Primary Cutaneous Anaplastic Large Cell Lymphoma in a 73-year-old Filipino Male: A Diagnostic Conundrum

Authors: Juan Antonio D. Cervantes, MD, Eunice Kaye M. Rayos-Lopez, MD, Ma. Teresita G. Gabriel, MD, FPDS, Reynaldo L. Ugalde, MD, FPDS, Johannes F. Dayrit, MD, FPDS, Eduardo Calonje, MD, DipRCPath

Abstract

Introduction: Primary cutaneous anaplastic large cell lymphoma (PLACL) is a rare form of cutaneous lymphoma under the classification of CD30 positive lymphoproliferative disorders which presents histologically as large atypical lymphocytes with pleomorphic and anaplastic cytology that localizes to the dermis. Although recurrent, PCALCL usually carries a good prognosis, with 5-year survival rates ranging from 85% to 95%.

Case Summary: We report a case of a 73-year-old male who presented at our out-patient department with a 3-year and 6-month history of multifocal, gradually enlarging, erythematous nodules with dry, necrotic areas on the scalp, right auricular area, left axillary area, right forearm, and right thigh, accompanied by loss of appetite and nontender cervical, left axillary, and right inguinal lymphadenopathy. Previous skin punch biopsies and immunohistochemical stains were signed out as “suggestive” of pseudolymphoma. However, management with intralesional corticosteroid injections provided no improvement. Multiple biopsies done at our institution revealed ALK negative, a CD30+ Anaplastic Lymphoma Kinase (ALK) (-) Anaplastic Large Cell Lymphoma. Patient was referred to an oncologist, however the patient was lost to follow-up and reportedly expired due to Community Acquired Pneumonia.

Conclusion: This case highlights the importance of a thorough diagnostic assessment as recent studies show a poorer prognosis of ALK (-) cases, with overall 5-year survival rates consistently below 50%.

 

Citation

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Keywords

anaplastic large cell lymphoma, ALCL, cutaneous lymphoma, CD30, ALK

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