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Primary cutaneous anaplastic large-cell lymphoma with metastases in an 81-year-old Filipino female

Terese Monette O. Aquino, MD, Ma. Jasmin J. Jamora, MD, FPDS, Karla Angela P. Cuenca-Luchangco, MD, FPDS, Julia Erika P. Pangasinan, MD, FPDS

Abstract

Introduction:

Primary Cutaneous Anaplastic Large Cell Lymphoma (PC-ALCL) is a rare Non-Hodgkin lymphoma (NHL) representing approximately 9% of all cutaneous lymphomas. It usually manifests as a slow-growing, solitary tumor which has a tendency to regress spontaneously. However, metastasis is reported in 5-10% of cases.

Case:

Our case is an 81-year-old female with a four-month history of an enlarging nodule on the left upper back. The initial impression was a malignant cutaneous tumor. Histopathology revealed epidermotropic large atypical lymphocytes and diffuse infiltrates of hyperchromatic, pleomorphic mononuclear cells and lymphocytes. Immunohistochemistry showed CD3+, CD20-, CD30+, epithelial membrane antigen (EMA)- and anaplastic lymphoma kinase (ALK)- consistent with PC-ALCL. Metastatic work-up revealed pulmonary involvement. The patient underwent two cycles of multi-agent chemotherapy with marked improvement. However, patient declined further treatment and expired five months after the diagnosis.

Conclusion:

This case emphasizes that although PC-ALCL commonly presents with an indolent course, extracutaneous spread can occur. Prompt treatment with chemotherapy increases survival significantly with a cure rate of 92%.

References

Al-Hamadani, M., et al., Non-Hodgkin lymphoma subtype distribution, geodemographic patterns, and survival in the US: A longitudinal analysis of the National Cancer Data Base from 1998 to 2011. Am J Hematol, 2015. 90(9): p. 790- 5. Available from: http://onlinelibrary.wiley.com/doi/10.1002/ajh.24086/epdf.
Kempf, W., et al., EORTC, ISCL, and USCLC consensus recommendations for the treatment of primary cutaneous CD30-positive lymphoproliferative disorders: lymphomatoid papulosis and primary cutaneous anaplastic large-cell lymphoma. Blood, 2011. 118(15): p. 4024-35. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3204726/.
Lee, W.J., et al., Cutaneous anaplastic large-cell lymphoma (ALCL): A comparative clinical feature and survival outcome analysis of 52 cases according to primary tumor site. J Am Acad Dermatol, 2016. 74(6): p. 1135-43. Available from: http://www.jaad.org/article/S0190-9622(16)00011-6/fulltext.
Willemze, R., et al., WHO-EORTC classification for cutaneous lymphomas. Blood, 2005. 105(10): p. 3768-85. Available from: http://www.bloodjournal.org/content/105/10/3768.long?sso-checked=true.

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A translation and validation study of the Filipino version of the Psoriasis Epidemiology Screening Tool (PEST) among Filipino patients with psoriasis seen at the Rizal Medical Center

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Primary cutaneous anaplastic large-cell lymphoma with metastases in an 81-year-old Filipino female