic regimens are still needed for patients whose disease is refractory to conventional treatment.
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Affiliation(s)
- K Pulford
- Immunodiagnostics Unit, Nuffield Department of Clinical Laboratory Sciences, John Radcliffe Hospital, Oxford, OX3 9DU, UK.
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