Anaplastic lymphoma kinase-negative anaplastic large cell lymphoma with extranodal involvement of the thigh muscle: a case report

Abstract

IntroductionAnaplastic large cell lymphoma is a rare type of non-Hodgkin lymphoma. The most common extranodal sites of anaplastic large cell lymphoma are skin, subcutaneous tissue, bone, lung, and gastrointestinal organs. The involvement of the skeletal muscle has been described rarely in extranodal anaplastic large cell lymphoma.Case presentationAn 89-year-old Japanese man visited our hospital with a three-month history of swelling of his left thigh and slight fever. The swelling had rapidly enlarged and become painful within the previous three days. Magnetic resonance imaging scans revealed two soft-tissue tumors in the intramuscular layer between the vastus medialis muscle and the adductor muscle. Extensive peritumoral inflammatory edema was obvious. As the results of physical and radiological examinations were highly suggestive of abscess formation, we prescribed antibiotics for two weeks. However, our patient’s symptoms did not improve. Therefore, we suspected a soft-tissue sarcoma, and our patient underwent an incision biopsy. Histological analysis revealed that the atypical cells were positive for CD3 and CD30 but negative for anaplastic lymphoma kinase. A computed tomography scan of the thorax revealed mediastinal lymphadenopathy and bilateral pleural effusions, suggestive of extranodal involvement of skeletal muscle in anaplastic lymphoma kinase-negative anaplastic large cell lymphoma. We planned to give our patient systemic chemotherapy. However, rapid systemic dissemination occurred and our patient died of multiple organ failure five weeks after his first visit to our hospital.ConclusionsHere, we present a case of anaplastic lymphoma kinase-negative anaplastic large cell lymphoma with extranodal involvement in the thigh muscle. The involvement of such a rare organ may lead to initial misdiagnosis and a delay in the onset of treatment.

A case of anaplastic large cell lymphoma of skeletal muscle

“…Our patient presented with severe pain and B‐symptoms (fever and night sweats), and with primary skeletal muscle CD30‐positive, ALK‐negative ALCL. The patient died 2 months after her admission, and similar survival of affected cases has been reported previously . However, some reports indicated that patients with primary skeletal muscle ALCL responded to systemic chemotherapy.…”

“…The patient died 2 months after her admission, and similar survival of affected cases has been reported previously. 5,12 However, some reports indicated that patients with primary skeletal muscle ALCL responded to systemic chemotherapy. Most of these patients had the aforementioned favorable prognostic factors (ALK-positive, young age).…”

Non-Hodgkin lymphoma of multiple extranodal involvement seen on MRI, FDG PET–CT scans

“…Unfortunately, our patient died of multiple organ failure 4 weeks after her first visit to our hospital and similar survival of such cases has been reported previously. [ 4 , 5 ]…”

“…[ 4 ] Extranodal involvement of skeletal muscles in ALCLs is extremely rare. [ 5 ] Here, we present a rare case of ALK− ALCL of multiple extranodal involvement, especially the whole body skeletal muscles, with the aim to share the imaging features of the ALCL including magnetic resonance imaging (MRI) and 18 F-fluorodeoxyglucose positron emission tomography–computed tomography ( 18 F-FDG PET–CT). Imaging findings from a review of relevant literature are presented.…”

Aggressive Disease Course of Multiple Myeloma with Concomitant ALK-Negative Anaplastic Large Cell Lymphoma: A Case Report with an Unusual Presentation

“…ALK-negative anaplastic large cell lymphoma (ALK-ALCL) is a rare CD30+ T-cell neoplasm involving both lymph nodes and extranodal sites, often presenting with B symptoms and advanced stage disease [1]. Primary involvement of the skeletal muscles is extremely rare in adults and has been associated with rapid dissemination and poor prognosis [2][3][4].…”