A rare cause of breast masses in childhood: ALK positive anaplastic large cell lymphoma

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Mustafa Özay
Zuhal Keskin
Sare Şipal
Zerrin Orbak
Handan Alp

Abstract

Objective: Non-Hodgkin's lymphomas (NHLs) are the result of malign proliferation of lymphoid cells. According to the morphological, immunological and genetic characteristics of childhood NHLs, they are classified as Burkitt lymphoma (BL), Lymphoblastic lymphoma (LL), diffuse large B-cell lymphoma (DLBCL) and anaplastic large cell lymphoma (ALCL). Anaplastic large cell lymphoma is a distinct form of non-Hodgkin lymphoma (NHL) which accounts for 15% of all childhood lymphomas. We report a girl presented with a breast mass and diagnosed with systemic ALCL.


Case: A 14-year-old girl was referred to our hospital with without a painless mass in the left breast. Physical examination, it was seen two painless mass was found in the left breast. Also, a 2x2 cm, painless lymphadenopathy was found in the left axilla. She had no systemic symptoms In laboratory tests; hemoglobin, white blood cell count, platelet count, liver and kidney function tests, LDH, and uric acid levels were normal. In the imaging and metastasis screenings made to the patient; ultrasound and computed tomography (CT) showed two masses breast region. A large number of lymphadenopathies were detected in the left axillary, which surrounded the paraaortic, the paracaval, and the celiac truncus. She was found to have a hypermetabolic two masses in the breast (SUVmax=33.05) and lymphadenopathies (SUVmax=27.04) in the left axillary, paraaortic, the paracaval, and the celiac truncus on Fluorine-18 fluorodeoxyglucose positron emission tomography/computed tomography (¹⁸F-FDG PET/CT) scan. Excisional biopsy of the tumor mass in the breast was done and immunohistochemical analysis showed CD30 and anaplastic lymphoma kinase (ALK) positive ALCL. The patient was diagnosed with stage III anaplastic large cell lymphoma with systemic involvement and she began chemotherapeutic treatment, according to the NHL BFM 1995 protocol. Bone marrow aspirate was normal, and no malignancy was observed in the cerebrospinal fluid. After V-phase, AM block, and BM block treatments evaluation were performed with ¹⁸F-FDG PET/CT according to protocol. In ¹⁸F-FDG PET/CT, it was seen that the lymph nodes in the abdominal and the small mass in the breast were completely retracted, and another lymph nodes had no detected. These results showed that the response to the treatment was complete and the patient's chemotherapy was completed by continuing with the protocol. ¹⁸F-FDG PET/CT taken after the completion of chemotherapy revealed no evidence of mass or lymph node. The patient's controls continue smoothly.


Conclusions: Anaplastic large cell lymphoma should also be considered in the differential diagnosis of children presented with a breast mass. Treatment procedures should be planned according to the involvement site and spread of the disease.

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How to Cite
Özay, M., Keskin, Z., Şipal, S., Orbak, Z., & Alp, H. (2021). A rare cause of breast masses in childhood: ALK positive anaplastic large cell lymphoma. Medical Science and Discovery, 8(5), 334-337. https://doi.org/10.36472/msd.v8i5.514
Section
Case Reports

References

1. Lanzkowsky Ped Manual of Pediatric Hematology and Oncology,. Fifth Edition ed: Elsevier; 2011. p. 624-46.

2. Eyre TA, Khan D, Hall GW, Collins GP. Anaplastic lymphoma kinase‐positive anaplastic large cell lymphoma: current and future perspectives in adult and paediatric disease. European journal of haematology. 2014;93(6):455-68.

3. Oschlies I, Lisfeld J, Lamant L, Nakazawa A, d'Amore ES, Hansson U, et al. ALK-positive anaplastic large cell lymphoma limited to the skin: clinical, histopathological and molecular analysis of 6 pediatric cases. A report from the ALCL99 study. haematologica. 2013;98(1):50.

4. Jaffe ES. Pathology and genetics of tumours of haematopoietic and lymphoid tissues: Iarc; 2001.

5. Gajendra S, Sachdev R, Lipi L, Goel S, Misra R. ALK positive anaplastic large cell lymphoma presenting as extensive bone involvement. Journal of clinical and diagnostic research: JCDR. 2015;9(1):XD04.

6. Dokmanović L, Rodić P, Krstovski N, Lazić J, Janić D. Non-Hodgkin lymphomas in childhood: How to move on? Srpski arhiv za celokupno lekarstvo. 2014;142(7-8):498-504.

7. Hryhorczuk AL, Harris MH, Vargas SO, Lee EY. Anaplastic large cell lymphoma of the esophagus in a pediatric patient. Pediatric radiology. 2012;42(5):627-31.

8. Han JY, Suh JK, Lee SW, Koh K-N, Im HJ, Seo JJ. Clinical characteristics and treatment outcomes of children with anaplastic large cell lymphoma: a single center experience. Blood research. 2014;49(4):246.

9. Sandlund JT. Non-Hodgkin lymphoma in children. Current hematologic malignancy reports. 2015;10(3):237-43.

10. Gould JW, Eppes RB, Gilliam AC, Goldstein JA, Mikkola DL, Zaim MT, et al. Solitary primary cutaneous CD30+ large cell lymphoma of natural killer cell phenotype bearing the t (2; 5)(p23; q35) translocation and presenting in a child. The American journal of dermatopathology. 2000;22(5):422-8.

11. Tokuyama M, Kurashige Y, Ota T, Manabe Y, Yamaoka H, Ikoma N, et al. Pediatric case of anaplastic lymphoma kinase‐positive anaplastic large cell lymphoma forming a solitary skin tumor on the forearm. The Journal of dermatology. 2017;44(4):465-7.