肉瘤样型间变性大细胞淋巴瘤临床病理特征

目的探讨肉瘤样型间变性大细胞淋巴瘤(sALCL)临床病理特点、免疫表型及分子遗传学特征。方法对1例sALCL的临床、病理组织学、免疫表型及免疫球蛋白重链(IgH)和T细胞受体(TCR)基因克隆性重排情况进行观察并复习相关文献。结果眼观:送检淋巴结1枚,1.5cm×1.0cm×1.0cm,切面呈鱼肉状。镜检:淋巴结基本结构几乎完全被破坏,异型的梭形和上皮样细胞弥漫增生。免疫表型:瘤细胞呈CD30、ALK1、EMA、CD45RO、CD45、TIA1、granzymeB、perforin、CD68(部分)、SMA(梭形成分)阳性。基因重排:TCRβ1克隆性重排。结论sALCL属罕见恶性肿瘤,其形态不典型,易误诊为其他恶性肿瘤,免疫表型和遗传学异常有助于其诊断和鉴别诊断。     

Anaplastic lymphoma kinase-positive diffuse large B-cell lymphoma presenting in nasal cavity: a case report and review of literature

Anaplastic lymphoma kinase (ALK)-positive diffuse large B-cell lymphoma (DLBCL) is a rare subtype of non-Hodgkin’s lymphoma (NHL) with distinct morphologic and immunohistochemical features. We reported a 57-year-old female with ALK-positive DLBCL in her left nasal cavity. Histologically, the tumor cells were characterized by plasmablastic morphology and tested positive for ALK in a cytoplasmic granular staining pattern. The neoplastic cells were positive for CD38, CD4, MUM1, CD138 and Vimentin. However, they failed to express CD56, CD30, as well as mature B cells markers, such as CD79a, CD20 and T cells markers such as CD2, CD3, CD5, CD7 and CD8. The patient achieved complete response after four cycles of CHOEP (cyclophosphamide, doxorubicin, vincristine, prednisone, and etoposide) treatment. Then she received radiotherapy of the originally involved area. This case represented a rare ALK-positive DLBCL in the nasal region.     

Anaplastic large cell lymphoma involving the urinary bladder: A case report and review of the literature

T cell‐derived malignant lymphoma is rarely detected as a bladder neoplasm. A literature review for anaplastic large cell lymphoma (ALCL) involving urinary bladder reveals only seven previously reported cases. Here, we report a case of a 59‐year‐old HIV‐negative man with ALK‐positive ALCL. He presented an unusual clinical course with initial consideration of adult onset Still's Disease (AOSD) due to his negative results searching for malignancy and infectious diseases. He rapidly developed macrophage activation (hemophagocytic) syndrome and experienced an unusual rapid disease progression and died in 39 days after onset of symptoms. Compared to previously reported cases, the current case of ALK‐1‐positive ALCL is a rare case with an unusual presentation. From this case, we learned that ALCL is one malignancy that should be considered and screened in patients with suspected AOSD. Also, T‐cell lymphoma associated hemophagocytic syndrome should be considered in a patient with sustained corticosteroid‐resistant spike fever, high serum ferritin, and rapid exacerbation of the disease course. Diagn. Cytopathol. 2015;43:60–65. © 2014 Wiley Periodicals, Inc.     

Anaplastic lymphoma kinase-positive diffuse large B-cell lymphoma presenting as an isolated nasopharyngeal mass: a case report and review of literature

Anaplastic lymphoma kinase (ALK)-positive diffuse large B-cell lymphoma is a rare and distinct variant of diffuse large B-cell lymphoma with characteristic morphologic, immunophenotypic, and cytogenetic features. We report a case of ALK-positive diffuse large B-cell lymphoma in a 44-year-old male with progressively worsening unilateral nasal congestion and obstruction secondary to a nasopharyngeal mass. Radiologically, the mass was showed to extend to orophanrynx from nasopharynx. Histologically, the tumor cells exhibited plasmablastic morphology with expression of Bob-1, CD4, CD10, CD45, CD56, CD138, EMA, MUM1, Oct-2, and kappa immunoglobulin light chain, but negative for CD20, CD30, CD79a, PAX-5, and lambda. More importantly, the neoplastic cells showed positive immunoreactivity for ALK with exclusive cytoplasmic granular staining pattern. This case represented the second reported ALK-positive diffuse large B-cell lymphoma in the nasopharyngeal region.     

