Anaplastic large cell lymphoma, ALK-negative exhibiting rare CD4 [  +] CD8 [ +] double-positive immunophenotype

AbstractAnaplastic large cell lymphoma is a relatively rare type of T cell lymphoma characterized by strong and uniform CD30 expression with a typical cohesive growth pattern and hallmark cells. Most cases are single-positive for CD4 or less often CD8-positive, with only very rare descriptions of having double positivity for both antigens. Agent Orange is a herbicide which was used during the Vietnam War and has been associated with non-Hodgkin lymphoma (including chronic lymphocytic leukemia, hairy cell leukemia, and other chronic B cell leukemias), Hodgkin lymphoma and monoclonal gammopathy of undetermined significance. Herein, we describe a unique case of anaplastic large cell lymphoma ALK-negative arising in a military veteran with documented Agent Orange exposure featuring double positivity for both CD4 and CD8 with a brief literature review that highlights the uniqueness of this rare phenotype. Our patient underwent a left neck lymph node biopsy that was worked up for a lymphoproliferative process. Based on the diagnosis rendered, a T cell lymphoma fluorescence in situ hybridization [FISH] panel was done. T cell receptor gene rearrangement studies could not be performed due to consumption of the material. A core biopsy of the left neck lymph node showed an infiltrate of frankly malignant large lymphoid cells with many featuring eccentric horseshoe/kidney shaped nuclei with an eosinophilic region near the nucleus, consistent with hallmark cells with admixed small lymphoc...
Source: Journal of Hematopathology - Category: Pathology Source Type: research