Primary pulmonary anaplastic large cell lymphoma: case report and literature review

Primary anaplastic large cell lymphoma (ALCL) is a rare pulmonary malignancy. Due to its nonspecific clinical and radiologic manifestations, the disease presents a great challenge to pulmonologists. Appropriate invasive biopsy and immunohistochemistry are important for its diagnosis. Here, we report an ALCL case of a 27-year-old Chinese woman who presented to our hospital complaining of coughing for 10+ days and breath holding for 4-5 days after the event. Positive signs on physical examination were dull percussion sounds and decreased right lung breath sounds. Chest CT scans revealed central carcinoma and atelectasis of the right lung, pleural effusion, and lung mass. Pathology consultation showed a right main bronchial ALCL that involved the parabronchial lymph nodes but not the bronchial tangent. The patient discontinued treatment after right pneumonectomy and died two months later. Postoperative lung biopsy showed anaplastic tumor cells with large and multiple nuclei. The ALCL was characterized by the expression of T cell antigens, CD30 and ALK, as indicated by immunohistochemistry. We also reviewed the atypical cases of ALCL that were previously published. The results indicated that primary pulmonary ALCL is an extremely rare and easily misdiagnosed disease with non-specific clinical and imaging manifestations. Its diagnosis is based on biopsy and immunohistochemistry, and its prognosis is poor.