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LETTER TO THE EDITOR
Year : 2013  |  Volume : 6  |  Issue : 2  |  Page : 215-217  

Anaplastic large cell lymphoma involving extranodal sites and soft tissue infiltration on fine needle aspiration cytology


Department of Pathology, Mamata Medical College, Khammam. Andhra Pradesh, India

Date of Web Publication10-Apr-2013

Correspondence Address:
Srikanth M Shastry
Department of Pathology, Mamata Medical College, Khammam - 507 002, Andhra Pradesh
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0975-2870.110323

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How to cite this article:
Shastry SM, Vamshi KR, Kumar T M, Gupta S. Anaplastic large cell lymphoma involving extranodal sites and soft tissue infiltration on fine needle aspiration cytology. Med J DY Patil Univ 2013;6:215-7

How to cite this URL:
Shastry SM, Vamshi KR, Kumar T M, Gupta S. Anaplastic large cell lymphoma involving extranodal sites and soft tissue infiltration on fine needle aspiration cytology. Med J DY Patil Univ [serial online] 2013 [cited 2024 Mar 29];6:215-7. Available from: https://journals.lww.com/mjdy/pages/default.aspx/text.asp?2013/6/2/215/110323

Sir,

Lymphomas are a type of cancer that attacks the lymphatic cells in the immune system. This makes lymphoma one of the most devastating types of cancer.

Anaplastic large cell lymphoma (ALCL) was considered as a high grade non-Hodgkin's lymphoma (NHL), accounting for nearly 3% of adult and 10% of childhood NHL. ALCL is a type of lymphoma that attacks the T-cells in the immune system. It is considered as an aggressive lymphoma as it attacks quickly and devastatingly.

ALCL was first described in 1985 as Ki-1 lymphoma which was characterized by a neoplastic proliferation of lymphoid cells that were anaplastic in appearance. [1]

Here, we are presenting a case of ALCL on fine needle aspiration cytology (FNAC) involving bilateral cervical lymph nodes, extranodal sites involving hard palate in the oral cavity, and soft tissue infiltration.

A 14-year-old female came with complaints of bilateral cervical lymphadenopathy, swelling over right side of cheek, swelling over right side of neck [Figure 1]a and b, and intraoral swelling arising from hard palate [Figure 2] since 3 months. Patient also complained of fever, generalized weakness, and weight loss since 3 months. On examination, lymph nodes were of size 3 × 3 cm, firm to hard in consistency, and with restricted mobility. Swelling over cheek was of size 5 × 4 cm, firm to hard in consistency, and fixed to the underlying bone.
Figure 1: Picture showing swelling over right cheek (a), swelling of cervical lymph nodes and also swelling over neck (b)

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Figure 2: Picture showing intraoral swelling arising from hard palate

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We also noticed a swelling arising from hard palate in the oral cavity of size 2 × 2 cm, firm, red in color, and having ulcerated ends. FNAC was performed from all the sites and reported as ALCL involving extranodal sites with soft tissue infiltration.

FNAC has been utilized as an important diagnostic tool in the investigation of ALCL. [2],[3],[4] On microscopy, we found highly cellular smears comprising small lymphocytes, large lymphocytes, large cleaved cells [Figure 3]a, b, monster cells, giant cells with horseshoe-shaped nuclei, and hallmark cells [Figure 4]a, b; few Reed Sternberg (RS) like cells were also seen [Figure 5]a, b. FNAC from swelling arising from hard palate also showed few giant cells having horseshoe-shaped nuclei and RS like cells.
Figure 3: Picture showing high cellularity comprising tumor cells arranged in tight clusters (a) and in sheets, (b) (H and E, ×4 and ×10)

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Figure 4: Picture showing hallmark cells having many horseshoe-shaped nuclei and tumor cells (a) and picture showing RS like cells, (b) (H and E, ×40)

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Figure 5: Picture showing hallmark cells, tumor giant cells having horseshoe-shaped nuclei (a), RS like cells and lymphocytes, (b) (H and E, ×40)

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We reported it as ALCL involving extranodal sites along with soft tissue infiltration on FNAC. Patient was not cooperative for excision of the tumor and we could not undertake histopathology. She left against medical advice, and proper follow-up and further investigations could not be undertaken. Routine blood tests including the number, shape, size, and other features of the blood cells should be examined including any atypical cells. Liver and kidney function tests may also be performed in the blood taken.

It is very important to recognize ALCL because it is a highly treatable type of lymphoma with a good 5-year survival rate. Majority of ALCL cases have lymphadenopathy that is likely to be superficial. However, extranodal disease is an important component of ALCL and involves the Waldayer's ring, skin, lung, bone, soft tissue, respiratory and gastrointestinal tract. [5] In the present study, also we noticed ALCL involving hard palate and soft tissues.

ALCL is a high-grade lymphoma. This means that it is fast growing and usually needs treatment straight away with chemotherapy. Some people may also have stem cell treatments. Radiotherapy may be given to treat early stage disease. This lymphoma usually responds well to chemotherapy. There is a risk of recurrence, in which case further chemotherapy can be given.

A chemotherapy treatment called CHOP (cyclophos-phamide, doxorubicin, vincristine, prednisone) is often used. [6] Most patients, especially those who show (ALK) Anaplastic Large cell lymphoma Kinase on the tumor cell surface, have good response to ALCL treatment and have a fair survival rate. [6]

Lymphomas account for 2-5% of all oral malignancies and are the third most common in this site. The morphological spectrum of ALCL is wide and it may be misdiagnosed as a metastatic poorly differentiated malignant tumor on FNAC. Identification of unusual giant cells with horseshoe-shaped nuclei on FNAC helps in arriving at a diagnosis of ALCL.

The aim of presenting this case is to highlight the extranodal involvement of ALCL along with soft tissue infiltration and the role of FNAC in diagnosing ALCL.

 
  References Top

1.Stein H, Mason DY, Gerdes J, O'Connor N, Wainscoat J, Pallesen G, et al. The expression of the Hodgkin's disease associated antigen Ki-1 in reactive and neoplastic lymphoid tissue: Evidence that Reed-Sternberg cells and histiocytic malignancies are derived from activated lymphoid cells. Blood 1985;66:848-58.  Back to cited text no. 1
    
2.Shin HJ, Thorson P, Gu J, Katz RL. Detection of a subset of CD 30 + anaplastic large cell lymphoma by interphase fluorescence in situ hybridization. Diagn Cytopathol 2003;29:61-6.  Back to cited text no. 2
    
3.Rapkiewicz A, Wen H, Sen F, Das K. Cytomorphologic examination of anaplastic large cell lymphoma by fine-needle aspiration cytology. Cancer 2007;111:499-507.  Back to cited text no. 3
    
4.Das P, Iyer VK, Mathur SR, Ray R. Anaplastic large cell lymphoma: A critical evaluation of cytomorphological features in seven cases. Cytopathology 2010;21:251-8  Back to cited text no. 4
    
5.Stein H, Foss HD, Stein H, Foss HD, Dürkop H, Marafioti T, et al. CD30 (+) anaplastic large cell lymphoma: A review of its histopathologic, genetic, and clinical features. Blood 2000;96:3681-95.  Back to cited text no. 5
    
6.Schmitz N, Trumper L, Ziepert M, Nickelsen M, Ho AD, Metzner B, et al. Treatment and prognosis of mature T-cell and NK-cell lymphoma: An analysis of patients with T-cell lymphoma treated in studies of the German High-Grade Non-Hodgkin Lymphoma Study Group. Blood 2010;116:18:3418-25.  Back to cited text no. 6
    


    Figures

  [Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5]



 

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