Li Weina, Li Fenggang, Chu Jingxue, Liu Shuping
Medical Research & Laboratory Diagnostic Center, Jinan Central Hospital, Cheeloo College of Medicine, Shandong University Jinan 250013, Shandong, China.
Medical Imaging Center, Jinan Central Hospital, Cheeloo College of Medicine, Shandong University Jinan 250013, Shandong, China.
Am J Transl Res. 2022 Jun 15;14(6):4184-4191. eCollection 2022.
Primary anaplastic large cell lymphoma (ALCL) is a rare pulmonary malignancy. Due to its nonspecific clinical and radiologic manifestations, the disease presents a great challenge to pulmonologists. Appropriate invasive biopsy and immunohistochemistry are important for its diagnosis. Here, we report an ALCL case of a 27-year-old Chinese woman who presented to our hospital complaining of coughing for 10+ days and breath holding for 4-5 days after the event. Positive signs on physical examination were dull percussion sounds and decreased right lung breath sounds. Chest CT scans revealed central carcinoma and atelectasis of the right lung, pleural effusion, and lung mass. Pathology consultation showed a right main bronchial ALCL that involved the parabronchial lymph nodes but not the bronchial tangent. The patient discontinued treatment after right pneumonectomy and died two months later. Postoperative lung biopsy showed anaplastic tumor cells with large and multiple nuclei. The ALCL was characterized by the expression of T cell antigens, CD30 and ALK, as indicated by immunohistochemistry. We also reviewed the atypical cases of ALCL that were previously published. The results indicated that primary pulmonary ALCL is an extremely rare and easily misdiagnosed disease with non-specific clinical and imaging manifestations. Its diagnosis is based on biopsy and immunohistochemistry, and its prognosis is poor.
原发性间变性大细胞淋巴瘤（ALCL）是一种罕见的肺部恶性肿瘤。由于其非特异性的临床和影像学表现，该病给肺科医生带来了巨大挑战。合适的侵入性活检和免疫组织化学检查对其诊断很重要。在此，我们报告一例27岁中国女性的ALCL病例，该患者因咳嗽10多天、事件发生后憋气4 - 5天前来我院就诊。体格检查阳性体征为叩诊浊音和右肺呼吸音减弱。胸部CT扫描显示中央型肺癌及右肺肺不张、胸腔积液和肺部肿块。病理会诊显示为右主支气管ALCL，累及支气管旁淋巴结，但未累及支气管切线。患者在右肺切除术后停止治疗，两个月后死亡。术后肺活检显示有多核大的间变性肿瘤细胞。免疫组织化学检查显示，该ALCL的特征是T细胞抗原、CD30和ALK表达阳性。我们还回顾了先前发表的ALCL非典型病例。结果表明，原发性肺ALCL是一种极其罕见且易被误诊的疾病，具有非特异性的临床和影像学表现。其诊断基于活检和免疫组织化学检查，预后较差。
