Atypical blood and bone marrow lymphocytes in ALK-positive anaplastic T-cell lymphoma: important lessons

A 42-year-old man presented with a short history of fever, significant weight loss and bilateral neck swelling. A CT scan revealed widespread lymphadenopathy and hepatosplenomegaly. Lymph node morphology and immunohistochemistry confirmed a diagnosis of anaplastic lymphoma kinase (ALK)-positive anap...

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Bibliographic Details
Published in:BMJ case reports 2013-09, Vol.2013, p.bcr2013200982
Main Authors: Mahdi, A J, Elmusharaf, N, Osman, H, Thompson, I
Format: Article
Language:English
Subjects:
Adult
Blood platelets
Bone marrow
Bone Marrow Cells - pathology
Chemotherapy
Europe (West)
Family medical history
Fever
Humans
Lymphocytes
Lymphocytes - pathology
Lymphoma
Lymphoma, T-Cell - metabolism
Lymphoma, T-Cell - pathology
Male
Medical imaging
Medical prognosis
Morphology
Neutrophils
Receptor Protein-Tyrosine Kinases - metabolism
Stem cells
Transplants & implants
Unexpected Outcome (Positive or Negative) Including Adverse Drug Reactions
White
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Summary:A 42-year-old man presented with a short history of fever, significant weight loss and bilateral neck swelling. A CT scan revealed widespread lymphadenopathy and hepatosplenomegaly. Lymph node morphology and immunohistochemistry confirmed a diagnosis of anaplastic lymphoma kinase (ALK)-positive anaplastic T-cell non-Hodgkin's lymphoma. Both the peripheral blood (PB) and bone marrow (BM) revealed atypical lymphocytes with cleaved nuclei, vacuolation and granulation, suggestive of disease involvement at both sites. However, BM and PB immunophenotyping and immunohistochemistry did not reveal typical markers (ALK and CD30) at either site. All features resolved with a short remission after conventional chemotherapy. Despite salvage chemotherapy and an autologous stem cell transplant, a relapse of the PB and BM features with stable radiological findings was noted. Rapid decline followed with pancytopenia resulting in death 12 months after the initial diagnosis.
ISSN:1757-790X
1757-790X
DOI:10.1136/bcr-2013-200982