Diffuse Large B-Cell Lymphoma with Anaplastic Clear Cells: A Rare Variant

Introduction: Diffuse Large B-Cell Lymphoma (DLBCL) is a heterogeneous group conformed by morphological and clinical varieties of neoplasms;it originates from peripheral B-cells and is distinguished into three groups: germinal center (GC), activated B lymphocyte (ABL), and the third type. The existence of DLBCL with anaplastic morphology and expression of CD30 without t (2;5) translocation is rare. The aim of the present article is to describe this morphologic variant in a 54-year-old woman and a 74-year-old man, respectively. Materials and Methods: Patients diagnosed with DLBCL with anaplastic variant were identified from the surgical pathology records. Results: Out of 357 biopsies with this diagnosis, 11 (3%) corresponded to the anaplastic variant, 2 presented morphological clear cells;they became visible because of an increase in volume in the cervical area of 4 months of evolution, usually associated to diaphoresis and weight loss with clinical fulminating progression. An autopsy study was performed to one patient and it showed infiltration in supraclavicular lymph nodes, thyroid, and lung. The neoplastic cells presented abundant clear cytoplasm and pleomorphic nuclei that expressed CD20, CD30 and CD45. Conclusion: This variation is rare. The clinical presentation and prognosis are controversial;we present the morphological and immunophenotype changes of this variant. The differential diagnosis from other clear cell neoplasms should be made.

Diagnosis and treatment of pediatric anaplastic lymphoma kinasepositive large B-cell lymphoma:A case report

BACKGROUND Anaplastic lymphoma kinase-positive(ALK+)large B-cell lymphoma(LBCL)is a rare type of lymphoma with high invasiveness and rapid progression.It occurs in all age groups,but is extremely rare in children.The lesions mainly involve the lymph nodes and may present with extra-nodal involvement.Response to conventional chemotherapies and local radiotherapy is poor,with a 5-year overall survival of less than 40%.Recently,the use of ALK inhibitors for the treatment of this disease has been reported.CASE SUMMARY We present a case of a 12-year-old boy diagnosed with ALK+LBCL.The patient had a 2-mo medical history of a calvarial mass,extensive systemic involvement,and positive bone marrow clathrin heavy chain(CLTC)-ALK fusion gene.Complete remission 1(CR1)was achieved using the modified LMB89 Group C regimen followed by autologous stem cell transplantation.The patient relapsed 3 mo later.He then achieved CR2 with three short courses of chemotherapy(COP,reduceddose ICE,low-dose Ara-c+VP16)and continuous alectinib targeted therapy.Afterward,allogeneic hematopoietic stem cell transplantation(allo-HSCT)was performed.At 16 mo after the allo-HSCT,the patient was still in CR2.CONCLUSION The modified LMB89 Group C regimen and ALK inhibitors are effective.Allo-HSCT should be performed after remission.

Transformation of Anaplastic Large Cell Lymphoma to High-grade Diffuse Large B-cell Ymphoma:Remission after Pegylated Liposomal Doxorubicin and Rituximab Immunotherapy

Summary:We demonstrate the usefulness of pegylated liposomal doxorubicin (PL-doxorubicin) combine with CD20 antibody Rituximab in a case of transformation of anaplastic large cell lymphoma (ALCL) to high-grade diffuse large B-cell lymphoma (B-DLCL).Case report:A 63-year-old woman suffering from anaplastic large cell lymphoma(stage Ⅳ a) since 2004 showed mediastinal relapse despite of 4 cyclesof chemotherapy following the