Primary cutaneous anaplastic large cell lymphoma masquerading as large pyogenic granuloma

Bains, Anupama; Vedant, Deepak; Shanker, Vinay; Tegta, Geeta Ram

doi:10.4103/2229-5178.193896

Cited by 8 publications

(4 citation statements)

References 9 publications

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“…1,2 A rich inflammatory background of neutrophils and eosinophils can be seen in some cases, giving rise to the so-called "pyogenic" variant, where the neoplastic infiltrate can be obscured by inflammatory cells. [4][5][6][7] In 1990, Chan et al 8 reported a case of ALCL with surrounding myxoid stroma, similar to that seen in malignant mesenchymal tumors. A subsequent lymph node biopsy showed a tumor composed of markedly atypical spindle cells reminiscent of the storiform pattern of an undifferentiated pleomorphic sarcoma.…”

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confidence: 87%

“…The presence of cells with “reniform” or “semilunar” nuclei (classic “hallmark” cells) is also typical of C-ALCL and systemic anaplastic large-cell lymphoma (ALCL) 1,2. A rich inflammatory background of neutrophils and eosinophils can be seen in some cases, giving rise to the so-called “pyogenic” variant, where the neoplastic infiltrate can be obscured by inflammatory cells 4–7…”

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confidence: 99%

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Spindle-cell (Sarcomatoid) Variant of Cutaneous Anaplastic Large-cell Lymphoma (C-ALCL)

Gru

Bhagat

Subtil

et al. 2020

American Journal of Surgical Pathology

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Cutaneous anaplastic large-cell lymphoma (C-ALCL) represents one of the entities within the group of CD30-positive lymphoproliferative disorders of the skin. Most cases are ALK-negative, though isolated cases of ALK-positive C-ALCL have also been reported. By definition, the diagnosis of C-ALCL requires the expression of CD30 in >75% of the cells. Histopathologically, C-ALCL shows a dermal-based nodular and circumscribed proliferation of large pleomorphic cells with vesicular nuclei, prominent nucleoli, and eosinophilic cytoplasm, including hallmark cells. Since 1990, isolated case reports of a so-called “sarcomatoid” variant have been published in the literature. Herein, we present a series of 11 cases of spindle (sarcomatoid) C-ALCL, with comprehensive histopathologic, immunophenotypic, and molecular data. Spindle C-ALCL represents a potential mimicker of malignant mesenchymal or hematopoietic tumors in the skin and should always be considered in the differential diagnosis when assessing cutaneous pleomorphic spindle cell neoplasms.

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confidence: 87%

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confidence: 99%

Spindle-cell (Sarcomatoid) Variant of Cutaneous Anaplastic Large-cell Lymphoma (C-ALCL)

Gru

Bhagat

Subtil

et al. 2020

American Journal of Surgical Pathology

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“…These lesions are true Kaposi sarcomas, not PG [ 32 ]. Other malignancies that can mimic PC are malignant lymphomas, basal cell carcinoma, or malignant melanoma [ 33 - 35 ]. In immunocompromised patients, deep soft tissue infections like phaeohyphomycosis or bartonellosis should be considered [ 36 , 37 ].…”

Section: Differential Diagnosesmentioning

confidence: 99%

Pyogenic Granuloma – A Common Benign Vascular Tumor with Variable Clinical Presentation: New Findings and Treatment Options

Wollina¹,

Langner²,

França³

et al. 2017

Open Access Maced J Med Sci

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Pyogenic granuloma is a common benign vascular tumour occurring in all ages. Both skin and mucous membranes can be affected. Of pathogenetic importance are trauma, BRAF mutations and probably herpes virus type 1, Orf virus and/or human papilloma virus type 2. The tumour consists of capillary proliferations, venules and fibromyxoid stroma. The development of a lesion occurs in three stages and bleeding is a common symptom. The tumour can mimic various other vascular lesions, solid tumours, and soft tissue infections. In recent years, targeted tumour therapies have become the most common cause of drug-induced pyogenic granulomas. The backbone of treatment is surgical procedures including laser therapy. New developments in medical drug therapy include topical and systemic beta-adrenergic receptor antagonists timolol and propranolol. Drug therapy is an alternative for young children, ocular and periungual pyogenic granuloma.

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“…Cutaneous manifestations of ALCL have been noted in the literature to mimic dermatologic conditions such as eczema, pyoderma gangrenosum, and squamous cell carcinoma [ 17 ]. Luo et al [ 2 ] reported a case of ALK-negative ALCL presenting as Behcet's disease, with recurrent penile and oral ulcers initially treated with steroids without improvement and later diagnosed 4 weeks later with penile tissue biopsy.…”

Section: Discussionmentioning

confidence: 99%

Anaplastic Large Cell Lymphoma Presenting as Ulcerative Facial Mass: A Case Report

Knauss¹,

Glosser²,

Beran³

et al. 2022

Case Rep Oncol

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Anaplastic large cell lymphoma (ALCL) is a rare form of non-Hodgkin lymphoma (NHL) that can be aggressive with rapid speed, thus mandating a timely diagnosis to optimize treatment and deter progression. NHL classically presents with lymphadenopathy and constitutional symptoms. However, ALCL can present with nonspecific cutaneous manifestations with minimal or absent constitutional symptoms. The cutaneous involvement may resemble common dermatologic conditions, delaying diagnosis. We present a case of an aggressive cutaneous ALCL lesion mimicking facial cellulitis that rapidly progressed from a small comedone to a large, exophytic mass over the course of 1 month. Prior to presentation at our institution, the patient was previously diagnosed and treated for suspected bacterial infection with no response to therapy. Core needle biopsy of the forehead lesion confirmed the diagnosis of anaplastic lymphoma kinase-negative ALCL. Chemotherapy with brentuximab vedotin, cyclophosphamide, doxorubicin, and prednisone was planned for a total of 6–8 cycles with curative intent. By cycle 5, positron emission tomography and computed tomography demonstrated response to therapy with no enlarged or metabolically active lymph nodes appreciated. Our case report highlights the importance of developing a broad differential diagnosis for ulcerative facial masses, particularly when unresponsive to antimicrobial therapies. Lymphomas should be included in the differential diagnosis of patients with rapidly growing facial lesions.

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Primary cutaneous anaplastic large cell lymphoma masquerading as large pyogenic granuloma

Cited by 8 publications

References 9 publications

Spindle-cell (Sarcomatoid) Variant of Cutaneous Anaplastic Large-cell Lymphoma (C-ALCL)

Spindle-cell (Sarcomatoid) Variant of Cutaneous Anaplastic Large-cell Lymphoma (C-ALCL)

Pyogenic Granuloma – A Common Benign Vascular Tumor with Variable Clinical Presentation: New Findings and Treatment Options

Anaplastic Large Cell Lymphoma Presenting as Ulcerative Facial Mass: A Case Report

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