images in haematology
ALK-positive anaplastic large cell lymphoma with prominent bone involvement
A 40-year-old woman presented with a 4-month history of pain in her left hip and low-grade fever. On examination, she had hepatosplenomegaly but no lymphadenopathy. A full blood count showed anaemia while her other laboratory results, including liver function tests and serum lactate dehydrogenase, were normal. Computerized tomography (CT) of the neck, chest and abdomen showed lytic lesions involving the sternum, vertebrae, ribs, sacrum, ilium, pubis and ischium (left image). 18F-fluorodeoxyglucose (FDG) positron emission tomography (PET) scanning showed increased FDG uptake in the cervical vertebrae 2–7, thoracic vertebrae 1–2, lumbar vertebrae 1–5, the right side of the mandible, the sphenoid, bilateral scapulae, sternum, left clavicle, ribs, sacrum, ilium, pubis and ischium (centre left and right images, centre right image PET-CT). PET-CT also showed a FDG-avid abdominal mass, suggesting lymphadenopathy, and a mass in the left thigh suggesting a soft tissue lesion around the ischium. A diagnosis of lymphoma was considered likely. A CT-guided biopsy of the ischial lesion was performed and showed anaplastic large cell lymphoma (ALCL). Lymphoma cells were positive for ALK, CD30, EMA and ª 2015 John Wiley & Sons Ltd British Journal of Haematology, 2015, 170, 443
MUM1, and negative for CD20, CD3 and CD138. Bone marrow aspiration and trephine biopsy showed no infiltration. A diagnosis of ALK-positive ALCL with prominent bone involvement was made. She was treated with six cycles of Hyper-CVAD/MA (hyper-fractionated cyclophosphamide, vincristine, doxorubicin and dexamethasone/methotrexate and cytarabine), as well as zoledronic acid to inhibit bone destruction. Complete remission was achieved and at last follow-up, the patient was disease-free at 2 years. ALK-positive ALCL is a distinct clinicopathological entity in which lymphoma cells show expression of ALK and strong expression of CD30. ALCL sometimes involves the bone marrow and, in advanced stages, there can be destructive bone lesions. However, prominent bone involvement, as shown in this patient, is uncommon. Chen Tian, Yafei Wang and Yizhuo Zhang Department of Haematology, Key Laboratory of Cancer Prevention and Therapy, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Centre for Cancer, Tianjin, China. E-mail: [email protected]
First published online 27 May 2015 doi: 10.1111/bjh.13505
ALK-positive anaplastic large cell lymphoma with prominent bone involvement
A 40-year-old woman presented with a 4-month history of pain in her left hip and low-grade fever. On examination, she had hepatosplenomegaly but no lymphadenopathy. A full blood count showed anaemia while her other laboratory results, including liver function tests and serum lactate dehydrogenase, were normal. Computerized tomography (CT) of the neck, chest and abdomen showed lytic lesions involving the sternum, vertebrae, ribs, sacrum, ilium, pubis and ischium (left image). 18F-fluorodeoxyglucose (FDG) positron emission tomography (PET) scanning showed increased FDG uptake in the cervical vertebrae 2–7, thoracic vertebrae 1–2, lumbar vertebrae 1–5, the right side of the mandible, the sphenoid, bilateral scapulae, sternum, left clavicle, ribs, sacrum, ilium, pubis and ischium (centre left and right images, centre right image PET-CT). PET-CT also showed a FDG-avid abdominal mass, suggesting lymphadenopathy, and a mass in the left thigh suggesting a soft tissue lesion around the ischium. A diagnosis of lymphoma was considered likely. A CT-guided biopsy of the ischial lesion was performed and showed anaplastic large cell lymphoma (ALCL). Lymphoma cells were positive for ALK, CD30, EMA and ª 2015 John Wiley & Sons Ltd British Journal of Haematology, 2015, 170, 443
MUM1, and negative for CD20, CD3 and CD138. Bone marrow aspiration and trephine biopsy showed no infiltration. A diagnosis of ALK-positive ALCL with prominent bone involvement was made. She was treated with six cycles of Hyper-CVAD/MA (hyper-fractionated cyclophosphamide, vincristine, doxorubicin and dexamethasone/methotrexate and cytarabine), as well as zoledronic acid to inhibit bone destruction. Complete remission was achieved and at last follow-up, the patient was disease-free at 2 years. ALK-positive ALCL is a distinct clinicopathological entity in which lymphoma cells show expression of ALK and strong expression of CD30. ALCL sometimes involves the bone marrow and, in advanced stages, there can be destructive bone lesions. However, prominent bone involvement, as shown in this patient, is uncommon. Chen Tian, Yafei Wang and Yizhuo Zhang Department of Haematology, Key Laboratory of Cancer Prevention and Therapy, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Centre for Cancer, Tianjin, China. E-mail: [email protected]
First published online 27 May 2015 doi: 10.1111/bjh.13505
