Primary Cutaneous CD30+Anaplastic Large Cell Lymphoma: A Case Report

Objective: In recent years, there is an upward trend in the incidence of skinlymphoma, and the primary cutaneous CD30+anaplastic large cell lymphoma is oneof the subtypes. Compared with other types of lymphoma, primary cutaneous CD30+anaplastic large cell lymphoma is a kind of indolent tumor. It is self-limited and doesnot progress with time. The prognosis of primary cutaneous CD30+anaplastic largecell lymphoma is generally excellent. Clinically, we should thorough understand thedisease. The early detection and diagnosis are important. We also should avoidover-treatment, and ensure the quality of patients’ life.Methods: We report one case with multiple nodules treated in the First AffiliatedHospital of Dalian Medical University.Case: A man, aged70, has had skin lesions since two month ago. The lesion beganas a nodule located in right forearm. After a week, some similar lesions presented onhis left leg. The lesions were asymptomatic. On June4,2012the patient was treated inthe dermatological department of the First Affiliated Hospital of Dalian MedicalUniversity. Physical examination: right forearm presented a grape-sized,well-demarcated, red-brown, nontender papule and left leg extensor side presentedseveral ill-defined, irregularly shaped fingernail-sized plaques with infiltration.Laboratory examination: Respectively B ultrasound examination showedlymphadenectasis in the both sides of the neck, axillas and groins. Enhanced neck CTscan did not show abnormalities signs, chest CT scan showed small nodules onright lower lobe and left upper lobe and ECG was normal. Abdominal color Dopplershowed fatty liver, and the gallbladder, pancreas, spleen, kidneys, retroperitonealshowed normal. Blood, urine, conventional biochemistry and electrolyte showednormal. Skin biopsy of leg lesion showed primary cutaneous CD30+anaplastic largecell lymphoma. Immunohistochemistry showed: CD3(+), CD4(+), CD8(+), CD30(+),and CD20(-), CD79α (-).On June18,2012the patient took an operation of the tumor on forearm, and thepathological examination showed:(forearm) cutaneous T-cell lymphoma, peripheralT-cell lymphoma, non-specific type. Immunohistochemistry showed: CD3(+), CD4(+),CD8(+), CD30(+), MUM-1(+), and CD20(-), CD56(-), CD79a (-),ALK(-), Ki-67(+60%).After1.5months the patient was treated in Peking University Third Hospital, andthe pathology consultation showed primary cutaneous anaplastic large cell lymphoma. After treated with interferon and electron beam irradiation, the disease is wellcontrolled without new lesions, and the primary rashes vanished.In May,2013, without obvious incentive, the patient felt pain in submandibularlymph nodes which showed progressively swelling. In Peking University ThirdHospital lymph node biopsy pathology suggested necrotic tissue. Bone marrow biopsyshowed no tissue involved. PET-CT showed the lesions on the left leg lateral tibialmuscle was metabolically active. Under the chin, the glucose metabolism of multiplebilateral neck lymph nodes increased, which was considered the performance of thelymphoma infiltration. The tissue out of the skin was considered to be involved byprimary cutaneous CD30+anaplastic large cell lymphoma. CHOPE chemotherapyregimen was given in June，July，August，September,2013，respectively. Before andafter each treatment, chest X-ray, ECG, B ultrasound of liver, gallbladder, pancreas,spleen, kidneys, blood, urine, stool and electrolytes, conventional biochemistry testshowed almost normal. Currently, the disease is well-controlled and the patient is stillwith follow-up.Conclusion:1. The primary cutaneous CD30+anaplastic large cell lymphoma is a kind of indolentskin lymphoma, with variant clinical manifestations, and is characterized by single ormultifocal papules, nodules with or without ulceration, and it is autoregressive.2.Only when the clinical manifestations, histopathological representation andimmunohistochemical expressions are closely combined together, the diagnosis ofprimary cutaneous CD30+anaplastic large cell lymphoma can be made clearly.3.The prognosis of primary cutaneous CD30+anaplastic large cell lymphoma isgenerally excellent. We Should choose appropriate treatment according to clinicalmanifestations, and avoid excessive treatment.