Unusual presentation and progression of CD30 positive anaplastic large cell lymphoma

• Introduction and Objectives: Unexpected pathology in a skin lesion on one finger growing during one year, preliminary dermatology diagnosis were among others mycobacterium marinum and leishmaniasis. Materials and methods: A 69 year old male was referred to our dermatology clinic because of a slowly growing mass on one of his fingers. He was otherwise healthy. He has lived in Sweden for many years, but was born in southwest Asia, last visit there was in 2012. He had an aquarium at home. Results: At first visit he had a big mass on his left forth finger but no other skin lesions and his general health was good. The preliminary dermatology diagnosis was mycobacterium marinum infection and he was put on antibiotics and a skin biopsy was taken. Three weeks later there were no signs of improvement. A second diagnosis was considered, leishmaniasis. Histopathology showed normal epidermis. In the dermis there was very dense pleomorphic large cell infiltrates with blastlike morphology. Immunohistochemistry revealed these cells to be Tlymphocytes with CD30 +, CD2 +, CD3 +, CD4 +, CD5 +. ALK and EMA were negative as well as test for Mycobacteria and leishmaniasis. Radiation therapy was started. He received 40 Gy with good regression of the tumour mass. Only few weeks later numerous skin tumours developed over the body, mostly arms and legs. Methotrexate was given, 15-20 mg per week, initially a tendency to response but after 6 months several tumours were dramatically enlarged with ulcerations progressing into oozing, eruptive and bad smelling wounds. General health was still good but he suffered from skin tumor pain. He was hospitalized for further evaluation and to alleviate the pain. Blood test now showed some anemia, but no other significant alterations. CTscan showed enlarged lymph nodes in the groin area, but not accessible for punction or excision. In one of the nose cavities a tumour mass gave him problems with nasal congestion. Tissue sample from this nasal tumor showed high malignant Tcell lymphoma. Treatment with CHOP was given for six sessions during 2 months. He had a complication with septicemia after the first session but could continue the treatment and already after the third session the skin tumours started to regress. After completion of the CHOP a new CTscan revealed also regress of the lymph nodes in the groin, from 18 to 11 mm and a total regress of the mass in the nose cavity. The patient is at home with his family and will have future checkups in the hospital. Conclusion: Anaplastic large cell lymphoma (CD30+) is considered indolent and sometimes selfhealing. This case illustrates both an unusual presenting symptom and shortly thereafter widespread tumours, not selfhealing and without response to methotrexate. With help from colleagues in haematology the patient got treatment with CHOP with good response. Follow up time is only 4 months.

Ämnesord

MEDICIN OCH HÄLSOVETENSKAP  -- Klinisk medicin -- Dermatologi och venereologi (hsv//swe)

MEDICAL AND HEALTH SCIENCES  -- Clinical Medicine -- Dermatology and Venereal Diseases (hsv//eng)

MEDICIN OCH HÄLSOVETENSKAP  -- Klinisk medicin (hsv//swe)

MEDICAL AND HEALTH SCIENCES  -- Clinical Medicine (hsv//eng)

Nyckelord

cutaneous lymphoma

cutaneous anaplastic large cell lymphoma

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