Anaplastic large cell lymphoma of the spinal cord

<span class="paragraphSection">A 28-year-old man with unremarkable past history presented with a 2-month history of low back pain and 3-day history of fever. Physical examination revealed limited range of motion while bending. His routine blood investigations showed a white blood cell count of 35 × 10<sup>3</sup>/μl; platlet count of 653 × 10<sup>3</sup>/μl; Hgb of 11.6 g/dl and ESR of 78 mm/1 h,CRP of 23.90 U/l, LDH of 260 U/l, ALP of 86 U/l. MRI of S-spine showed bony destruction over S1 surrounded by inflammatory process from S4 to S2 with epidural invasion. <a href="#hcw200-F1" class="reflinks">Figure 1a</a>. The patient underwent empiric antibiotic treatment with vancomycin and ceftriaxone due to suspected underlying osteomeylitis. Given the known compression on MR image, urgent surgical decompression and fusion was elected to prevent progressive neurological decline. Histological specimen analysis was consistent with highly aggressive anaplastic large cell lymphoma composed of moderate to large sized lymphoid cells with hyperchromatic nuclei and moderate amount of eosinophilic cytoplasma. The tumor was CD2(+), CD4(+), CD30(+), CD45(+) and negative for other markers, suggestive of a T-cell phenotype. Immunochemistry was positive for Epithelial Membrane Antigen (EMA), ALK, CD45, CD30, CD2, CD4, and vimentin(+); and negative for CK, CD34, CD138 (<a href="#hcw200-F1" class="reflinks">Figure 1b</a>)The pat...
Source: QJM - Category: Internal Medicine Source Type: research