title: Small cell variant of anaplastic large cell lymphoma diagnosed by a novel chromosomal abnormality t(2;5;3)(p23;q35;p21) of bone marrow cells.
abstract: Because of the rarity and the morphological variations, small cell variant of anaplastic large cell lymphoma (ALCL) represents a diagnostic challenge. Herein is reported a case of leukemic type of small cell variant of ALCL, in which the diagnosis was established by a cytogenetic analysis. The patient was a 23-year-old woman who presented with fever and leukocytosis with circulatory atypical lymphoid cells. The initial differential diagnosis on bone marrow trephine biopsy sections included viral infection and peripheral T-cell lymphoma unspecified. But a cytogenetic study on bone marrow cells indicated a novel complex translocation, t(2;5;3)(p23;q35;p21), which led to confirmation of anaplastic lymphoma kinase (ALK)-positive pleomorphic small to medium-sized cells scattered in bone marrow cells, on immunohistochemistry. ALK was distributed in both nuclear and cytoplasmic regions of neoplastic cells. The patient achieved complete remission after four courses of combination chemotherapy, and received autologous peripheral stem cell transplantation (auto-PBSCT) after two additional courses of combination chemotherapy, but relapsed 2 months after auto-PBSCT in the bilateral lung. Allogeneic stem cell transplantation led to a second remission. This case demonstrates the diagnostic importance of cytogenetic study for malignant lymphoma involving bone marrow.
authors.affiliation: Division of Hematology, Department of Internal Medicine, Kawasaki Medical School, Kurashiki, Japan.
authors.forename: Fuminori
authors.initials: F
authors.lastname: Sano
authors.forename: Taizo
authors.initials: T
authors.lastname: Tasaka
authors.forename: Hirotake
authors.initials: H
authors.lastname: Nishimura
authors.forename: Takashi
authors.initials: T
authors.lastname: Akiyama
authors.forename: Yasutaka
authors.initials: Y
authors.lastname: Kubo
authors.forename: Yoshiko
authors.initials: Y
authors.lastname: Matsuhashi
authors.forename: Hideho
authors.initials: H
authors.lastname: Wada
authors.forename: Takashi
authors.initials: T
authors.lastname: Sugihara
authors.forename: Yoshito
authors.initials: Y
authors.lastname: Sadahira
mesh_terms: D000328:Adult; D000077548:Anaplastic Lymphoma Kinase; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D014408:Biomarkers, Tumor / Q000378:metabolism; D001854:Bone Marrow Cells / Q000201:enzymology / Q000473:pathology*; D002871:Chromosome Banding; D002900:Chromosomes, Human, 1-3 / Q000235:genetics*; D002895:Chromosomes, Human, Pair 5 / Q000235:genetics*; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D017728:Lymphoma, Large-Cell, Anaplastic / Q000175:diagnosis* / Q000201:enzymology / Q000235:genetics; D016411:Lymphoma, T-Cell, Peripheral / Q000175:diagnosis; D011505:Protein-Tyrosine Kinases / Q000276:immunology / Q000378:metabolism; D020794:Receptor Protein-Tyrosine Kinases; D012074:Remission Induction; D032681:Spectral Karyotyping; D014178:Translocation, Genetic; D014777:Virus Diseases / Q000175:diagnosis
chemical_list: D014408:Biomarkers, Tumor; C000626173:ALK protein, human; D000077548:Anaplastic Lymphoma Kinase; D011505:Protein-Tyrosine Kinases; D020794:Receptor Protein-Tyrosine Kinases