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The management of breast implant-associated anaplastic large cell lymphoma in the setting of pregnancy: seeking for clinical practice guidelines. Arch Plast Surg 2021; 48:373-377. [PMID: 34352947 PMCID: PMC8342241 DOI: 10.5999/aps.2021.00185] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Accepted: 05/27/2021] [Indexed: 11/08/2022] Open
Abstract
Breast implant-associated anaplastic large cell lymphoma (BIA-ALCL) is a recently described form of T-cell non-Hodgkin lymphoma now formally recognized by the World Health Organization classification of lymphoid neoplasms. The aim of this paper is to report the first case of BIA-ALCL diagnosed in a pregnant patient. It is well known that BIA-ALCL appears as an indolent lymphoma with a good prognosis when diag-nosed at early stages and clinical guidelines for its management have been clearly published. Nevertheless, they lack a standardized approach for BIA-ALCL during pregnancy. With limited experience in our case, treatment has been safely postponed after term without affecting patient’s overall prognosis and without fetal complication. The fact that the disease was diagnosed at an early stage (stage I) undoubtedly influenced the course of treatment. A multidisciplinary approach weighing the risks and benefits of treatment is of paramount importance in order to ensure the best possible outcome for both the mother and her child and clinical update guidelines should be issued.
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Yamashita D, Shimada K, Kohno K, Kogure Y, Kataoka K, Takahara T, Suzuki Y, Satou A, Sakakibara A, Nakamura S, Asano N, Kato S. PD-L1 expression on tumor or stromal cells of nodal cytotoxic T-cell lymphoma: A clinicopathological study of 50 cases. Pathol Int 2020; 70:513-522. [PMID: 32424876 PMCID: PMC7496983 DOI: 10.1111/pin.12950] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2020] [Revised: 04/12/2020] [Accepted: 04/24/2020] [Indexed: 12/15/2022]
Abstract
Inhibitors of programmed cell-death 1 (PD-1) and programmed cell-death ligand 1 (PD-L1) have revolutionized cancer therapy. Nodal cytotoxic T-cell lymphoma (CTL) is characterized by a poorer prognosis compared to nodal non-CTLs. Here we investigated PD-L1 expression in 50 nodal CTL patients, with and without EBV association (25 of each). We identified seven patients (14%) with neoplastic PD-L1 (nPD-L1) expression on tumor cells, including three males and four females, with a median age of 66 years. One of the seven cases was TCRαβ type, three were TCRγδ type and three were TCR-silent type. Six of the seven cases exhibited a lethal clinical course despite multi-agent chemotherapy, of whom four patients died within one year of diagnosis. Morphological findings were uniform, with six cases showing centroblastoid appearance. Among nPD-L1+ cases, two of three examined had structural variations of PD-L1 disrupting 3'-UTR region. Notably, all of the TCRγδ-type nodal CTL cases showed nPD-L1 or miPD-L1 positivity (3 and 10 cases, respectively). TCRγδ-type cases comprised 42% of nPD-L1+ cases (P = 0.043 vs. PD-L1- ), and 35% of miPD-L1+ cases (P = 0.037 vs. PD-L1- ). The results indicate that PD-L1+ nodal CTL cases, especially of the TCRγδ type, are potential candidates for anti-PD-1/PD-L1 therapies.
