A rare cause of breast masses in childhood: ALK positive anaplastic large cell lymphoma

Abstract

Objective: Non-Hodgkin's lymphomas (NHLs) are the result of malign proliferation of lymphoid cells. According to the morphological, immunological and genetic characteristics of childhood NHLs, they are classified as Burkitt lymphoma (BL), Lymphoblastic lymphoma (LL), diffuse large B-cell lymphoma (DLBCL) and anaplastic large cell lymphoma (ALCL). Anaplastic large cell lymphoma is a distinct form of non-Hodgkin lymphoma (NHL) which accounts for 15% of all childhood lymphomas. We report a girl presented with a breast mass and diagnosed with systemic ALCL.

Case: A 14-year-old girl was referred to our hospital with without a painless mass in the left breast. Physical examination, it was seen two painless mass was found in the left breast. Also, a 2x2 cm, painless lymphadenopathy was found in the left axilla. She had no systemic symptoms In laboratory tests; hemoglobin, white blood cell count, platelet count, liver and kidney function tests, LDH, and uric acid levels were normal. In the imaging and metastasis screenings made to the patient; ultrasound and computed tomography (CT) showed two masses breast region. A large number of lymphadenopathies were detected in the left axillary, which surrounded the paraaortic, the paracaval, and the celiac truncus. She was found to have a hypermetabolic two masses in the breast (SUVmax=33.05) and lymphadenopathies (SUVmax=27.04) in the left axillary, paraaortic, the paracaval, and the celiac truncus on Fluorine-18 fluorodeoxyglucose positron emission tomography/computed tomography (¹⁸F-FDG PET/CT) scan. Excisional biopsy of the tumor mass in the breast was done and immunohistochemical analysis showed CD30 and anaplastic lymphoma kinase (ALK) positive ALCL. The patient was diagnosed with stage III anaplastic large cell lymphoma with systemic involvement and she began chemotherapeutic treatment, according to the NHL BFM 1995 protocol. Bone marrow aspirate was normal, and no malignancy was observed in the cerebrospinal fluid. After V-phase, AM block, and BM block treatments evaluation were performed with ¹⁸F-FDG PET/CT according to protocol. In ¹⁸F-FDG PET/CT, it was seen that the lymph nodes in the abdominal and the small mass in the breast were completely retracted, and another lymph nodes had no detected. These results showed that the response to the treatment was complete and the patient's chemotherapy was completed by continuing with the protocol. ¹⁸F-FDG PET/CT taken after the completion of chemotherapy revealed no evidence of mass or lymph node. The patient's controls continue smoothly.

Conclusions: Anaplastic large cell lymphoma should also be considered in the differential diagnosis of children presented with a breast mass. Treatment procedures should be planned according to the involvement site and spread of the disease.