Primary ALK-negative anaplastic large cell lymphoma with extensive bone involvement mimicking multiple myeloma and metastatic carcinoma
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Bone biopsy revealed large pleomorphic mononuclear cells, sometimes multinucleated and often with eccentric reniform or horseshoe nuclei, with dispersed chromatin and conspicuous nucleoli (Fig. 1d, hematoxylin and eosin stain, ×400). Immunohistochemical stain revealed a diffuse strong CD30 immunoreactivity in the lymphoma cells, especially in membrane regions (Fig. 1e, CD30 stain, ×400). Neoplastic cells were also positive for epithelial membrane antigen (EMA) and CD3, and negative for CD15, PAX5, CD20, CD138, cytokeratin, CEA, Melan-A, p40 and ALK-1. A diagnosis of ALK-negative anaplastic large cell lymphoma (ALCL) with primary and multifocal bone involvement was made.
Primary lymphoma of the bone constitutes only 5% of the malignant tumors of the bone, and most are diffuse large B-cell lymphomas . Although bone marrow involvement by ALCL occasionally occurs in patients with extensive nodal disease, primary multiple bone lesions without lymphadenopathy are very rare [2, 3]. Multifocal osteolytic lesions may remind physicians of multiple myeloma or metastatic carcinoma, but although unusual, ALCL should be considered in the differential diagnosis .
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Conflict of interest
The authors declare that they have no conflict of interest.
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