Anaplastic Large Cell Lymphoma: A Unique Presentation with Urinary Bladder Involvement

PAX5-expressing ALK-negative anaplastic large cell lymphoma with extensive extranodal and nodal involvement

A 55-year-old man with a history of well controlled HIV infection was admitted with acute renal impairment, peripheral oedema, constitutional symptoms, deranged liver function and hypercalcaemia. Core biopsies of a retroperitoneal mass demonstrated anaplastic lymphoma kinase (ALK) negative anaplastic large cell lymphoma (ALCL) with unusual Paired box 5 (PAX5) positivity. The same malignant cells were identifiable on urine cytology. Staging investigations revealed extensive nodal and extranodal disease including ALK negative ALCL involving the kidney and prostate, which has not previously been reported in the published literature.

Anaplastic lymphoma kinase-positive anaplastic large-cell lymphoma with involvement of the urinary bladder: a case report and review of literature

We report a unique case of anaplastic large-cell lymphoma (ALCL) involving the urinary bladder in a 22-year-old man. The patient presented with left lower back pain for 4 weeks. The computed tomography (CT) scan demonstrated an exophytic nodule on the left bladder wall and abdominopelvic lymphadenopathy. Histologically, a population of large pleomorphic cells extensively infiltrated the lamina propria of the bladder. These cells were diffusely and strongly immunoreactive for CD30, ALK, EMA, and vimentin, but were negative for AE1/AE3, CK20, CK7, CK5/6, P63, SMA, HMB-45, pan-Melan, S-100, Myo D1, synaptophysin, CD56, desmin, CD15, CD20, Pax-5, and CD3. Few cells exhibited positive immunohistochemical staining of CD45. The patient underwent cyclophosphamide, doxorubicin, vincristine, and prednisone (CHOP) regime of chemotherapy and achieved a complete remission after four cycles. This case is the tenth documented case of systemic ALCL involving urinary bladder. Due to its rarity, it is important to be aware of the features of ALCL in bladder, and make prompt and accurate diagnosis.

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.

ALK+ Anaplastic Large Cell Lymphoma With Bladder Involvement Presenting as Fever of Unknown Origin: A Case Report and Literature Review

Anaplastic large cell lymphoma (ALCL) is a rare malignant tumor normally originating in lymph nodes, though it can occur in extranodal sites. We report a 59-year-old man with anaplastic lymphoma kinase (ALK) positive ALCL involving the bladder diagnosed post-mortem who presented with fever of unknown origin. This is the seventh reported case of ALCL presenting as a bladder neoplasm. The patient presented to his primary care physician with a several day history of fever. An eventual computed tomography scan of the abdomen and pelvis showed widespread adenopathy in the pelvis and retroperitoneum. After a negative infectious investigation, the patient underwent exploratory laparotomy with excisional biopsy of periaortic lymph nodes. Pathology revealed reactive lymphocytes. Bone marrow biopsy also was negative for malignancy. The patient’s fevers persisted, and he later exhibited dysuria and hematuria with evidence of bilateral hydronephrosis. Cystoscopy revealed an erythematous, diffusely friable bladder mucosa with inaccessible ureteral orifices, and biopsies were taken. The patient continued to deteriorate clinically because of associated macrophage activation syndrome, a close variant of hemophagocytic lymphohistiocytosis, and expired the following day. Autopsy was declined. Post-mortem pathology reports from cystoscopy revealed ALK+ ALCL of the bladder.