Sarcomatoid variant of anaplastic large cell lymphoma mimicking a primary breast cancer: a challenging diagnosis.
ABSTRACT The sarcomatoid variant of anaplastic large cell lymphoma is one of the rarest histologic variants of this neoplasm. Due to its sarcomatoid features, it is frequently misdiagnosed as a poorly differentiated sarcoma, anaplastic carcinoma, or melanoma. We report the case of a 92-year-old woman with a sarcomatoid anaplastic large cell lymphoma mimicking a primary breast neoplasm. The patient presented with a rapidly enlarging lump in the left breast and nodules in the right axilla. The immunohistochemical profile showed reactivity for leukocyte common antigen, UCHL-1, vimentin, and CD30, but immunoexpression of anaplastic lymphoma kinase was lacking. Anaplastic large cell lymphomas are lymphoid neoplasms of T-cell/null-cell lineage that consistently express the activation marker CD30 and usually carry a gene rearrangement of the anaplastic lymphoma kinase gene. To the best of our knowledge, this is the first reported case of sarcomatoid anaplastic large cell lymphoma presenting as a primary breast neoplasm in which anaplastic lymphoma kinase expression was assessed.
- Archiv für Pathologische Anatomie und Physiologie und für Klinische Medicin 07/2003; 442(6):611-3. DOI:10.1007/s00428-003-0789-z · 2.56 Impact Factor
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ABSTRACT: Although primary carcinomas account for the majority of breast malignancies, nonepithelial malignancies form a subset that must be differentiated accurately for treatment purposes. The purpose of this study was to identify cytological characteristics that differentiate between these two entities. Twenty-six fine-needle aspiration (FNA) specimens with histological correlation were reviewed (five lymphomas, two myelomas, six sarcomas, seven melanomas, and six carcinomas). On review, nonepithelial tumors presented as single cells with scant or ill-defined cytoplasm with rare cluster formations present. In contrast, carcinomas were arranged predominantly in clusters and contained more-defined, abundant, and sometimes vacuolated cytoplasm. Moreover, a major aid to diagnosis was an accurate clinical history. We conclude that nonepithelial malignancies of the breast are best differentiated from epithelial malignancies by a combination of cytological features and clinical information. These findings emphasize the importance of the triple test, in which integration of cytological findings and clinical information play a key role. Diagn. Cytopathol. 2004;31:352–357. © 2004 Wiley-Liss, Inc.Diagnostic Cytopathology 11/2004; 31(5):352 - 357. DOI:10.1002/dc.20147 · 1.52 Impact Factor
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ABSTRACT: A rare case of a spindle cell (sarcomatoid) B-cell lymphoma is described. The patient, a 48-year-old male, presented with a several month history of an enlarging lesion on the scalp. Although there have been a few recent reports of cutaneous sarcomatoid lymphomas, this case is especially unusual because it presented as a scarlike plaque rather than a tumor and microscopically exhibited a prominent myxoid matrix. Given these features, the lesion was initially interpreted as an atypical fibromucinosis. The differential diagnosis included fibromucinous lesion consistent with variant of lichen myxedematosus, spindle cell carcinoma, spindle cell melanoma, atypical fibroxanthoma, and atypical smooth muscle tumors. Initial immunoperoxidase studies demonstrated negative staining for CD68, factor XIIIa, CD57, cytokeratin(AE1/AE3), S100, EMA, and vimentin, essentially ruling out the previously mentioned neoplasms. Subsequently, strong positive staining for LCA(CD45RB) and CD20 was demonstrated characteristic of a B-cell lymphoma. The patient underwent local radiotherapy with complete resolution. Although all variants of cutaneous sarcomatoid B-cell lymphomas are rare, it is imperative to consider them in the differential diagnosis of otherwise difficult to categorize spindle cell proliferations. This includes neoplasms and, based on the current case, fibromucinoses as well.American Journal of Dermatopathology 03/2007; 29(1):96-8. DOI:10.1097/01.dad.0000245205.52139.c1 · 1.43 Impact Factor