Wang Shan, Meng Meng, Wang Qiuhu, Xu Kai
Department of Radiology, Affiliated Hospital of Xuzhou Medical University School of Medical Imaging, Xuzhou Medical University, Xuzhou Guizhou Medical University, Guiyang, China.
Medicine (Baltimore). 2017 Nov;96(45):e8456. doi: 10.1097/MD.0000000000008456.
Anaplastic large cell lymphoma (ALCL) is a rare type of non-Hodgkin lymphoma (NHL). The most common extranodal sites of ALCL are skin, subcutaneous tissue, bone, lung, and gastrointestinal organs. This study reports a case of ALCL with multiple extranodal involvement, especially the whole body skeletal muscles, with the aim to share the imaging features of the ALCL including magnetic resonance imaging (MRI) and 18F-fluorodeoxyglucose positron emission tomography-computed tomography (18F-FDG PET-CT).
A 54-year-old female patient presented with two-month history of bilateral shoulder pain, which had exacerbated for 6 days prior to admission. MRI scans revealed multiple hyperintense on T2-weighted image (T2WI) and marked inhomogenous diffuse or rim enhancement masses in shoulder muscles. The probable diagnoses must include metastatic carcinoma in the skeletal muscle, purulent abscess, soft-tissue sarcoma and lymphoma. For our patient, however, she did not have a history of cancer or hyperleukocytosis. 18F-FDG PET-CT was made for further evaluation and identified whether there is another related lesion. PET-CT image showed widespread FDG uptake lesions, including cervical/retroperitoneal lymphnodes, subcutaneous tissue, hepar and multiple groups of whole body muscles.
An ultrasound-guided tissue biopsy was performed on the left cervical lymphnodes. Histological and immunohistochemical examination showed ALK- ALCL.
Clinicians planned to give our patient systemic chemotherapy.
Our patient died of multiple organ failure four weeks after her first visit to our hospital.
This disease should be considered when patient presented diffuse muscle swelling in particular when a history of cancer and hyperleukocytosis was not supported. The presence of soft tissue masses in skeletal muscles on MRI scans, as well as multiple marked focal tracer uptake on PET-CT and immunohistochemical analysis of the mass, may help the recognition of ALCL and the state of illness evaluation, allowing for the appropriate treatment strategy to be initiated.
间变性大细胞淋巴瘤（ALCL）是一种罕见的非霍奇金淋巴瘤（NHL）。ALCL最常见的结外部位是皮肤、皮下组织、骨骼、肺和胃肠道器官。本研究报告一例多结外受累的ALCL病例，尤其是全身骨骼肌受累，旨在分享ALCL的影像学特征，包括磁共振成像（MRI）和18F-氟脱氧葡萄糖正电子发射断层扫描-计算机断层扫描（18F-FDG PET-CT）。
一名54岁女性患者，有两个月双侧肩部疼痛病史，入院前6天加重。MRI扫描显示T2加权像（T2WI）上多个高信号，肩部肌肉内有明显不均匀的弥漫性或边缘强化肿块。可能的诊断必须包括骨骼肌转移性癌、脓性脓肿、软组织肉瘤和淋巴瘤。然而，我们的患者没有癌症或白细胞增多症病史。进行了18F-FDG PET-CT进一步评估，以确定是否存在其他相关病变。PET-CT图像显示广泛的FDG摄取病变，包括颈部/腹膜后淋巴结、皮下组织、肝脏和多组全身肌肉。
对左侧颈部淋巴结进行了超声引导下组织活检。组织学和免疫组化检查显示ALK- ALCL。
临床医生计划对我们的患者进行全身化疗。
我们的患者在首次就诊我院四周后死于多器官功能衰竭。
当患者出现弥漫性肌肉肿胀时，尤其是在不支持癌症和白细胞增多症病史的情况下，应考虑这种疾病。MRI扫描显示骨骼肌内有软组织肿块，以及PET-CT上多个明显的局灶性示踪剂摄取和肿块的免疫组化分析，可能有助于识别ALCL和评估病情，从而启动适当的治疗策略。
