engleski

Anaplastic Large Cell Lymphoma ALK Positive Clinical Mimicking Soft Tissue Sarcoma

Background: ALK positive anaplastic large cell lymphoma is a T cell lymphoma usually occurring in children and young adults. It frequently involves lymph nodes and extra nodal sites and is associated with favorable prognosis. Case: A 20-year old man was admitted for painful mass in the left axilla with overlying skin redness. Laboratory evaluation revealed increased levels of lactate dehydrogenase, beta-2 microglobulin and gamma-glutamyl transferase and low levels of albumin. Ultrasonography (US) and computerized tomography revealed splenomegaly and multiple enlarged left axillary lymph nodes with two large conglomerates (55 · 45 mm and 45 · 40 mm) as well as blurring of subcutaneous fat tissue. Clinical presentation and US findings were highly suspicious for sarcoma. Fine needle aspiration cytology of tumor mass (lymph node conglomerate and surrounding tissue)show predominance of large, pleomorphic, atypical cells with large nuclei and vacuolated cytoplasm. Atypical cells were positive for LCA, CD30, EMA and ALK, negative for CD15 and CD56. These findings excluded sarcoma and corroborated the diagnosis of ALK positive ALCL. NPM-ALK transcript was detected by reverse transcriptase- polymerase chain reaction (RT-PCT). Molecular analysis of TCRb and TCRc genes demonstrated clonal TCR genes rearrangement. Complex kariotype with t(2 ; 5) and multiple numerical and structural changes was found on conventional cytogenetics. Bone marrow aspirate and biopsy did not show signs of infiltration. Conclusion: Cutaneous involvement in ALCL can clinically mimic sarcoma, especially in cases with localized disease without B symptoms. In those cases, immunostaining, PCR and conventional cytogenetics are helpful to exclude sarcoma.

ALK positive ALCL

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