Lawrenz Joshua, Tomal Justin, Towne James, Johnson Beth, Rieger Brent
Division of General Internal Medicine, Department of Medicine, Loyola University Medical Center, 2160 S. First Ave. Maywood, IL 60153, USA.
Department of Pathology, Central DuPage Hospital of Cadence Health, 25 N. Winfield Rd. Winfield, IL 60190, USA.
World J Oncol. 2013 Apr;4(2):95-101. doi: 10.4021/wjon644w. Epub 2013 May 6.
Anaplastic large cell lymphoma (ALCL) is a rare malignant tumor normally originating in lymph nodes, though it can occur in extranodal sites. We report a 59-year-old man with anaplastic lymphoma kinase (ALK) positive ALCL involving the bladder diagnosed post-mortem who presented with fever of unknown origin. This is the seventh reported case of ALCL presenting as a bladder neoplasm. The patient presented to his primary care physician with a several day history of fever. An eventual computed tomography scan of the abdomen and pelvis showed widespread adenopathy in the pelvis and retroperitoneum. After a negative infectious investigation, the patient underwent exploratory laparotomy with excisional biopsy of periaortic lymph nodes. Pathology revealed reactive lymphocytes. Bone marrow biopsy also was negative for malignancy. The patient's fevers persisted, and he later exhibited dysuria and hematuria with evidence of bilateral hydronephrosis. Cystoscopy revealed an erythematous, diffusely friable bladder mucosa with inaccessible ureteral orifices, and biopsies were taken. The patient continued to deteriorate clinically because of associated macrophage activation syndrome, a close variant of hemophagocytic lymphohistiocytosis, and expired the following day. Autopsy was declined. Post-mortem pathology reports from cystoscopy revealed ALK+ ALCL of the bladder.
间变性大细胞淋巴瘤（ALCL）是一种罕见的恶性肿瘤，通常起源于淋巴结，不过也可发生于结外部位。我们报告一例59岁男性，尸检诊断为间变性淋巴瘤激酶（ALK）阳性的ALCL累及膀胱，患者最初表现为不明原因发热。这是第七例报告的以膀胱肿瘤形式出现的ALCL。患者因发热数天就诊于其初级保健医生。最终的腹部和骨盆计算机断层扫描显示骨盆和腹膜后广泛淋巴结肿大。在感染性检查结果为阴性后，患者接受了剖腹探查术并对主动脉旁淋巴结进行了切除活检。病理显示为反应性淋巴细胞。骨髓活检也未发现恶性肿瘤。患者的发热持续存在，随后出现排尿困难和血尿，并伴有双侧肾积水。膀胱镜检查发现膀胱黏膜红斑、弥漫性脆弱，输尿管口无法观察到，遂取活检。由于相关的巨噬细胞活化综合征（噬血细胞性淋巴组织细胞增生症的一种密切变体），患者临床状况持续恶化，于次日死亡。家属拒绝尸检。膀胱镜检查的尸检病理报告显示膀胱ALK + ALCL。
