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Difference between revisions of "Anaplastic large cell lymphoma"
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Anaplastic large cell lymphoma (view source)
Revision as of 19:00, 29 September 2023
, 19:00, 29 September 2023additional features
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| Caption = Anaplastic large cell lymphoma. [[H&E stain]]. | | Caption = Anaplastic large cell lymphoma. [[H&E stain]]. | ||
| Synonyms = | | Synonyms = | ||
| Micro = | | Micro = large cells with eosinophilic cytoplasm, Hallmark cells ("horseshoe-shaped or donut-shaped nucleus + eosinophilic paranuclear region") | ||
| Subtypes = | | Subtypes = | ||
| LMDDx = [[Hodgkin's lymphoma]], poorly differentiated [[carcinoma]] | | LMDDx = [[Hodgkin's lymphoma]], poorly differentiated [[carcinoma]] | ||
| Line 43: | Line 43: | ||
ALK IHC - systemic form: | ALK IHC - systemic form: | ||
* +ve = good prognosis | * +ve = good prognosis (generally a disease of children, teenagers and young adults) | ||
* -ve = bad prognosis | * -ve = bad prognosis | ||
==Microscopic== | ==Microscopic== | ||
| Line 51: | Line 51: | ||
*Usually appear cohesive. | *Usually appear cohesive. | ||
*May be subcapsular in a [[lymph node]] and mimic a carcinoma. | *May be subcapsular in a [[lymph node]] and mimic a carcinoma. | ||
*''Hallmark cells'' = "horseshoe-shaped or donut-shaped nucleus + eosinophilic paranuclear region"<ref name=pmid17941004>{{Cite journal | last1 = Rapkiewicz | first1 = A. | last2 = Wen | first2 = H. | last3 = Sen | first3 = F. | last4 = Das | first4 = K. | title = Cytomorphologic examination of anaplastic large cell lymphoma by fine-needle aspiration cytology. | journal = Cancer | volume = 111 | issue = 6 | pages = 499-507 | month = Dec | year = 2007 | doi = 10.1002/cncr.23120 | PMID = 17941004 | url=http://onlinelibrary.wiley.com/doi/10.1002/cncr.23120/full}}</ref><ref name=pmid12419758>{{Cite journal | last1 = Ponzoni | first1 = M. | last2 = Terreni | first2 = MR. | last3 = Ciceri | first3 = F. | last4 = Ferreri | first4 = AJ. | last5 = Gerevini | first5 = S. | last6 = Anzalone | first6 = N. | last7 = Valle | first7 = M. | last8 = Pizzolito | first8 = S. | last9 = Arrigoni | first9 = G. | title = Primary brain CD30+ ALK1+ anaplastic large cell lymphoma ('ALKoma'): the first case with a combination of 'not common' variants. | journal = Ann Oncol | volume = 13 | issue = 11 | pages = 1827-32 | month = Nov | year = 2002 | doi = | PMID = 12419758 }}</ref> - '''key feature'''. | *''Hallmark cells'' = "horseshoe-shaped or [[donut cell|donut-shaped nucleus]] + eosinophilic paranuclear region"<ref name=pmid17941004>{{Cite journal | last1 = Rapkiewicz | first1 = A. | last2 = Wen | first2 = H. | last3 = Sen | first3 = F. | last4 = Das | first4 = K. | title = Cytomorphologic examination of anaplastic large cell lymphoma by fine-needle aspiration cytology. | journal = Cancer | volume = 111 | issue = 6 | pages = 499-507 | month = Dec | year = 2007 | doi = 10.1002/cncr.23120 | PMID = 17941004 | url=http://onlinelibrary.wiley.com/doi/10.1002/cncr.23120/full}}</ref><ref name=pmid12419758>{{Cite journal | last1 = Ponzoni | first1 = M. | last2 = Terreni | first2 = MR. | last3 = Ciceri | first3 = F. | last4 = Ferreri | first4 = AJ. | last5 = Gerevini | first5 = S. | last6 = Anzalone | first6 = N. | last7 = Valle | first7 = M. | last8 = Pizzolito | first8 = S. | last9 = Arrigoni | first9 = G. | title = Primary brain CD30+ ALK1+ anaplastic large cell lymphoma ('ALKoma'): the first case with a combination of 'not common' variants. | journal = Ann Oncol | volume = 13 | issue = 11 | pages = 1827-32 | month = Nov | year = 2002 | doi = | PMID = 12419758 }}</ref> - '''key feature'''. | ||