血管内淋巴瘤

目的：探讨血管内淋巴瘤的临床病理特征。方法：对1例血管内淋巴瘤进行免疫表型分析及原位杂交检测与EB病毒的关系,并文献复习,结果：女性,48岁,不明原因发热伴体重下降3个月,CT扫描示子宫肿块而行子宫加双侧附件切除,病理学检查发现瘤细胞位于血管内,伴少许管周浸润,瘤细胞免疫表型CD45（LCA）和CD20（L26）呈阳性表达,原位杂交显示E－BERs阴性,患者经CHOP联合化疗后获得完全缓解,结论：血管内淋巴瘤是一种极罕见的B细胞肿瘤,此瘤的诊断只能依赖病理学检查,治疗上应予以积极联合化疗。     

Anaplastic large cell lymphoma arising in a silicone breast implant capsule: a case report and review of the literature

Anaplastic large cell lymphoma is a rare type of primary breast lymphoma. We report a case of anaplastic large cell lymphoma, T-cell phenotype, occurring in the periprosthetic capsule of a silicone breast prosthesis 9 years after implantation for augmentation mammoplasty. This case is unique for its unusual presentation.     

Anaplastic lymphoma kinase (ALK 1) staining and molecular analysis in inflammatory myofibroblastic tumours of the bladder: a preliminary clinicopathological study of nine cases and review of the literature.

Inflammatory myofibroblastic tumours (IMFT) may arise at any anatomical site, including lung, soft tissues, retroperitoneum and bladder. Although morphologically similar, these lesions encompass a spectrum of entities with differing aetiology, ranging from reactive/regenerative proliferations to low-grade neoplasms with a risk of local recurrence, but no significant metastatic potential. Vesical IMFT usually presents as a polypoid mass with a pale firm cut surface and can be of considerable size, mimicking a malignant tumour clinically and radiologically. Its good outcome, however, warrants conservative surgical excision, emphasising the importance of identification and distinction from malignant tumours of the bladder that may require more radical surgery and/or adjuvant therapy. We conducted a preliminary retrospective, comparative immunocytochemical study of 20 bladder tumours, including nine IMFTs, five spindle cell (sarcomatoid) carcinomas, two rhabdomyosarcomas, two leiomyosarcomas and two neurofibromas. The results confirmed IMFT positivity for smooth muscle actin, desmin and cytokeratin in 78-89% cases, resulting in potential confusion with sarcomatoid carcinoma or leiomyosarcoma. In contrast, cytoplasmic anaplastic lymphoma kinase (ALK 1) staining was present in eight IMFT (89%), but was not seen in any other lesion examined. The ALK 1 staining was confirmed by fluorescence in situ hybridisation, with translocation of the ALK gene present in 15-60% tumour cells in four of six IMFT examined, but not in four cases of sarcomatoid carcinoma or three of leiomyosarcoma. In conclusion, ALK 1 staining may be of value in the distinction of vesical IMFT from morphologically similar entities, and often reflects ALK gene translocations in these lesions.     

Fine needle aspiration cytology of ALK 1(−), CD 30(+) anaplastic large cell lymphoma post renal transplantation: A case report and literature review

Post transplant lymphoproliferative disorders (PTLD) complicates the course of 0.3 to 3% of renal transplant patients receiving immunosuppression. 1 , 2 Epstein‐Barr Virus (EBV) related Non‐Hodgkin's Lymphomas of B‐cell type is more common than those of T‐cell origin. 1 CD30 positive Anaplastic Large Cell Lymphoma (ALCL) is a Non‐Hodgkin's lymphoma (B or T cell type) that accounts for a small percentage of PTLD's. ALCL of T‐cell type are a spectrum of disease ranging from primary cutaneous to systemic nodal ALCL. The systemic nodal ALCL is further subdivided into anaplastic lymphoma kinase‐1 (ALK‐1) positive or negative. 3 ALK‐1 protein is a gene fusion product of translocation (2;5) and carries prognostic implications. 4 - 6 We present an unusual manifestation of ALK‐1 negative CD30 positive ALCL in a post renal transplant patient in FNA cytology with all supportive adjuvant studies and differential diagnoses and review the cytology literature on this topic. Diagn. Cytopathol. 2010. © 2009 Wiley‐Liss, Inc.     

