A Supraclavicular ALK-Positive Anaplastic Large-Cell Lymphoma Initially Misdiagnosed and Yet Successfully Treated with Wide Excision and Adjuvant Chemotherapy: a Case Report
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Date
2019
Journal Title
Journal ISSN
Volume Title
Publisher
SN Comprehensive Clinical Medicine
Abstract
ALK-positive Anaplastic Large-Cell Lymphomas (ALCL) are chemo-sensitive cancers; combination of histologic and
immunophenotypic or genetic studies remains the main strategy to prevent their unnecessary surgical excision as they canmimic softtissues
sarcomas in histology. In sub-Saharan Africa, however, availability and affordability of immunophenotypic studies, especially
extended immunohistochemistry (IHC) tests, constitute major limitations for accurate diagnoses. The case presented herein is an
example of a heavy surgical management resulting from an initially inaccurate diagnosis, but eventually treated successfully.
Case presentation A 15-year-old female patient presented with a 5-month history of a painless right supraclavicular mass. The
initial biopsies had conflicting histology reports. In view of its rapid growth, it was first managed surgically, as a high-grade
sarcoma stage T4N1M0: a wide “en bloc resection” with primary flap covering was done. Post-operative histology with an
extended IHC from the widely resected tissue finally revealed an ALK-positive ALCL, which proved to be sensitive to chemotherapy.
An adjuvant chemotherapy of six cycles of CHOP regimen followed with a good response; the patient became clinically
stable, and all the investigations that were done, including a PET-CT scan, could not detect any residual active disease. She was
still disease-free at 2 years after completion of chemotherapy.
Conclusions Although cost-effective, combined histologic and immunophenotypic studies, especially extended IHC tests, can
reduce the incidence of misdiagnosed large-cell lymphoma. As exemplified in this present case, obtaining appropriate and
sufficient tissue from the tumor could possibly increase the chance of finding an accurate diagnosis.
Description
Keywords
Anaplastic large-cell lymphoma, Case report, Chemotherapy, Fascio-cutaneous flap, IHC, PET-CT scan, Misdiagnosis
Citation
Lekuya, H. M., Kalanzi, E. W., Mbiine, R., Omoding, A., Rosenwald, A., Lemperle, G., & Bringmann, G. (2019). A supraclavicular ALK-positive anaplastic large-cell lymphoma initially misdiagnosed and yet successfully treated with wide excision and adjuvant chemotherapy: A case report. SN Comprehensive Clinical Medicine, 1, 716-725. https://doi.org/10.1007/s42399-019-00112-2https://doi.org/10.1007/s42399-019-00112-2