ALK-negative primary cutaneous T-cell anaplastic large cell lymphoma, myxoid variant; masquerading as sarcoma: unveiling the diagnostic dilemma

We present a case of 50-year-old man with history of ulcerative right axillary mass for 6 months. Axillary lymphadenopathy and organomegaly were absent. Microscopic examination showed sheets of pleomorphic cells which were mitotically active. Distinctive myxoid change was seen throughout the tumor....

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Published in:BMJ case reports 2021-02, Vol.14 (2), p.e239350
Main Authors: Misra, Medha, Raghuvanshi, Shivanjali, Goel, Madhu Mati, Verma, Shailendra Prasad
Format: Article
Language:English
Subjects:
Abdomen
Anaplastic Lymphoma Kinase
Antigens
Antineoplastic Combined Chemotherapy Protocols - therapeutic use
Axilla
Biomarkers, Tumor - analysis
Biopsy
Bone marrow
Case Report
Case reports
Chemotherapy
Cytokeratin
Diagnosis, Differential
Disease
Humans
Liposarcoma
Lymphocytes
Lymphoma
Lymphoma, Large-Cell, Anaplastic - diagnosis
Lymphoma, Large-Cell, Anaplastic - drug therapy
Male
Medical diagnosis
Medical prognosis
Melanoma
Microscopy
Middle Aged
Neutrophils
Patients
Sarcoma
Sarcoma - diagnosis
Skin cancer
Skin Neoplasms - diagnosis
Skin Neoplasms - drug therapy
Supervision
Tumors
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description We present a case of 50-year-old man with history of ulcerative right axillary mass for 6 months. Axillary lymphadenopathy and organomegaly were absent. Microscopic examination showed sheets of pleomorphic cells which were mitotically active. Distinctive myxoid change was seen throughout the tumor. These cells were strongly positive for CD30 and vimentin but were negative for CD3, CD5, CD20, CD15, anaplastic lymphoma kinase protein (ALK), CD56, cytokeratin, melan A, desmin, myogenin, CD68, S100, epithelial membrane antigen and CD34. The final diagnosis of primary cutaneous ALK-negative T-cell anaplastic large cell lymphoma (PCALCL), myxoid variant was made. Work-up revealed no systemic involvement. The patient received eight cycles of cyclophosphamide, doxorubicin, vincristine, prednisone and etoposide chemotherapy with complete resolution of disease. This case report highlights that a high index of suspicion is necessary in patients of PCALCL due to varied clinical presentation, and to discuss in brief the histopathologic and immunophenotypic features of this entity along with its differential diagnosis.
doi_str_mv 10.1136/bcr-2020-239350
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Axillary lymphadenopathy and organomegaly were absent. Microscopic examination showed sheets of pleomorphic cells which were mitotically active. Distinctive myxoid change was seen throughout the tumor. These cells were strongly positive for CD30 and vimentin but were negative for CD3, CD5, CD20, CD15, anaplastic lymphoma kinase protein (ALK), CD56, cytokeratin, melan A, desmin, myogenin, CD68, S100, epithelial membrane antigen and CD34. The final diagnosis of primary cutaneous ALK-negative T-cell anaplastic large cell lymphoma (PCALCL), myxoid variant was made. Work-up revealed no systemic involvement. The patient received eight cycles of cyclophosphamide, doxorubicin, vincristine, prednisone and etoposide chemotherapy with complete resolution of disease. 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subjects Abdomen
Anaplastic Lymphoma Kinase
Antigens
Antineoplastic Combined Chemotherapy Protocols - therapeutic use
Axilla
Biomarkers, Tumor - analysis
Biopsy
Bone marrow
Case Report
Case reports
Chemotherapy
Cytokeratin
Diagnosis, Differential
Disease
Humans
Liposarcoma
Lymphocytes
Lymphoma
Lymphoma, Large-Cell, Anaplastic - diagnosis
Lymphoma, Large-Cell, Anaplastic - drug therapy
Male
Medical diagnosis
Medical prognosis
Melanoma
Microscopy
Middle Aged
Neutrophils
Patients
Sarcoma
Sarcoma - diagnosis
Skin cancer
Skin Neoplasms - diagnosis
Skin Neoplasms - drug therapy
Supervision
Tumors
title ALK-negative primary cutaneous T-cell anaplastic large cell lymphoma, myxoid variant; masquerading as sarcoma: unveiling the diagnostic dilemma
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