Lozano-Jaramillo Diego Alberto, Millan-Arreola Esperanza, Esquer-Cota Oscar Omar, Lozano-Garcia Jesus Manuel, Valenzuela-Espinoza Miguel Alfonso
Centro de Investigacion Valle Bibb Fundacion, Tijuana, Baja California, Mexico.
Centro Oncologico Pediatrico de Baja California, Tijuana, Baja California, Mexico.
J Hematol. 2023 Feb;12(1):37-41. doi: 10.14740/jh1081. Epub 2023 Feb 25.
Anaplastic large cell lymphoma (ALCL) is children's most common mature T-cell neoplasm. The majority is positive for anaplastic lymphoma kinase (ALK). Initial presentation as a soft-tissue pelvic mass without nodal involvement is rare and can be easily misdiagnosed. We report a case of a 12-year-old male presenting with pain and movement restriction in the right extremity. Computed tomography (CT) scan revealed a solitary pelvic mass. Initial biopsy examination concluded rhabdomyosarcoma. After developing pediatric multisystemic inflammatory syndrome due to coronavirus disease 2019 (COVID-19), central and peripheral lymph node enlargement appeared. New cervical adenopathy and pelvic mass biopsies were performed. Immunohistochemistry concluded an ALK-positive ALCL with a small-cell pattern. The patient was treated with brentuximab-based chemotherapy and eventually improved. Differential diagnosis of pelvic masses in children and adolescents must include ALCL. An inflammatory trigger may promote the appearance of a typical nodal disease, previously absent. Attention is warranted during histopathological examination to avoid diagnostic errors.
间变性大细胞淋巴瘤（ALCL）是儿童最常见的成熟T细胞肿瘤。大多数病例间变性淋巴瘤激酶（ALK）呈阳性。最初表现为盆腔软组织肿块且无淋巴结受累的情况较为罕见，容易误诊。我们报告一例12岁男性患者，表现为右下肢疼痛和活动受限。计算机断层扫描（CT）显示盆腔有一个孤立性肿块。最初的活检检查诊断为横纹肌肉瘤。在因2019冠状病毒病（COVID-19）出现儿童多系统炎症综合征后，出现了中央和外周淋巴结肿大。进行了新的颈部淋巴结病变和盆腔肿块活检。免疫组织化学诊断为小细胞型ALK阳性ALCL。该患者接受了以 Brentuximab 为基础的化疗，最终病情好转。儿童和青少年盆腔肿块的鉴别诊断必须包括ALCL。炎症触发因素可能促使先前不存在的典型淋巴结疾病出现。在组织病理学检查过程中需要引起注意，以避免诊断错误。
