CLL-055 Simultaneous Diagnosis of Anaplastic Large Cell Lymphoma ALK-Negative and Chronic Lymphocytic Leukemia: A Case Report

• Published in: Clinical lymphoma, myeloma and leukemia myeloma and leukemia, 2024-09, Vol.24, p.S341-S342
• Main Authors: Salcedo, Andrés Bonilla, Ramirez, Alejandro, Barboza, Thaimy, Carballo, Adrian
• Format: Article
• Language: English
• Subjects: anaplastic lymphoma; chronic lymphocytic leukemia; CLL; leukemia; T lymphoma
• ISSN: 2152-2650
• DOI: 10.1016/S2152-2650(24)01257-6

Chronic lymphocytic leukemia (CLL) is a chronic lymphoproliferative disorder typically seen in the fifth decade of life, characterized by an indolent course and prolonged survival. Occasionally, CLL may coexist with other lymphomas, such as anaplastic large cell lymphoma (ALCL), albeit rarely. Some studies have proposed theories suggesting a common clonal origin and similar evolutionary course between CLL and ALCL; however, there is currently no established treatment guideline or optimal therapeutic approach. We present the case of an 81-year-old woman with synchronous ALCL and CLL diagnosed simultaneously in breast and lymph node biopsies. The lymph node biopsy from the cervical region exhibited diffuse effacement of architecture composed of small lymphocytes with clustered chromatin, inconspicuous nucleoli, and scant cytoplasm, consistent with CLL expressing CD20, CD5, CD23, and LEF1. Conversely, the mammary lesion revealed the presence of large cells with hyperchromatic nuclei and moderate cytoplasm, expressing CD45, CD43, CD4, CD30, EMA, granzyme B, and TIA-1, and negative for ALK, indicative of ALK-negative ALCL. Progression from CLL to high-grade lymphoma was ruled out due to negativity for CD20, as well as undifferentiated breast carcinoma (negative for CKAE1/AE3). This case is noteworthy as the first reported in Latin America, although similar experiences have been documented mainly in Asian and Oceanian populations, with only 2 reported cases of simultaneous diagnosis. Analysis of this small series supports the theory of a possible common clonal origin. However, emphasis is placed on the importance of morphologic diagnosis and this association in guiding medical decisions, as there is currently no recognized standard treatment approach. Further studies are warranted to define the optimal treatment regimen.