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MESH Headings
- Adult
- Aged
- B7-H1 Antigen/metabolism
- Biomarkers, Tumor/metabolism
- Epstein-Barr Virus Infections/diagnosis
- Epstein-Barr Virus Infections/pathology
- Female
- Humans
- Lymphoma, T-Cell/diagnosis
- Lymphoma, T-Cell/metabolism
- Lymphoma, T-Cell/pathology
- Lymphoma, T-Cell, Peripheral/diagnosis
- Lymphoma, T-Cell, Peripheral/metabolism
- Lymphoma, T-Cell, Peripheral/pathology
- Male
- Middle Aged
- Prognosis
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Affiliation(s)
- Daisuke Yamashita
- Department of Pathology and Laboratory MedicineNagoya University HospitalAichiJapan
- Department of PathologyKobe City Hospital Organization Kobe City Medical Center General HospitalHyōgoJapan
| | - Kazuyuki Shimada
- Department of Hematology and OncologyNagoya University Graduate School of MedicineAichiJapan
| | - Kei Kohno
- Department of Pathology and Laboratory MedicineNagoya University HospitalAichiJapan
| | - Yasunori Kogure
- Division of Molecular OncologyNational Cancer Center Research InstituteTokyoJapan
| | - Keisuke Kataoka
- Division of Molecular OncologyNational Cancer Center Research InstituteTokyoJapan
| | - Taishi Takahara
- Department of Surgical PathologyAichi Medical University HospitalAichiJapan
| | - Yuka Suzuki
- Department of Pathology and Laboratory MedicineNagoya University HospitalAichiJapan
| | - Akira Satou
- Department of Surgical PathologyAichi Medical University HospitalAichiJapan
| | - Ayako Sakakibara
- Department of Pathology and Laboratory MedicineNagoya University HospitalAichiJapan
| | - Shigeo Nakamura
- Department of Pathology and Laboratory MedicineNagoya University HospitalAichiJapan
| | - Naoko Asano
- Department of Molecular DiagnosticsNagano Prefectural Suzaka HospitalNaganoJapan
| | - Seiichi Kato
- Department of Pathology and Laboratory MedicineNagoya University HospitalAichiJapan
- Department of Pathology and Molecular DiagnosticsAichi Cancer Center HospitalAichiJapan
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Yang S, Jiang WM, Yang HL. ALK-positive anaplastic large cell lymphoma of the thoracic spine occurring in pregnancy: A case report. World J Clin Cases 2019; 7:2857-2863. [PMID: 31616703 PMCID: PMC6789405 DOI: 10.12998/wjcc.v7.i18.2857] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2019] [Revised: 08/06/2019] [Accepted: 08/26/2019] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Anaplastic large cell lymphoma (ALCL) is a type of non-Hodgkin’s lymphoma (NHL). ALCL is rare as a bone lesion and in pregnancy.
CASE SUMMARY We present the first case of anaplastic lymphoma kinase (ALK)+ ALCL of the thoracic spine during pregnancy. A 25-year-old pregnant woman was presented to us at 24 wk’ gestation with severe back pain and weakness in the left lower limb. Imaging examination showed lesions at T10 and T11. She underwent posterior pedicle screw fixation and vertebroplasty. Pathological examination showed ALK+ ALCL. The patient chose to have therapeutic abortion after surgery and received chemotherapy in the hematology department. She now remains disease free with no neurological deficit after 30 mo’ follow-up.
CONCLUSION ALK+ ALCL with the thoracic spine involvement is uncommon, especially in pregnancy. Many symptoms can be misunderstood during pregnancy; therefore, when a pregnant patient has persistent back pain or lower limb neurological symptoms, imaging examinations should be performed.
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Affiliation(s)
- Sen Yang
- Department of Orthopedics, The First Affiliated Hospital of Soochow University, Suzhou 215000, Jiangsu Province, China
| | - Wei-Min Jiang
- Department of Orthopedics, The First Affiliated Hospital of Soochow University, Suzhou 215000, Jiangsu Province, China
| | - Hui-Lin Yang
- Department of Orthopedics, The First Affiliated Hospital of Soochow University, Suzhou 215000, Jiangsu Province, China
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Amante MA, Galagnara SJP, Ignacio J. Anaplastic large cell lymphoma in a pregnant Filipino woman successfully treated with prepartum and postpartum chemotherapy. BMJ Case Rep 2018; 2018:bcr-2018-225576. [PMID: 30209141 DOI: 10.1136/bcr-2018-225576] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Diagnosis of a malignancy during pregnancy presents a dilemma regarding the work-up and treatment of the patient. This report presents a 42-year-old woman on her 23rd week of pregnancy with multiple enlarging fungating violaceous skin masses. Biopsy of the dominant mass revealed anaplastic large cell lymphoma. Due to the progressive enlargement and increase in number of the masses, the patient was given two cycles of chemotherapy (doxorubicin, vincristine, cyclophosphamide and prednisone) before delivering a live baby boy via spontaneous vaginal delivery, Apgar 9.9, at 37 4/7 weeks. After delivery, she completed four more cycles of treatment. A full-body positron emission tomography scan done 2 months after the last chemotherapy showed no evidence of disease. The patient is doing well with no evidence of disease 9 months after treatment. Her baby is thriving and has no gross deformities and no developmental delays.
