Zhang Huai-Feng, Guo Yan
Department of Hematology, The First Affiliated Hospital of Shandong First Medical University, Jinan 250014, Shandong Province, China.
World J Clin Cases. 2020 Nov 6;8(21):5439-5445. doi: 10.12998/wjcc.v8.i21.5439.
Anaplastic large cell lymphoma (ALCL) is a rare and heterogeneous malignant tumor, which is classified as anaplastic lymphoma kinase (ALK)positive ALCL and ALK- ALCL. Many patients are diagnosed with ALCL at the stage of bone marrow involvement. However, ALCL patients with clinical manifestations consistent with acute leukemia are relatively rare.
In this report, the patient did not receive appropriate diagnosis and treatment despite a two-year history of lymph node enlargement. Hereafter, she was admitted for B symptoms and was diagnosed as ALK-ALCL by lymph node biopsy. Then, the disease progressed to leukemia without any treatment after 2 mo. The proportion of lymphoma cells in bone marrow was as high as 96%, and the proportion of peripheral blood was 84%. She also had clinical manifestations similar to acute leukemia. After completion of chemotherapy, she developed granulocytopenia and fever and died from septicemia.
ALCL with leukemic presentation is a late manifestation of lymphoma with low chemotherapy tolerance and poor prognosis.
间变性大细胞淋巴瘤（ALCL）是一种罕见的异质性恶性肿瘤，分为间变性淋巴瘤激酶（ALK）阳性ALCL和ALK阴性ALCL。许多患者在骨髓受累阶段被诊断为ALCL。然而，临床表现与急性白血病一致的ALCL患者相对少见。
本报告中，患者有两年淋巴结肿大病史，但未得到恰当诊断和治疗。此后，她因B症状入院，经淋巴结活检诊断为ALK阴性ALCL。然后，2个月未接受任何治疗，疾病进展为白血病。骨髓中淋巴瘤细胞比例高达96%，外周血中为84%。她还出现了类似急性白血病的临床表现。化疗结束后，她出现粒细胞减少和发热，死于败血症。
白血病表现的ALCL是淋巴瘤的晚期表现，化疗耐受性低，预后差。
