An ALK-Positive Anaplastic Large Cell Lymphoma with Striking Cutaneous Manifestations and Diagnostic Insights
Year: 2025
Type: article
Study design: Case Report
Abstract: Introduction: Secondary Cutaneous Lymphomas (SCL) result from nodal or extranodal lymphoma dissemination and are characterized by skin infiltration. Diagnosing SCL is complex and requires clinical, histopathological and molecular evaluations. SCL can present with diverse manifestations, with disseminated lesions indicating a poor prognosis. This report describes a rare case of ALK-positive Anaplastic Large Cell Lymphoma (ALCL) with cutaneous involvement. Case Report: An 18-year-old male presented with an eight-month history of a tumoral lesion with serohematic crusts on the anterior thoracic region and satellite erythematous-violaceous nodules. No systemic B symptoms were reported. Histopathology revealed a diffuse proliferation of large pleomorphic lymphoid cells in the dermis and hypodermis. Immunohistochemistry showed strong positivity for CD30, EMA and ALK, supporting the diagnosis of secondary cutaneous involvement by ALK-positive nodal/systemic ALCL. Bone marrow biopsy confirmed lymphoma infiltration. The patient was referred for surgical and hematological evaluation and initiated chemotherapy protocols. Discussion: SCL accounts for up to 50% of cutaneous lymphomas and presents as nodules, plaques or ulcerations. Disseminated lesions within six months of diagnosis reduce survival rates significantly. Accurate differentiation between primary and secondary lymphoproliferative diseases requires imaging, bone marrow biopsy and molecular techniques. Treatment includes chemotherapy, radiotherapy and emerging therapies such as checkpoint inhibitors, CAR-T cells and targeted agents like brentuximab vedotin. ALK-positive ALCL is generally associated with a more favorable prognosis compared to ALK-negative subtypes. Conclusion: Early diagnosis and intervention are critical for improving survival in SCL patients. Dermatologists play a crucial role in recognizing these lesions and initiating multidisciplinary management. Introduction: Secondary Cutaneous Lymphomas (SCL) result from nodal or extranodal lymphoma dissemination and are characterized by skin infiltration. Diagnosing SCL is complex and requires clinical, histopathological and molecular evaluations. SCL can present with diverse manifestations, with disseminated lesions indicating a poor prognosis. This report describes a rare case of ALK-positive Anaplastic Large Cell Lymphoma (ALCL) with cutaneous involvement. Case Report: An 18-year-old male presented with an eight-month history of a tumoral lesion with serohematic crusts on the anterior thoracic region and satellite erythematous-violaceous nodules. No systemic B symptoms were reported. Histopathology revealed a diffuse proliferation of large pleomorphic lymphoid cells in the dermis and hypodermis. Immunohistochemistry showed strong positivity for CD30, EMA and ALK, supporting the diagnosis of secondary cutaneous involvement by ALK-positive nodal/systemic ALCL. Bone marrow biopsy confirmed lymphoma infiltration. The patient was referred for surgical and hematological evaluation and initiated chemotherapy protocols. Discussion: SCL accounts for up to 50% of cutaneous lymphomas and presents as nodules, plaques or ulcerations. Disseminated lesions within six months of diagnosis reduce survival rates significantly. Accurate differentiation between primary and secondary lymphoproliferative diseases requires imaging, bone marrow biopsy and molecular techniques. Treatment includes chemotherapy, radiotherapy and emerging therapies such as checkpoint inhibitors, CAR-T cells and targeted agents like brentuximab vedotin. ALK-positive ALCL is generally associated with a more favorable prognosis compared to ALK-negative subtypes. Conclusion: Early diagnosis and intervention are critical for improving survival in SCL patients. Dermatologists play a crucial role in recognizing these lesions and initiating multidisciplinary management.
Source: Journal of Dermatology Research
Authors: Patrícia Imai Zanardi, Carolina Ferreira Baldecerra, Daiane de Souza, Fernanda Diacópulos Silva, Silvio Cesar Franco Giovanni Filho, Cássio Rafael Moreira
Language: English
Subfield: Dermatology
Field: Medicine
Domain: Health Sciences
Open Access status: hybrid
OpenAlex ID: W4408205208