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Affiliation(s)
- Madelaine Amurao Amante
- Section of Medical Oncology, Department of Medicine, Philippine General Hospital, University of the Philippines Manila, Manila, Philippines
| | - Sharon Jane Pingol Galagnara
- Section of Perinatology, Department of Obstetrics and Gynecology, Philippine General Hospital, University of the Philippines Manila, Manila, Philippines
| | - Jorge Ignacio
- Section of Medical Oncology, Department of Medicine, Philippine General Hospital, University of the Philippines Manila, Manila, Philippines
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Mizutani K, Yamada S, Guo X, Futatsuya C, Kumagai M, Shioya A, Aikawa A, Nakada S, Kurose N, Minato H, Nojima T. An autopsy case of peripheral T cell lymphoma occurring in a postpartum woman: a unique case suggesting changes in the immunocharacteristics of lymphoma cells before and after delivery. Diagn Pathol 2018; 13:32. [PMID: 29788970 PMCID: PMC5964686 DOI: 10.1186/s13000-018-0707-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2017] [Accepted: 05/06/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The occurrence of malignant lymphoma after delivery is an extremely rare event. Although several cases of Hodgkin lymphoma and B cell lymphoma and a few cases of peripheral T cell lymphoma (PTCL) after delivery have been reported, there are no report of autopsy cases of PTCL in the puerperal period. CASE PRESENTATION A 32-year-old Japanese woman with a past medical history of atopic dermatitis and bronchial asthma presented with generalized eruptions four days after the delivery of her first child; generalized skin induration and lymphadenopathy subsequently emerged. A skin biopsy specimen showed the diffuse proliferation of atypical lymphoid cells that were immunohistochemically-positive for CD4 but negative for CD8. She was diagnosed as PTCL, not otherwise specified (PTCL, NOS). She died one year and three months after the onset of symptoms. At autopsy, the systemic infiltration of lymphoma cells into the whole body was observed. Unexpectedly, these lymphoma cells were immuno-reactive with CD8 but not with CD4. CONCLUSION The occurrence and development of PTCL after delivery with the shift from CD4 positivity to CD8 positivity may be associated with not only the selection of resistant subclone as a result of chemotherapy but also the changes of immune status before and after delivery.
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Affiliation(s)
- Kenichi Mizutani
- Department of Pathology and Laboratory Medicine, Kanazawa Medical University, 1-1 Daigaku, Uchinada, Kahoku, Ishikawa 920-0293 Japan
- Department of Pathology, Field of Oncology, Graduate School of Medical and Dental Sciences, Kagoshima University, 8-35-1 Sakuragaoka, Kagoshima, Kagoshima 890-8544 Japan
| | - Sohsuke Yamada
- Department of Pathology and Laboratory Medicine, Kanazawa Medical University, 1-1 Daigaku, Uchinada, Kahoku, Ishikawa 920-0293 Japan
| | - Xin Guo
- Department of Pathology and Laboratory Medicine, Kanazawa Medical University, 1-1 Daigaku, Uchinada, Kahoku, Ishikawa 920-0293 Japan
| | - Chizuru Futatsuya
- Department of Pathology and Laboratory Medicine, Kanazawa Medical University, 1-1 Daigaku, Uchinada, Kahoku, Ishikawa 920-0293 Japan
| | - Motona Kumagai
- Department of Pathology and Laboratory Medicine, Kanazawa Medical University, 1-1 Daigaku, Uchinada, Kahoku, Ishikawa 920-0293 Japan
| | - Akihiro Shioya
- Department of Pathology and Laboratory Medicine, Kanazawa Medical University, 1-1 Daigaku, Uchinada, Kahoku, Ishikawa 920-0293 Japan
| | - Akane Aikawa
- Department of Pathology and Laboratory Medicine, Kanazawa Medical University, 1-1 Daigaku, Uchinada, Kahoku, Ishikawa 920-0293 Japan
| | - Satoko Nakada
- Department of Pathology and Laboratory Medicine, Kanazawa Medical University, 1-1 Daigaku, Uchinada, Kahoku, Ishikawa 920-0293 Japan
| | - Nozomu Kurose
- Department of Pathology and Laboratory Medicine, Kanazawa Medical University, 1-1 Daigaku, Uchinada, Kahoku, Ishikawa 920-0293 Japan
| | - Hiroshi Minato
- Department of Pathology, Ishikawa Prefectural Central Hospital, 2-1 Kuratsukihigashi, Kanazawa, Ishikawa 920-8530 Japan
| | - Takayuki Nojima
- Department of Orthopaedic Surgery, Kanazawa University Hospital, 13-1 Takara-machi, Kanazawa, Ishikawa 920-8641 Japan
