CD 30+ anaplastic large cell lymphoma with regional lymph node metastases in a 59-year old male

Authors: Jo Faustine Q. Manzano, MD, Maricar Pamela Lacuesta-Gutierrez, MD, FPDS

Abstract

Introduction: Cutaneous anaplastic large cell lymphoma (CALCL) has an estimated incidence of 0.1 to 0.2 per 100,000.  This condition usually occurs as localized lesions in adults with extremities, head and buttocks as most common presenting sites. It is characterized by large tumor cells, majority which express the CD30 antigen.

Case Summary: A 59 year old hypertensive and diabetic male sought consult for nine months’ history of exophytic mass on the right knee. Cutaneous examination revealed an 18cm x 14cm tumor with areas of necrosis and purulent discharge on the right knee extending to right leg and thigh. There were no palpable lymph nodes noted. Histopathologic evaluation of right knee tumor revealed dense infiltration of large, neoplastic cells. Immunohistochemical studies showed positivity for leukocyte common antigen, vimentin and CD 30 and negative pancytokeratin, CD3, CD4, CD20 and anaplastic lymphoma kinase (ALK) which confirmed our diagnosis of CD30+ cutaneous anaplastic large cell lymphoma.  Abdominal CT scan revealed involvement of inguinal and external iliac nodes thereby highly suggesting CD30+ systemic anaplastic large cell lymphoma, ALK negative which portends poorer prognosis. Despite initiation of chemotherapy with vincristine, cyclophosphamide, doxorubicin and prednisone, patient still succumbed to death.

Conclusion: Given their rarity and heterogeneity, correct classification of CD30+ lymphomas may be challenging. Immunohistochemical evaluation as well as multidisciplinary expertise and treatment approach are essential for early diagnosis and prompt management.

 

 

Citation

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Keywords

CD 30+ cutaneous anaplastic large cell lymphoma, systemic anaplastic large cell lymphoma, CD30 antigen, anaplastic lymphoma kinase

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