Nodal Alk Positive Anaplastic Large Cell Lymphoma Of The Axilla With Spontaneous Regression
Patel, P., Godwin, J., Velankar, M., & Alkan, S. (2007). Nodal ALK positive anaplastic large cell lymphoma of the axilla with spontaneous regression. Leukemia & Lymphoma, 48(6), 1250–1252. https://doi.org/10.1080/10428190701342026
View Original Source →Abstract
Anaplastic large cell lymphoma (ALCL) is a well-characterized entity of T-cell lymphomas comprising 5% of all non-Hodgkin lymphomas in adults that characteristically shows the t(2;5)(p23;q35) trans...
Case Details
Disease Location
Left axilla
Personal Characteristics
35 -year-old female
Clinical Characteristics
Recent onset of intense pain and swelling of her left arm a CT scan of the chest and mammography confirmed the presence of the left axillary lymphadenopathy, measuring approx. 10x10x10cm but demonstrated no additional findings MRI of the left brachial plexus demonstrated a mass extending from the axilla to the subclavian vessels whole body bone scan did not demonstrate any metastatic lesions, but a PET scan showed increased uptake in the thoracic and lumbar spine as well as the pelvis, liver, and left axilla, consistent with widespread metastatic disease a complete blood count at presentation showed only mild neutrophilia while the basic metabolic profile was within norms. A pre-op urinalysis demonstrated the presence of small amount of ketones and bilirubin, but was otherwise unremarkable incisional biopsy was performed for diagnosis and parts of the specimen were tested in aerobic, anaerobic, acid-fast cultures as well as histologic exam. Cultures were negative, histologic exam demonstrated an atypical lymphoid infiltrate with focal areas having a vague perivascular distribution in an edematous background several of the atypical large lymphoid cells contained eccentric, horseshoe-shaped nuclei with central areas of eosinophil within the cytoplasm and were consistent with "hallmark" cells numerous histiocytes were present in the background immunohistochemistry found the neoplastic cells were CD4+, CD30+ and CD43+ but were weakly positive for alk and granzyme b. Alk staining was positive within both the cytoplasm and nucleus of the neoplastic cells. These cells were negative for CD20, 3, 8; moreover, CD68 highlighted the neoplastic cells with granular cytoplasmic staining in addition to the benign histiocytes in the background these findings were consistent with anaplastic large cell lymphoma diagnosis fluorescent in situ hybridization (fish) analysis demonstrated the presence of the alk-1/npm rearrangement secondary to the t(2;5) translocation pcr amplification of the t-cell receptor-gamma chain gene showed a monoclonal band consistent with the diagnosis of t-cell lymphoma bone marrow biopsy during staging showed no lymphoma evidence her disease was clinically stable and no therapy was implemented
Remission Characteristics
2 months after presentation, a PET scan showed only minimal residual uptake in the left axilla with complete resolution of the lesions previously detected in the pelvis a CT scan of the chest, abdomen and pelvis showed a single prominent left axillary ln with a fatty hilum, but no other thoracic, abdominal or pelvis lymphadenopathy to be noted 2 years after original diagnosis, the patient remains free of disease
Treatment & Mechanisms
Proposed Remission Mechanisms
No major mechanisms reported
Clinical Treatment
None reported
Non-Clinical Treatment
None reported