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Blessing or curse? Proteomics in granzyme research. Proteomics Clin Appl 2014; 8:351-81. [DOI: 10.1002/prca.201300096] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2013] [Revised: 11/29/2013] [Accepted: 12/21/2013] [Indexed: 01/08/2023]
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Freerksen N, Kirschner M, Pecks U, Westphal S, Jost E, Maass N, Bauerschlag DO. Fulminant puerperal sepsis due to anaplastic large-cell lymphoma (ALCL) with therapy-refractory cerebral edema. Arch Gynecol Obstet 2014; 290:191-3. [PMID: 24563187 DOI: 10.1007/s00404-014-3171-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2013] [Accepted: 01/27/2014] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Lymphoma is among the five most frequent malignancies during pregnancy while anaplastic large-cell lymphoma (ALCL) is rare, accounting only for 2-3 % of all adult-onset non-Hodgkin lymphomas. CASE REPORT A 23-year-old gravida 1, para 1 presented with puerperal mastitis and septicemia following secondary cesarean section. Mastitis had been present for a week prior to delivery. A CT scan for further diagnostics revealed numerous prominent lymph nodes. Cerebrospinal fluid testing, bone marrow and lymph node biopsy confirmed diagnosis of ALCL. Systemic and intrathecal chemotherapy was initiated, stabilizing the patient's clinical situation. 30 days postpartum (pp.), a cerebral edema was diagnosed responsible for cerebro-venous hypoperfusion. Immediate ventricle drainage and further therapeutic measures revealed no improvement. The patient died 33 days pp. CONCLUSION Puerperal septicemia seemingly caused by mastitis still needs rapid further evaluation if the patient's clinical presentation quickly declines despite antibiotic therapy. Immediate initiation of chemotherapy after confirmation of ALCL is required to increase the therapeutic benefit due to the poor prognosis of ALCL.
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Affiliation(s)
- Nele Freerksen
- Department of Obstetrics and Gynecology, University Hospital Aachen, Pauwelsstr. 30, 52074, Aachen, Germany,
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8
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Reproductive organ involvement in non-Hodgkin lymphoma during pregnancy: a systematic review. Lancet Oncol 2013; 14:e275-82. [DOI: 10.1016/s1470-2045(12)70589-2] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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Grandhi A, Boros AL, Berardo N, Reich RF, Freedman PD. Two cases of CD30+, anaplastic lymphoma kinase (ALK)-negative anaplastic large cell lymphoma with oral manifestations. Oral Surg Oral Med Oral Pathol Oral Radiol 2013; 115:e41-7. [DOI: 10.1016/j.oooo.2012.04.010] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2012] [Revised: 04/19/2012] [Accepted: 04/19/2012] [Indexed: 10/27/2022]
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10
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Hagiwara M, Tomita A, Takata K, Shimoyama Y, Yoshino T, Tomita Y, Nakamura S. Primary cutaneous CD30 positive T-cell lymphoproliferative disorders with aberrant expression of PAX5: Report of three cases. Pathol Int 2012; 62:264-70. [DOI: 10.1111/j.1440-1827.2011.02784.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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11
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Rizack T, Mega A, Legare R, Castillo J. Management of hematological malignancies during pregnancy. Am J Hematol 2009; 84:830-41. [PMID: 19844988 DOI: 10.1002/ajh.21547] [Citation(s) in RCA: 68] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
The management of hematological malignancies during pregnancy is a challenging endeavor, which not only requires technical skills and knowledge by the clinicians but also requires sound clinical judgment and compassion, keeping in mind the patient and family preferences and, ultimately, the wellbeing of the neonate. The incidence of hematological malignancies during pregnancy is rare, ranging from 1 in 1,000 to 1 in 10,000 deliveries, impeding the design and execution of large prospective studies. The purpose of this review is to evaluate the limited existing data and make useful suggestions in the management of acute and chronic leukemias, Hodgkin and non-Hodgkin lymphomas, plasma cell myeloma, and other hematological malignancies, such as myelodysplastic syndromes and hairy cell leukemia, during pregnancy.
