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Anaplastic large cell lymphoma

Anaplastic large-cell lymphoma (ALCL) is an uncommon type of T-cell lymphoma first reported by Stein et al 1) It is characterized by large pleomorphic CD30 (Ki-1)-expressing lymphoid blasts containing horseshoe-shaped nuclei 2).

Classification

Currently, the fourth edition of the WHO classification of tumors of hematopoietic and lymphoid tissues, published in 2008, divides systemic Anaplastic large cell lymphomas into two entities: anaplastic lymphoma kinase (ALK)-positive and ALK-negative.

Outcome

Some cases lack ALK translocation correlated with a more unfavorable prognosis 3).

see also Primary central nervous system ALK-positive anaplastic large cell lymphoma

see also Primary central nervous system ALK-negative anaplastic large cell lymphoma

Case reports

A case of ALCL-ALK(-) that presented as a progressive, enlarged, swollen mass on the scalp after an acute head injury in an 84-year-old man. Neither palpable lymph nodes nor any B symptoms were noted at admission. Brain computed tomography showed a hematoma in the right posterior occipital region of the scalp as the only remarkable finding. Debridement and biopsy were performed. Histologic and immunohistochemical analysis of the specimen revealed an ALCL-ALK(-) of the scalp. The lymphoma was resistant to bendamustine-containing chemotherapies, ultimately leading to the patient's death within 2 months.

This case report highlights the importance of recognizing the possibility of an ALCL presenting as a focal inflammatory swelling mass on the scalp 4).

1)
Stein H, Mason DY, Gerdes J, O'Connor N, Wainscoat J, Pallesen G, Gatter K, Falini B, Delsol G, Lemke H, et al. The expression of the Hodgkin's disease-associated antigen Ki-1 in reactive and neoplastic lymphoid tissue: evidence that Reed-Sternberg cells and histiocytic malignancies are derived from activated lymphoid cells. Blood. 1985 Oct;66(4):848-58. PMID: 3876124.
2)
affe ES, Harris NL, Stein H, Vardiman JW. Anaplastic large cell lymphoma. In: Jaffe ES, Harris NL, Stein H, Vardiman JW, et al., editors. Pathology and Genetics: Tumors of Haematopoietic and Lymphoid Tissues. IARC Press; Lyon: 2001. pp. 230–235.
3)
Sugino T, Mikami T, Akiyama Y, Wanibuchi M, Hasegawa T, Mikuni N. Primary central nervous system anaplastic large-cell lymphoma mimicking lymphomatosis cerebri. Brain Tumor Pathol. 2013 Jan;30(1):61-5. doi: 10.1007/s10014-012-0094-0. Epub 2012 Mar 18. PubMed PMID: 22426596.
4)
Yeung CY, Hong KT, Chiang CP, Chen YH, Ma HI, Tsai TH. ALK-negative anaplastic large-cell lymphoma presenting as a scalp hematoma after an acute head injury-A case report and literature review. World Neurosurg. 2015 Nov 23. pii: S1878-8750(15)01540-5. doi: 10.1016/j.wneu.2015.11.020. [Epub ahead of print] PubMed PMID: 26615790.