**The donut-shaped version is also known as a "wreath cell"<ref>{{Cite journal | last1 = Amin | first1 = HM. | last2 = Lai | first2 = R. | title = Pathobiology of ALK+ anaplastic large-cell lymphoma. | journal = Blood | volume = 110 | issue = 7 | pages = 2259-67 | month = Oct | year = 2007 | doi = 10.1182/blood-2007-04-060715 | PMID = 17519389 | url=http://bloodjournal.hematologylibrary.org/content/110/7/2259.full.html}}</ref> - large (multi-nucleated) cells with (morphologically) one toroidal-shaped nucleus. | **The donut-shaped version is also known as a "wreath cell"<ref>{{Cite journal | last1 = Amin | first1 = HM. | last2 = Lai | first2 = R. | title = Pathobiology of ALK+ anaplastic large-cell lymphoma. | journal = Blood | volume = 110 | issue = 7 | pages = 2259-67 | month = Oct | year = 2007 | doi = 10.1182/blood-2007-04-060715 | PMID = 17519389 | url=http://bloodjournal.hematologylibrary.org/content/110/7/2259.full.html}}</ref> - large (multi-nucleated) cells with (morphologically) one toroidal-shaped nucleus. | ||
*ALK+ ALCL includes variants without the classical hallmark cells, e.g. small cell variant and lymphohistiocytic variant | |||
DDx: | DDx: | ||
*[[Hodgkin's lymphoma]]. | *[[Hodgkin's lymphoma]] | ||
*Carcinoma | *Anaplastic variants of other haematolymphoid malignancies, e.g. DLBCL or myeloma | ||
*Carcinoma | |||
*Melanoma | |||
===Images=== | ===Images=== | ||
<gallery> | <gallery> | ||
Image: Anaplastic large cell lymphoma - high mag.jpg | ALCL - high mag. (WC) | |||
Image:Anaplastic_large_cell_lymphoma_-_very_high_mag.jpg | ALCL - very high mag. (WC) | Image:Anaplastic_large_cell_lymphoma_-_very_high_mag.jpg | ALCL - very high mag. (WC) | ||
Image:Anaplastic_large_cell_lymphoma_-_cropped_-_very_high_mag.jpg | ALCL - cropped - very high mag. (WC) | Image:Anaplastic_large_cell_lymphoma_-_cropped_-_very_high_mag.jpg | ALCL - cropped - very high mag. (WC) | ||
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==IHC== | ==IHC== | ||
Features: | Features: | ||
*CD30 +ve | *CD30 +ve (usually strong and diffuse) | ||
*ALK-1 -ve/+ve; strongly supports ALCL Dx if +ve. | *ALK-1 -ve/+ve; strongly supports ALCL Dx if +ve. | ||
*CD45 +ve. | *CD45 +ve. | ||
| Line 76: | Line 80: | ||
*CD7 -ve/+ve. | *CD7 -ve/+ve. | ||
*EMA +ve. | *EMA +ve. | ||
*Cytotoxic markers (e.g. TIA, perforin) | |||
==Molecular== | ==Molecular== | ||
*t(2,5)(p23;q35)<ref name=pmid8547653>{{cite journal |author=Lamant L, Meggetto F, al Saati T, ''et al.'' |title=High incidence of the t(2;5)(p23;q35) translocation in anaplastic large cell lymphoma and its lack of detection in Hodgkin's disease. Comparison of cytogenetic analysis, reverse transcriptase-polymerase chain reaction, and P-80 immunostaining |journal=Blood |volume=87 |issue=1 |pages=284–91 |year=1996 |month=January |pmid=8547653 |doi= |url=}}</ref> - | *In ALK+ ALCL, there is commonly an ALK1 rearrangement. | ||
**This may be ALK::NPM1, i.e. t(2,5)(p23;q35)<ref name=pmid8547653>{{cite journal |author=Lamant L, Meggetto F, al Saati T, ''et al.'' |title=High incidence of the t(2;5)(p23;q35) translocation in anaplastic large cell lymphoma and its lack of detection in Hodgkin's disease. Comparison of cytogenetic analysis, reverse transcriptase-polymerase chain reaction, and P-80 immunostaining |journal=Blood |volume=87 |issue=1 |pages=284–91 |year=1996 |month=January |pmid=8547653 |doi= |url=}}</ref> - combined nuclear and cytoplasmic ALK staining is a surrogate for this translocation. | |||
*Other non-NPM1 partners may occur. A ALK1 break-apart probe will detect these. | |||
==See also== | ==See also== | ||