Journal of Pathology and Translational Medicine

Case Report

Metallic implant-associated lymphoma: ALK-negative anaplastic large cell lymphoma associated with total knee replacement arthroplasty: Jai-Hyang Go; J Pathol Transl Med. 2023;57(1):75-78. Published online January 10, 2023; DOI: https://doi.org/10.4132/jptm.2022.10.30

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Metallic implant-associated lymphomas are extremely rare. Only seven cases have been reported in association with knee joint arthroplasty, and all tumors were large B-cell lymphomas. This report is the first case of anaplastic large cell lymphoma occurring after total knee replacement arthroplasty. An 80‑year‑old female patient was admitted because of right knee pain for 2 years. She had undergone total knee replacement arthroplasty 10 years prior. Computed tomography showed an irregular osteolytic lesion in the right lateral femoral condyle, adjacent to the metallic prosthesis. Histologic findings reveal sheets of anaplastic tumor cells that were positive for CD2, CD4, CD5, CD43, and CD30 but negative for CD3, CD20, CD15, and anaplastic lymphoma kinase. Epstein-Barr encoding region in situ hybridization was negative. Analysis of T-cell receptor γ gene rearrangement studies using BIOMED-2–based multiplex polymerase chain reaction confirmed monoclonal T cell proliferation. The woman was finally diagnosed with ALK-negative anaplastic large cell lymphoma.

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Vanesa‐Sindi Ivanova, John Davies, Thomas Menter, Damian Wild, Anne Müller, Fatime Krasniqi, Frank Stenner, Alexandros Papachristofilou, Stefan Dirnhofer, Alexandar Tzankov
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Original Article

Analysis of Histologic Features Suspecting Anaplastic Lymphoma Kinase (ALK)-Expressing Pulmonary Adenocarcinoma: In Ho Choi, Dong Won Kim, Sang Yun Ha, Yoon-La Choi, Hee Jeong Lee, Joungho Han; J Pathol Transl Med. 2015;49(4):310-317. Published online June 22, 2015; DOI: https://doi.org/10.4132/jptm.2015.05.13

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Abstract PDF

Background
Since 2007 when anaplastic lymphoma kinase (ALK) rearrangements were discovered in non-small cell lung cancer, the ALK gene has received attention due to ALK-targeted therapy, and a notable treatment advantage has been observed in patients harboring the EML4/ALK translocation. However, using ALK-fluorescence in situ hybridization (FISH) as the standard method has demerits such as high cost, a time-consuming process, dependency on interpretation skill, and tissue preparation. We analyzed the histologic findings which could complement the limitation of ALK-FISH test for pulmonary adenocarcinoma. Methods: Two hundred five cases of ALK-positive and 101 of ALK-negative pulmonary adenocarcinoma from January 2007 to May 2013 were enrolled in this study. The histologic findings and ALK immunohistochemistry results were reviewed and compared with the results of ALK-FISH and EGFR/KRAS mutation status. Results: Acinar, cribriform, and solid growth patterns, extracellular and intracellular mucin production, and presence of signet-ring-cell element, and psammoma body were significantly more often present in ALK-positive cancer. In addition, the presence of goblet cell-like cells and presence of nuclear inclusion and groove resembling papillary thyroid carcinoma were common in the ALK-positive group. Conclusions: The above histologic parameters can be helpful in predicting ALK rearranged pulmonary adenocarcinoma, leading to rapid FISH analysis and timely treatment.

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Case Report

Effusion Cytology of Ki - 1 Positive Anaplastic Large Cell Lymphoma: A Case Report.: Mi Sook Lee, Mi Ja Lee, Yu Kyung Jeong, Sung Chul Lim, Keun Hong Kee, Ho Jong Jeon; Korean J Cytopathol. 1995;6(2):163-168.

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Abstract PDF: Ki-1 positive anaplastic large cell lymphoma is a newly described high-grade lymphoma and is defined by histopathological and immunologic criteria. We experienced a case of systemically involving Ki-1 positive anaplastic large cell lymphoma in a 44 year-old female which initially manifested as pleural effusion. Abdominopelvic CT scan showed the evidence of marked lymphadenopathy in retroperitoneal and both external and inguinal lymph nodes. On cytologic examination of pleural fluid tumor cells revealed pleomorphic large isolated cells with prominent nucleoli and abundant cytoplasms. The nuclei were large with irregular profiles including some deep invaginations. Also. occasional multilobed/multinucleated and binucleated nuclei were seen. Immunohistochemical examination was performed to differentiate from the undifferentiated adenocarcinoma. Hodgkin's disease, non-Hodgkin's lymphoma and malignant histiocytosis. The neoplastic cells were positive for leukocyte common antigen. CD3 CD30(ki-1) but negative for cytokeratin. epithelial membrane antigen. and CD15. A histologic diagnosis of Ki-1 positive anaplastic lymphoma was made by biopsies of the inguinal lymph node, polypoid lesion of the stomach and cecum.

