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CASE REPORT Table of Contents   
Year : 2009  |  Volume : 52  |  Issue : 1  |  Page : 69-70
Anaplastic large-cell lymphoma with florid granulomatous reaction: A case report and review of literature


Department of Pathology, Chettinad Health City, IT highway Padur, Kancheepuram, India

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   Abstract 

Granulomatous reactions have been reported in association with lymphomas, more often with Hodgkins disease than with Non-Hodgkins Lymphoma. Not many reports are available on the association of anaplastic large-cell lymphoma with sarcoid-type granuloma. Herein, we report a case of an elderly female with generalized lymphadenopathy who had a florid granulomatous reaction almost masking the lymphoma cells in the lymph node biopsy. A detailed clinical history, careful histological examination and immunohistochemistry helped in attaining the correct diagnosis.

Keywords: Anaplastic large-cell lymphoma, sarcoid-like granuloma

How to cite this article:
Balamurugan S, Rajasekar B, Rao R R. Anaplastic large-cell lymphoma with florid granulomatous reaction: A case report and review of literature. Indian J Pathol Microbiol 2009;52:69-70

How to cite this URL:
Balamurugan S, Rajasekar B, Rao R R. Anaplastic large-cell lymphoma with florid granulomatous reaction: A case report and review of literature. Indian J Pathol Microbiol [serial online] 2009 [cited 2014 Oct 25];52:69-70. Available from: http://www.ijpmonline.org/text.asp?2009/52/1/69/44969



   Introduction Top


Epithelioid cell granuloma has been reported in association with a wide range of neoplasms including malignant lymphomas. Among lymphomas, this occurs more often in Hodgkins disease and T cell derived Non-Hodgkins Lymphoma where a granulomatous reaction is probably evoked by aberrant cytokine production in the tumor cells or other cells composing the tumor background. [1] However, not many reports are available in literature on the association of granuloma with anaplastic large-cell lymphoma. Herein, we report a case of anaplastic large-cell lymphoma with an unusual florid granulomatous reaction.


   Case Report Top


A 61-year-old female presented with a continued loss of weight over the past 2 months. Clinical examination showed enlarged axillary and inguinal lymph nodes. A computed tomography (CT) scan of the abdomen revealed adenopathy involving paraaortic, peripancreatic, superior mesenteric and celiac nodes. Matted right iliac nodes were seen compressing the lower third of the ureter causing hydroureteronephrosis. The liver and spleen were normal. Chest x-ray revealed cardiomegaly attributed to coexistent hypertension. Peripheral smear examination showed no abnormal cells. Biopsy of the right axillary node was performed and sent for a histopathological examination. Microscopic examination showed a lymph node partially replaced by a neoplastic infiltrate composed of highly pleomorphic cells. Many of the cells showed multinucleation, nuclear lobulation and high mitotic activity. Some of the cells resemble hallmark cells of anaplastic large-cell lymphoma [Figure 1]. The infiltrate was seen mainly in the parafollicular and subcapsular areas. The residual node showed reactive follicles and numerous non caseating sarcoid-like granulomas with Schaumann and Asteroid bodies [Figure 2] and [Figure 3]. There were also foci of hyalinization. Immunohistochemically, the tumor cells were found to be positive for CD 30 and CD3 and negative for ALK1.


   Discussion Top


Sarcoid-like granulomas may occur in association with Hodgkins disease and Non-Hodgkins Lymphoma. [2],[3],[4] The granulomas may be concomitant and so extensive that they may obscure the malignant process. In addition, a sarcoidosis-lymphoma syndrome has been described in which there appears to be a relationship between sarcoidosis and the development of a lymphoproliferative disorder. [4] However, this patient had no diagnostic clinical evidence of sarcoidosis. The relationship between the exuberant epithelioid granulomas and the underlying neoplastic lymphoid proliferation is not clear. [2] Regardless of whether it represents a distinct clinicopathological entity, recognition of this remarkable association has important practical implications since the lesions may be erroneously interpreted by the pathologist.

 
   References Top

1.Basu D, Bundele M. Angioimmunoblastic T-cell lymphoma obscured by concomitant florid epithelioid cell granulomatous reaction: A case report. Indian J Pathol Microbiol 2005;48:500-2.  Back to cited text no. 1    
2.Braylan RC, Long JC, Jaffe ES, Greco FA, Orr SL, Berard CW. Malignant lymphoma obscured by concomitant extensive epithelioid granulomas: Report of three cases with similar clinicopathologic features. Cancer 1977;39:1146-55.  Back to cited text no. 2  [PUBMED]  
3.Haralambieva E, Rosati S, van Noesel C, Boers E, van Marwijk Kooy M, Schuuring E, et al. Florid granulomatous reaction in Epstein-Barr virus-positive nonendemic Burkitt lymphomas: Report of four cases. Am J Surg Pathol 2004;28:379-83.  Back to cited text no. 3  [PUBMED]  [FULLTEXT]
4.Dunphy CH, Panella MJ, Grosso LE. Low-grade B-cell lymphoma and concomitant extensive sarcoidlike granulomas: A case report and review of the literature. Arch Pathol Lab Med 2000;124:152-6.  Back to cited text no. 4    

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Correspondence Address:
S Balamurugan
3D, K.G. Traditions, No.1, North Gopalapuram First Street, Chennai, Tamilnadu - 600 086
India
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DOI: 10.4103/0377-4929.44969

PMID: 19136786

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    Figures

  [Figure 1], [Figure 2], [Figure 3]



 

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