Primary lymphoma of the heart: case report and literature review

Primary cardiac lymphoma (PCL) is a rare and usually fatal neoplasma. A case of PCL in a 78-year-old man who complained of exertional dyspnea and peripheral edema is presented. Echocardiography revealed a mass in the right atrium and a diagnosis of low-grade B-cell lymphoma was obtained with the surgically resected tumor. The lesion appeared to have originated in the right atrium and involved the right ventricle. The patient died of bronchopneumonia 8 months after the initial consultation. The present case and 39 patients with PCL reported between 1995 and 2002 were reviewed. Forty patients showed various and non-specific symptoms such as dyspnea, edema, arrhythmia and pericardial effusion. Primary cardiac lymphoma occurred slightly more often in male patients (M : F = 23:17) and in the elderly in general (mean age, 67 years), with lesions found in the following locations, listed in order of frequency: right atrium, pericardium, right ventricle, left atrium, left ventricle, and other sites. Antemortem diagnosis was obtained in 37 of the 40 patients. Thirty-seven cases were of B-cell lineage and two cases were of T-cell lineage. Complete remission was obtained in only 15 of the 40 patients. Although PCL antemortem diagnoses have been made in the majority of recent cases, the prognosis still remains poor.     

Nodular pulmonary amyloidosis following liver transplantation: report of a case and review of the literature

Nodular pulmonary lesions seen in liver transplant recipients have a broad differential diagnosis including both infectious and noninfectious etiologies. Here, we report the first case of nodular pulmonary amyloidosis, an uncommon and benign localized form of amyloidosis occurring after orthotopic liver transplantation for end-stage primary biliary cirrhosis.     

Timely topic: anaplastic lymphoma kinase (ALK) spreads its influence

Anaplastic lymphoma kinase (ALK) is normally not expressed in human tissues except selected sites in the nervous system. Its expression and constitutive activation as a result of a chromosomal translocation involving 2p23 plays a pivotal role in the genesis of anaplastic large cell lymphoma. ALK expression has been instrumental in defining a homogeneous subset from the category of anaplastic large cell lymphoma, characterised by occurrence in young patients, primary systemic presentation, favorable prognosis, a broad morphological spectrum, nuclear and/or cytoplasmic immunostaining for ALK protein, and a number of possible fusion partner genes such as NPM, ATIC, TFG, TPM3 and CLTCL. Recently ALK has been implicated in the genesis of another tumour type, the inflammatory myofibroblastic tumours. The ALK-positive examples occur in children and young adults, involving a variety of sites, such as the abdomen, mesentery, liver, bladder, mediastinum, lung and bone. The partner genes identified in some cases are TPM3 (tropomyosin 3) and TPM4 (tropomyosin 4). These molecular findings also further support the neoplastic nature of at least a subset of inflammatory myofibroblastic tumours.     

Clinicopathologic and genetic features of anaplastic lymphoma kinase (ALK)-positive diffuse large B-cell lymphoma:report of 3 cases

目的 探讨间变性淋巴瘤激酶(anaplastic lymphoma kinase,ALK)阳性的弥漫性大B细胞淋巴瘤(diffuse large B-cell lymphoma,DLBCL)的临床病理及分子遗传学特点.方法 对3例ALK(+) DLBCL进行光镜观察、免疫组化及荧光原位杂交检测,并复习相关文献.结果 镜下观察淋巴结结构破坏,可见淋巴窦侵犯,肿瘤细胞大,呈免疫母细胞样,免疫组化示肿瘤细胞ALK、Bob-1、CD4、CD10、CD45、CD56、CD138、EMA、MUM1、Oct-2均(+),CD20、CD79a、PAX-5、CD3和CD30均(-),3例荧光原位杂交均检测到ALK基因易位.结论 ALK(+) DLBCL是一种DLBCL的少见独立亚型,具有特征性免疫表型、形态学及分子遗传学特点.     

ALK阳性大B细胞淋巴瘤3例临床病理及分子遗传学分析

目的探讨间变性淋巴瘤激酶(anaplastic lymphoma kinase,ALK)阳性的弥漫性大B细胞淋巴瘤(diffuse large B-cell lym-phoma,DLBCL)的临床病理及分子遗传学特点。方法对3例ALK(+)DLBCL进行光镜观察、免疫组化及荧光原位杂交检测,并复习相关文献。结果镜下观察淋巴结结构破坏,可见淋巴窦侵犯,肿瘤细胞大,呈免疫母细胞样,免疫组化示肿瘤细胞ALK、Bob-1、CD4、CD10、CD45、CD56、CD138、EMA、MUM1、Oct-2均(+),CD20、CD79a、PAX-5、CD3和CD30均(-),3例荧光原位杂交均检测到ALK基因易位。结论 ALK(+)DLBCL是一种DLBCL的少见独立亚型,具有特征性免疫表型、形态学及分子遗传学特点。     

Extra-oral plasmablastic lymphoma: report of a case and review of literature

Plasmablastic lymphoma (PBL) of the oral cavity is classified as one subtype of diffuse large B-cell lymphoma that is most commonly seen in patients with human immunodeficiency virus infection. We report a rare case of PBL in the anal canal of a 33-year-old man with human immunodeficiency virus infection. The lymphoma cells were positive for CD138 and weakly positive for CD79a. In addition, these cells were also positive for CD10. The neoplastic cells were positive for Epstein-Barr virus and negative for human herpes virus 8. Review of the English medical literature revealed many more cases of extra-oral PBL. We propose that the term plasmablastic lymphoma of the oral cavity in World Health Organization classification be revised to simply plasmablastic lymphoma, which would include both oral and extra-oral PBLs, and the term to define the primary site of the lymphoma (ie, oral cavity) be dropped from the terminology used in World Health Organization classification.     

