Anaplastic large cell lymphoma

From Libre Pathology
Jump to navigation Jump to search

Anaplastic large cell lymphoma, abbreviated ALCL, is an uncommon large cell lymphoma.

Anaplastic large cell lymphoma
Diagnosis in short

Anaplastic large cell lymphoma. H&E stain.

LM large cells with eosinophilic cytoplasm, Hallmark cells ("horseshoe-shaped or donut-shaped nucleus + eosinophilic paranuclear region")
LM DDx Hodgkin's lymphoma, poorly differentiated carcinoma
IHC CD30 +ve, ALK-1 -ve/+ve, CD45 +ve, CD4 +ve, CD3 -ve/+ve, CD7 -ve/+ve, EMA +ve
Molecular t(2,5)(p23;q35)
Site skin, lymph node, other

Prevalence uncommon
Prognosis good to poor, dependent on ALK status and site

General

  • May look a lot like a carcinoma.
    • Often subcapsular in LNs.
  • Usually T-cell derived.
  • May be isolated to the skin - good prognosis.

Subtypes:

  • Systemic ALCL.
  • Cutaneous ALCL -- ALK -ve.

ALK IHC - systemic form:

  • +ve = good prognosis.
  • -ve = bad prognosis.

Microscopic

Features:

  • Large cells with eosinophilic cytoplasm.
  • Usually appear cohesive.
  • May be subcapsular in a lymph node and mimic a carcinoma.
  • Hallmark cells = "horseshoe-shaped or donut-shaped nucleus + eosinophilic paranuclear region"[1][2] - key feature.
    • The donut-shaped version is also known as a "wreath cell"[3] - large (multi-nucleated) cells with (morphologically) one toroidal-shaped nucleus.

DDx:

Images

www:

IHC

Features:

  • CD30 +ve.
  • ALK-1 -ve/+ve; strongly supports ALCL Dx if +ve.
  • CD45 +ve.
  • CD4 +ve.
  • CD3 -ve/+ve.
  • CD7 -ve/+ve.
  • EMA +ve.

Molecular

  • t(2,5)(p23;q35)[4] - can be detected with FISH break apart probe.

See also

References

  1. Rapkiewicz, A.; Wen, H.; Sen, F.; Das, K. (Dec 2007). "Cytomorphologic examination of anaplastic large cell lymphoma by fine-needle aspiration cytology.". Cancer 111 (6): 499-507. doi:10.1002/cncr.23120. PMID 17941004. http://onlinelibrary.wiley.com/doi/10.1002/cncr.23120/full.
  2. Ponzoni, M.; Terreni, MR.; Ciceri, F.; Ferreri, AJ.; Gerevini, S.; Anzalone, N.; Valle, M.; Pizzolito, S. et al. (Nov 2002). "Primary brain CD30+ ALK1+ anaplastic large cell lymphoma ('ALKoma'): the first case with a combination of 'not common' variants.". Ann Oncol 13 (11): 1827-32. PMID 12419758.
  3. Amin, HM.; Lai, R. (Oct 2007). "Pathobiology of ALK+ anaplastic large-cell lymphoma.". Blood 110 (7): 2259-67. doi:10.1182/blood-2007-04-060715. PMID 17519389. http://bloodjournal.hematologylibrary.org/content/110/7/2259.full.html.
  4. Lamant L, Meggetto F, al Saati T, et al. (January 1996). "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". Blood 87 (1): 284–91. PMID 8547653.