A case of anaplastic lymphoma kinase‐positive large B‐cell lymphoma: Aspiration cytology findings

Abstract

Anaplastic lymphoma kinase-positive (ALK+) large B-cell lymphoma (LBCL) is a rare subtype of non-Hodgkin B-cell lymphoma that exhibits a more aggressive clinical course and poorer prognosis than the typical diffuse large B-cell lymphoma. In this study, we report the case of a 67-year-old man with left cervical lymph node swelling. Aspiration cytology revealed many clusters of cohesive, large, and solitary cells. The tumor cells had abundant cytoplasm and large round-to-oval nuclei with prominent nucleoli. The Giemsa staining specimens exhibited amorphous global bodies adjacent to some clusters. Histologically, large tumor cells occupied the lymph nodes in a sinusoidal pattern, and immunohistochemically, these cells were cytokeratin-, CD19(-), CD20(-), CD79a(-), CD3(-), CD30(-), CD138(+), IgG(-), IgA(+), and ALK(+). Chromogenic in situ hybridization revealed restricted immunoglobulin light-chain expression. Fluorescent in situ hybridization demonstrated translocation of the ALK gene. The tumor cells were negative for Epstein-Barr virus and human herpesvirus 8. It is important to differentiate ALK+LBCL from metastatic carcinoma and other lymphoma subtypes with similar histological features to ensure a proper treatment strategy and prediction of prognosis.

Anaplastic lymphoma kinase positive large B‐cell lymphoma: Literature review and report of an endoscopic fine needle aspiration case with tigroid backgrounds mimicking seminoma

“…[10][11][12] The cytomorphologic appearance of large cells with admixed background lymphocytes in "tigroid" backgrounds in the air-dried and modified Giemsa stained preparations in our case raised the differential diagnosis of seminoma at the time of ROSE. The available reports of ALK1 LBCL in the cytology literature focus on potential pitfalls of diagnosis such as the possibility of mistakenly diagnosing this disease as a carcinoma secondary to epithelioid morphology with cohesiveness/clustering, pseudo-acinar or pseudo-papillary formations, and abundant cytoplasm.…”

“…The available reports of ALK1 LBCL in the cytology literature focus on potential pitfalls of diagnosis such as the possibility of mistakenly diagnosing this disease as a carcinoma secondary to epithelioid morphology with cohesiveness/clustering, pseudo-acinar or pseudo-papillary formations, and abundant cytoplasm. [10][11][12] The cytomorphologic appearance of large cells with admixed background lymphocytes in "tigroid" backgrounds in the air-dried and modified Giemsa stained preparations in our case raised the differential diagnosis of seminoma at the time of ROSE. [28][29][30] Tigroid backgrounds are classically present in smears and scrape preparations made from seminomatous germ cell tumors and are described as having delicate, blue-gray, frothy background material dispersed in a pattern of interlacing ribbons, felt reminiscent of a tiger's coat pattern.…”

“…[3][4][5][6][7][8][9] Immunohistochemically, the lesional cells in this disease demonstrate strong immunoreactivity for ALK protein, with patterns of staining differing according to translocation partner. [10][11][12] This report focuses on a challenging case in which the combination of clinical presentation and the presence of a tigroid background in modified Giemsa stained FNA smears from splenic hilar lymph nodes suggested an initial differential diagnosis of seminoma. Clathrin (CTLC) and nucleophosmin (NPM) fusions with ALK are perhaps the most commonly encountered translocations in ALK1 non-Hodgkin lymphomas; however, there are several other fusion gene partners for ALK reported in ALK1 LBCLs.…”

“…[2][3][4][5][6][7][8] Very few published manuscripts exist (three to our knowledge) which detail specific cytologic or needle aspiration features of cases of ALK1 LBCL, and there are no previously documented examples of this disease entity encountered by endoscopic ultrasound-guided fine needle aspiration (EUS FNA). [10][11][12] This report focuses on a challenging case in which the combination of clinical presentation and the presence of a tigroid background in modified Giemsa stained FNA smears from splenic hilar lymph nodes suggested an initial differential diagnosis of seminoma.…”

Cytologic perspectives on neoteric B‐cell lymphoproliferative disorders

“…[24][25][26][27][28][29][30][31][32][33] Only a few cases of ALK1 LBCL have been described in the cytology literature with most of these focusing on potential pitfalls in diagnosis, such as the possibility of mistakenly diagnosing this rare disease as carcinoma or seminoma because of epithelioid morphology, cohesion and comparatively abundant cytoplasm ( Figure 3). [34][35][36][37] Immunohistochemically, ALK1 LBCLs show a characteristic pattern of reactivity in which the lesional cells are classically positive for ALK1, plasma cell markers (CD38, CD138, and MUM1), and epithelial membrane antigen (EMA). The cells are typically CD30 non-reactive (negative); although, focal areas of positivity for CD30, CD79a, and AE1/3 have been reported.…”