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Peripheral eosinophilia camouflaging anaplastic large cell lymphoma
Michelle L E Powers1, Brian W Watson, John L Frater
1Department of Pathology and Immunology, Washington University School of Medicine, Saint Louis, Missouri 63110, USA. mpowers@path.wustl.edu
International Journal of Surgical Pathology
|September 23, 2008
Summary
Persistent eosinophilia can indicate serious conditions like cancer. This case highlights Anaplastic Large Cell Lymphoma (ALCL) presenting as eosinophilia, emphasizing comprehensive diagnostics over assuming myeloid disorders.
Area of Science:
- Hematology
- Oncology
- Pathology
Background:
- Eosinophilia is a common finding with various causes, including infections, drug reactions, and malignancies.
- Anaplastic Large Cell Lymphoma (ALCL) with tissue eosinophilia is rare and typically does not present with significant leukocytosis.
Observation:
- A patient presented with marked leukocytosis and profound peripheral eosinophilia, initially suspected to be a chronic myeloproliferative disorder.
- Diagnostic evaluation revealed Anaplastic Large Cell Lymphoma (ALCL) in the bone marrow, obscured by myeloid hyperplasia and eosinophilia.
Findings:
- This case demonstrates ALCL masquerading as a myeloid malignancy due to significant eosinophilia and leukocytosis.
- Bone marrow involvement by ALCL is uncommon and usually associated with lytic bone lesions, which were absent in this patient.
Implications:
- Emphasizes the necessity of thorough T-cell malignancy workup, including ALCL, in cases of marked eosinophilia.
- Highlights a rare presentation of ALCL primarily involving bone marrow without radiographic evidence of bone lesions.
- Suggests re-evaluating diagnostic approaches for unexplained eosinophilia to include less common hematologic malignancies.