10.5826/dpc.1303a142
text/xml
2160-9381
2902
en
Paola  Vitielllo
https://creativecommons.org/licenses/by-nc/4.0
Dermatology Practical & Conceptual
 early diagnosis
A Single Skin Lesion as Expression of Widespread Disease: a Case of Systemic Anaplastic Large Cell Lymphoma With a Cutaneous Onset
Text.Serial.Journal
https://dpcj.org/index.php/dpc
Research Letter
2023-07-31
2022-10-10
2023-07-31
2023-08-24
e2023142
Dermatol Pract Concept
Paola  Vitielllo
2023/07/31
10.5826/dpc.1303a142
e2023142
Dermatology Unit, Department of Mental and Physical Health and Preventive Medicine, University of Campania Luigi Vanvitelli, Naples, Italy
2160-9381
 early diagnosis
en
e2023142
Xing X, Feldman AL. Anaplastic large cell lymphomas: ALK positive, ALK negative, and primary cutaneous. Adv Anat Pathol. 2015;22(1):29-49. DOI: 10.1097/PAP.0000000000000047. PMID: 25461779.
A Single Skin Lesion as Expression of Widespread Disease: a Case of Systemic Anaplastic Large Cell Lymphoma With a Cutaneous Onset
https://dpcj.org/index.php/dpc/article/download/2902/2227
   A Single Skin Lesion as Expression of Widespread
     Disease: A Case of Systemic Anaplastic Large
        Cell Lymphoma With a Cutaneous Onset
            Stefano Caccavale1, Vittorio Tancredi1, Andrea Ronchi2, Francesca Pagliuca2,
                                Sebastiano Pellerone1, Paola Vitiello1


1 Dermatology Unit, Department of Mental and Physical Health and Preventive Medicine, University of Campania Luigi Vanvitelli,
  Naples, Italy
2 Pathology Unit, Department of Mental and Physical Health and Preventive Medicine, University of Campania Luigi Vanvitelli, Naples, Italy



Key words: systemic anaplastic large cell lymphoma, ALK, skin, dermoscopy, early diagnosis
Citation: Caccavale S, Tancredi V, Ronchi A, Pagliuca F, Pellerone S, Vitiello P. A Single Skin Lesion as Expression of Widespread
Disease: A Case of Systemic Anaplastic Large Cell Lymphoma with a Cutaneous Onset. Dermatol Pract Concept. 2023;13(3):e2023142.
DOI: https://doi.org/10.5826/dpc.1303a142
Accepted: February 3, 2023; Published: July 2023
Copyright: ©2023 Caccavale et al. This is an open-access article distributed under the terms of the Creative Commons Attribution-
NonCommercial License (BY-NC-4.0), https://creativecommons.org/licenses/by-nc/4.0/, which permits unrestricted noncommercial use,
distribution, and reproduction in any medium, provided the original authors and source are credited.
Funding: None.
Competing interests: None.
Authorship: All authors have contributed significantly to this publication.
Corresponding author: Vittorio Tancredi, MD, Dermatology Unit, Department of Mental and Physical Health and Preventive Medicine,
University of Campania Luigi Vanvitelli, Via Sergio Pansini, 5, 80131 Naples, Italy; phone: +39 3313919797;
fax: +39 081 987252; E-mail: tancredivittorio@ymail.com




Introduction                                                             and ichthyol for several weeks. Dermoscopic differential
                                                                         diagnosis included amelanotic melanoma, basal cell carci-
Anaplastic large cell lymphomas (ALCL) are a subgroup                    noma, sarcoidosis and B cell lymphomas (Figure 1B).
of non-Hodgkin T-cell lymphomas which includes anaplas-                       A   complete    excisional    biopsy     was    performed.
tic lymphoma kinase (ALK)-positive ALCL, ALK-negative                    ­Histopathological examination revealed a diffuse lymphoid
ALCL and primary cutaneous ALCL.                                         population and immunohistochemistry was positive for
                                                                         CD4, CD7, ALK, CD30, partially positive for CD3, and neg-
Case Presentation                                                        ative for CD2, CD5, CD8, granzyme, CD20, CD15, CD8
                                                                         (Figure 2, A-D). A diagnosis of ALCL was made. Moreover,
A 44-year-old woman was referred to our Department for                   histologic features, and in particular ALK expression, were
a large, rapid-growing, eroded, erythematous nodule of her               more deponent for a cutaneous manifestation of a systemic
right arm (Figure 1A).The lesion had developed about one                 lymphoma.
month before, diagnosed as a suppurate sebaceous cyst by                      Meanwhile, the patient began to complain about sys-
her general practitioner and treated with topical antibiotics            temic symptoms, such as night sweating and weight loss.




Research Letter | Dermatol Pract Concept. 2023;13(3):e2023142                                                                            1
Figure 1. (A) Dermatologic examination revealed a large red nodule, with eroded surface of the right arm. (B) Dermoscopy was char-
acterized by a diffuse structureless red zone with some orange and white areas. Vessels were polymorphic in shape, sizes with a random
distribution: some were linear, others were curved and coiled.




    Figure 2. Histological findings. (A) Microscopic examination showing a diffuse lymphoid population filling the dermis (H&E, orig-
    inal magnification 40x). (B) The lymphoid population was constituted by large and atypical cells, with small mature lymphocytes
    in the background (H&E, original magnification 200x). (C,D) Immunohistochemically, the large neoplastic cells resulted positive
    for ALK (C) (immunohistochemical stain, original magnification 100x) and (D) CD30 (immunohistochemical stain, original mag-
    nification 100x).




2                                                                         Research Letter | Dermatol Pract Concept. 2023;13(3):e2023142
Besides, the following cutaneous examination revealed an-        ALK gene translocation is a feature of this lymphoma and its
other skin nodule on her right hip, and a lymphadenopathy        finding is important to differentiate systemic forms, which
in her right groin.                                              are generally positive, from primary cutaneous ALCL, usu-
   CT (computed tomography) scan revealed diffuse large          ally ALK negative [3]. When ALK is negative, differentiating
lymphadenopathies in the left axilla and in the right groin.     primary cutaneous ALCL from systemic ALK negative ALCL
Positron emission tomography (PET) showed a remarkably           is more difficult. Even when integrative exams are negative,
increased intake of 18–fluorodeoxyglucose in both sites          often only the course of the disease allows to distinguish the
with a maximum standardized uptake value (SUV) of 22.6.          two entities.
­Ultimately, PET/CT scan confirmed that cutaneous nodules           Skin involvement is possible during systemic ACLC, but
were secondarisms, thus metastases of a systemic lymphoma.       primary cutaneous onset without other symptoms is un-
So, according to the TNM system, the disease was a stage IV      usual. A complete physical examination should always be
lymphoma. The patient was hospitalized and admitted to the       conducted to evaluate other signs of a systemic disease. Our
onco-hematology ward for the management and treatments.          case is a striking example of how even a single skin lesion
                                                                 might be an expression of a systemic and widespread onco-
                                                                 logical disease.
Conclusions
ALCL is a subtype of non-Hodgkin T-cell lymphoma, ac-            References
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Research Letter | Dermatol Pract Concept. 2023;13(3):e2023142                                                                     3