Original Articles

Fine Needle Aspiration Cytology of Anaplastic Large Cell Lymphoma: A case mimicking malignant fibrous histiocytoma.: Jung Won Lee, Young Lyun Oh, Young Hyeh Ko; Korean J Cytopathol. 1998;9(1):99-104.

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Abstract PDF: Anaplastic large cell lymphoma(ALCL) is an uncommon type of non-Hodgkin's lymphoma(NHL) populated with anaplastic, often bizarre cells that express CD30 (Ki-1) antigen. The unusual histologic and cytologic features may cause confusion with other neoplasms, such as poorly differentiated carcinoma, melanoma, Hodgkin's disease, or true histiocytic lymphoma. Although the cytologic features of ALCL have been well described, there are few reports about cytologic findings of the sarcomatoid variant of ALCL. We experienced a case of fine needle aspiration(FNA) cytologic findings of ALCL which mimicks malignant fibrous histiocytoma. FNA cytology of chest wall mass in a 62-year-old female with a history of peripheral T-cell lymphoma(Lennert lymphoma) revealed a heterogeneous population of single cells and poorly cohesive cells with large, pleomorphic nuclei and spindle cells gathering around vascular structures within an inflammatory background. Additional features of the neoplastic cells were eccentric, multilobated nuclei with occasional "wreath-like" configuration; abundant cytoplasm with vacuolization; and prominent nucleoli. The cytologic features suggested sarcoma, especially malignant fibrous histiocytoma. The diagnosis was made retrospectively with an aid of immunocytochemical staining.

Cytomorphologic Comparison of Hodgkin Lymphoma and Anaplastic Large cell Lymphoma in Fine Needle Aspiration Cytology.: Seung Sook Lee, Jae Soo Koh, Sunhoo Park, Min Suk Kim, Soo Youn Cho, Soo Young Chung, Han Suk Ryu, Jung Soon Kim, Hwa Jung Ha, Baek Youl Ryoo; Korean J Cytopathol. 2006;17(2):126-135.

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Abstract PDF: To study the differentiating cytomorphological features of Hodgkin lymphoma (HL) and anaplastic large cell lymphoma (ALCL) using fine needle aspiration cytology (FNAC), cytomorphological features of 16 patients with HL (n=8) or ALCL (n=8) were analyzed. In the initial cytological diagnosis prior to biopsy, HLs were properly diagnosed in 4 out of 8 cases (4 HL, 2 atypical, 2 benign), whereas all ALCL were diagnosed as malignancies. However, correct diagnosis of non-Hodgkin lymphoma (NHL) was made in only two ALCL patients (2 NHL, 1 HL, 1 sarcoma, 4 malignancy without specific type). Overall, the percentage of large abnormal cells ranged from 30% to 90% in ALCL except for one case, whereas it was less than 5% in all 8 HL. A spectrum of atypical cells was more characteristic of ALCL. In contrast, HL showed an sharp difference between reactive lymphoid cells and neoplastic ones (bimorphic pattern). Moreover, the emergence of kidney-shaped abnormal cells or wreath-like multinucleated cells was helpful in diagnosing ALCL. The combination of thesefeatures would be useful in differentiating HL and ALCL. Nevertheless, these two types of lymphomas cannot be definitely distinguished based on cytomorphological features alone. Therefore, the aim of FNAC would be to suggest a specific diagnosis and indicate the need for a biopsy.

Immunohistochemical Study for Ki-1 and EMA Antigens in Large Cell Lymphoma including Anaplastic Large Cell Lymphoma.: Soon Ae Oak, Young Hyeh Ko, Jung Dal Lee; Korean J Pathol. 1994;28(2):135-143.

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Abstract PDF: To evaluate the frequency of EM A and Ki-I antigen expression in the large cell lymphoma and to define the histologic characteristics of Ki-1 positive anaplastic large cell lymphoma, 40 cases of malignant lymphoma, diffuse large cell type were immunostained by Ki-I and EMA monoclonal antibodies. Eight cases of large cell lymphomas expressed EMA, among which 4 cases were positive for Ki-I antibody as well. The positive rate for EMA was much higher in T cell lymphomas than in B cell lymphomas. Among 4 cases of Ki-I positive lymphomas, 2 cases showing membrane staining of Ki-1 with prototypic histologic feature of anaplastic large cell lymphoma were classified as Ki-1 positive anaplastic large cell lymphoma(ALCL). Ki-I positive ALCL were T-cell in one and non-T, non-B cell type in the other, respectively. The remaining 2 cases of Ki-1 positive lymphomas showing cytoplasmic staining were classified as both B-cell centroblastic/centrocytic lymphoma and T-cell pleomorphic large cell lymphoma.

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