肾脏原发性淋巴瘤临床病理分析

目的 :对肾脏原发性淋巴瘤的临床病理特点、组织学起源、诊断及鉴别诊断等进行初步探讨。方法 :对 1例手术切除的肾脏原发性淋巴瘤标本做HE染色和S P免疫组化染色 ,光镜观察。结果 :左肾脏上极见一 7 5cm× 6cm× 4cm界限不清的肿块。镜下见在肾实质内有弥漫大片淋巴瘤细胞浸润。瘤细胞核呈略不规则形 ,染色质呈凝块状。免疫表型肿瘤细胞表达LCA、L2 6、IgA弥漫阳性。病理诊断为弥漫小核裂细胞型。 结论 :肾脏原发性淋巴瘤甚为罕见。结合文献 ,其主要诊断依据为 :①肾脏内有弥漫大片形态一致的淋巴瘤细胞浸润 ;②肿瘤主要位于肾脏实质内 ,肾包膜及其周围脂肪组织内亦可见瘤细胞浸润 ;③患者浅表淋巴结不肿大 ,CT检查未见胸、腹腔内有肿大的淋巴结 ;④骨髓穿刺涂片和活检未见异常细胞。⑤发现肾脏淋巴瘤至少 3月后未发现其它部位的淋巴瘤。发生于肾脏的淋巴瘤应与肾脏的肉瘤样癌、Wilm瘤、慢性炎症等相鉴别。其主要治疗方法为肾切除加化疗和 (或 )放疗。     

Primary hepatic mucosa-associated lymphoid tissue lymphoma: case report and literature review

Background: The prevalence of primary hepatic mucosa-associated lymphoid tissue (MALT) lymphomas is extremely low. Here, we describe a case of this disease misdiagnosed as hepatocellular carcinoma (HCC) and review relevant literature to prevent future misdiagnoses. Case presentation: a 58-year-old woman complained about abdominal pain for more than four months. About two months prior, she came to our hospital with elevated levels of HBV DNA and positive HBsAg and HBcAb. After two months of entecavir treatment, HBV DNA decreased to a normal level. She returned to the hospital with worsened abdominal pain for over a month. Magnetic resonance imaging and systemic positron emission tomography-computed tomography identified two nodes in the liver, and she was diagnosed with HCC. The patient then underwent a laparoscopic hepatectomy. Microscopic examination showed a diffuse infiltrate of small-to-medium-sized lymphocytes and lymphoepithelial lesions. Immunohistochemical staining showed that most of the lymphoid cells were strongly positive for CD20, CD79a, BCL2, IgM and weakly positive for IgD, while negative for CD3, CD10, BCL6, MUM1, CD43, CD5, cyclin D1, CD23, CD30, and PD1. The Ki-67 index of lymphoid cells was 5%. Further pathologic analysis confirmed the diagnosis of primary hepatic MALT lymphoma. The patient received antiviral treatment and recovered well with no sign of relapse for 17 months. Conclusions: Primary hepatic MALT lymphoma is an uncommon disease that is difficult to diagnose and has no widely accepted treatment. Surgical resection is a good choice for both diagnosis and local therapy, and strict follow-up of the patient is essential.     

Ciprofloxacin-induced acute liver injury: case report and review of literature

Ciprofloxacin is a fluorinated quinolone antibiotic with relatively low occurrence of adverse side effects. However, increasing evidence suggests that ciprofloxacin may cause severe liver damage. Until now, 14 cases of ciprofloxacin-associated liver injuries have been reported. We describe a case of a 22-year-old male who developed hepatic failure after intake of ciprofloxacin. The patient had been treated with 2×250 mg ciprofloxacin per day. He presented with symptoms of acute liver failure 14 days later. Liver biopsy revealed extensive hepatocellular necrosis involving zones 3 and 2 of hepatic acini and a mixed inflammatory infiltration containing abundant eosinophils. Symptoms resolved after corticoidsteroid therapy. In the present paper, we report the clinico-pathological characteristics of a case of ciprofloxacin-associated acute hepatic failure and discuss the current literature.