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MESH Headings
- Abnormalities, Drug-Induced/etiology
- Abnormalities, Drug-Induced/prevention & control
- Abortion, Induced
- Adult
- Antiemetics/therapeutic use
- Antineoplastic Agents/administration & dosage
- Antineoplastic Agents/adverse effects
- Antineoplastic Agents/therapeutic use
- Cesarean Section
- Clinical Protocols
- Combined Modality Therapy
- Contraindications
- Disease Management
- Female
- Hematologic Neoplasms/drug therapy
- Hematologic Neoplasms/epidemiology
- Hematologic Neoplasms/therapy
- Humans
- Incidence
- Infant, Newborn
- Infant, Newborn, Diseases/chemically induced
- Infant, Newborn, Diseases/prevention & control
- Leukapheresis
- Pregnancy
- Pregnancy Complications, Hematologic/drug therapy
- Pregnancy Complications, Hematologic/epidemiology
- Pregnancy Complications, Hematologic/therapy
- Pregnancy Complications, Neoplastic/drug therapy
- Pregnancy Complications, Neoplastic/epidemiology
- Pregnancy Complications, Neoplastic/therapy
- Pregnancy Outcome
- Pregnancy Trimesters
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Affiliation(s)
- Tina Rizack
- Division of Hematology and Oncology, The Miriam Hospital, The Warren Alpert Medical School of Brown University, Providence, Rhode Island 02906, USA.
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12
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Peccatori FA, Azim HA, Pruneri G, Piperno G, Raviele PR, Preda L, Ciocca M, Orecchia R, Martinelli G. Management of anaplastic large-cell lymphoma during pregnancy. J Clin Oncol 2009; 27:e75-7. [PMID: 19506155 DOI: 10.1200/jco.2009.22.2042] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Fedro A Peccatori
- Department of Medicine, Division of Haematology-Oncology, European Institute of Oncology, Milan, Italy
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Alalade AO, Odejinmi FO. A rare and potentially fatal cause of pelvic pain in pregnancy: anaplastic large cell lymphoma. J OBSTET GYNAECOL 2007; 26:691-2. [PMID: 17071444 DOI: 10.1080/01443610600930621] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Affiliation(s)
- A O Alalade
- Department of Obstetrics and Gynaecology, Whipps Cross University Hospital, London, UK
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Iyengar P, Reid-Nicholson M, Moreira AL. Pregnancy-associated anaplastic large-cell lymphoma of the breast: a rare mimic of ductal carcinoma. Diagn Cytopathol 2006; 34:298-302. [PMID: 16544330 DOI: 10.1002/dc.20442] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
Anaplastic large-cell lymphoma (ALCL) is a rare T-cell lymphoma typically seen in children and young adults. It has been described in numerous sites; however, the breast is one of the least common locations. We herein report a case of ALCL arising in the breast of a 36-yr-old pregnant woman. To our knowledge this is the second such case in the English literature. We would like to highlight the cytologic and histologic features of ALCL, as this case was initially misdiagnosed as a ductal carcinoma. Differential diagnosis with other tumors is also discussed. This case serves to emphasize the importance of the triple test, and the need for correlation of fine-needle aspiration findings with core biopsy findings in breast tumor management.
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Affiliation(s)
- P Iyengar
- Department of Pathology, Memorial Sloan-Kettering Cancer Center, New York, New York
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