Gómez-Román José Javier, Cobo María Luisa Cagigal, Val-Bernal José Fernando
Pathology Department, University Hospital Marqués de Valdecilla, Cantabria Health Service, Medicine Faculty, Cantabria University, Santander, Spain.
Pathol Int. 2008 Apr;58(4):249-52. doi: 10.1111/j.1440-1827.2008.02219.x.
Malignant lymphoma presenting in the bladder has been classified in primary cases, as the first sign of disseminated disease and as a secondary infiltration. Most of the examples in the literature have been reported as single cases. Reported herein is the case of a 45-year-old man with an anaplastic large cell lymphoma (anaplastic lymphoma kinase (ALK) and granzyme B positive) that presented as a bladder neoplasm. The morphological differential diagnosis was complex because the EMA-positive immunophenotype, CD45 and CD3 negativity and the clinical manifestation simulated a transitional cell carcinoma. It is important to be aware of its existence because a poorly differentiated bladder carcinoma cannot be ruled out if CD30 and ALK immunostaining are not performed. T-cell receptor-gamma clonal rearrangement could be also helpful in these cases. Although bladder involvement by recurrent lymphoma is a sign of widely disseminated disease and it is associated with a very poor prognosis, it seems that chemotherapeutic regimens in this kind of ALK-positive lymphoma could be effective, given that the present patient had an impressive response to chemotherapy treatment.
膀胱恶性淋巴瘤可分为原发性病例、作为播散性疾病的首发症状以及继发性浸润。文献中的大多数病例报告均为单例。本文报道了一名45岁男性，患有间变性大细胞淋巴瘤（间变性淋巴瘤激酶（ALK）和颗粒酶B阳性），表现为膀胱肿瘤。形态学鉴别诊断较为复杂，因为EMA阳性免疫表型、CD45和CD3阴性以及临床表现类似于移行细胞癌。认识到其存在很重要，因为如果不进行CD30和ALK免疫染色，不能排除低分化膀胱癌。T细胞受体γ克隆重排在这些病例中也可能有帮助。尽管复发性淋巴瘤累及膀胱是广泛播散性疾病的标志，且预后很差，但鉴于本例患者对化疗有显著反应，似乎这种ALK阳性淋巴瘤的化疗方案可能有效。
