Anaplastic large cell lymphoma presenting as a mass in the uterine cervix: a case report

T-cell lymphoma is an extremely rare form of malignancy in the female genital tract. Most of the reported cases of lymphoma are B-cell lymphomas. A few cases of primary T-cell lymphomas involving the vagina or the vulva have been reported. We are reporting the first case of anaplastic large cell lymphoma (ALCL) presenting as a uterine cervical mass. The patient is a 24-year-old female who presented to the emergency room with a history of menorrhagia, night sweats and 40-pound weight loss. The diagnosis of ALCL was confirmed through immunohistochemical studies with strong CD30 and ALK expression. Fluorescent hybridization showed a rearrangement of the anaplastic lymphoma kinase (ALK) gene. Since ALCL may have a variable expression of T-cell antigens, the diagnosis may easily be missed when CD45 and/or CD3 is negative, and screening epithelial stains for carcinoma (e.g., p63 and EMA) are positive. CD30 must be performed to raise the consideration of ALCL when reniform nuclei are observed.

Decidualized Stroma in Pelvic Lymph Nodes in a Pregnant Patient With Cervical Squamous Cell Carcinoma: A Case Report

Decidualized endometrial stroma is an uncommon finding in lymph nodes but is typically found in the setting of endometriosis where endometrial glands give a hint toward the diagnosis. On the other hand, endometrial stroma with no identifiable endometrial glands can be challenging to differentiate from metastatic squamous cell carcinoma. We report a case of a 22-year-old female who presented to our medical center as a known case of cervical squamous cell carcinoma. The patient desired future fertility and became pregnant. She was treated during her second trimester and underwent a radical cesarean hysterectomy at 37 weeks’ gestation with bilateral pelvic lymph node dissection. Resection showed residual moderately differentiated squamous cell carcinoma of the cervix with lymphovascular invasion. Two pelvic lymph nodes were found to have decidualized stroma. Immunohistochemistry was done to rule out metastasis and no metastatic carcinoma was identified in any of the lymph nodes. It is necessary to be aware of the possibility of decidualized stromal changes in pelvic lymph nodes to avoid misdiagnosis.

B-Cell Acute Lymphoblastic Leukemia Presenting as Leukemia Cutis: A Case Report

Leukemia cutis (LC) is a manifestation of leukemia with infiltration of the dermis, epidermis, or subcutis by malignant leukocytes resulting in papules, plaques, nodules, or ulcers. It is usually associated with acute and chronic myeloid leukemia as well as T-cell acute lymphoblastic leukemia (T-ALL) but is very rare in patients with B-cell acute lymphoblastic leukemia (B-ALL). We report a case of a 58-year-old Hispanic male who presented with a non-healing leg ulcer of three months along with patches on the face, left arm, and bilateral legs with white blood cell (WBC) count of 50800/mm³ with 83% blasts, and flow cytometry findings of B-ALL. Punch biopsies from affected skin showed numerous dermal nodules composed of large atypical cells with open chromatin and prominent nucleoli. Immunohistochemical stains were consistent with B-ALL involving the skin and a diagnosis of LC was rendered. A high index of suspicion in relevant cases and prompt diagnosis is imperative to prevent any delays in appropriate therapy. Diagnosis in our case was aided by concurrent identification of B-ALL in the patient's peripheral blood. Since this information may not always be available, it is important to keep B-ALL in the differential any time there is a neoplastic infiltration of leukocytes in the dermis.