Pulmonary Anaplastic Large Cell Lymphoma - a Rare Case

Anaplastic large cell lymphoma (ALCL) is a rare NHL, representing only 2-3% of all lymphomas. Pulmonary involvement is rare (5-15%). A thirty one year old female was admitted to a center with purulent fistulized lesions on the neck and axilla and enlargement of the breasts. There was no improvement with antibiotics and she had a fever. Pyogenic granulation was detected in the soft tissue biopsy of the axillary and breast. All the cultures were negative. Antituberculosis therapy was given for three months. This patient was admitted to our clinic due to clinical progression. Bilaterally painful, purulent flowing lesions on the neck and axilla, tension and sensitive breasts and high fever were found. Anemia, thrombocytosis, neutrophilic leukocytosis, low iron level and iron binding capacity and high CRP levels were detected in the laboratory tests. Anaerobic, actinomycosis, mycobacteria, nocardia and tularemia cultures were negative. Thorax CT showed a mediastinal conglomerate LN, left upper apicoposterior cavitary lesion and millimetric nodules. Abdominal CT was normal. Neck CT showed masses which erased the fat plain and submandibular LN. LN biopsy diagnosed an inflammatory variant of CD30(+) ALCL. It was considered to be stage IV due to pulmonary parenchyma, mediastinum, neck, axilla and breast involvement. After five chemotherapy sessions, there was a significant improvement in the lesions