A Rare Case of Anaplastic Lymphoma Kinase-negative Anaplastic Large Cell Lymphoma Presenting as Right Heart Failure

A 17-year-old male was admitted with progressive dyspnea on exertion, generalized edema, loss of appetite, and weight loss for 4 months. Clinical examination revealed features of right heart failure. Transthoracic echo showed a large hyperechoic sessile mass (6.5 cm × 5 cm) in the right ventricle, extending to the right ventricular outflow tract with mild pericardial effusion. Color Doppler across the tricuspid valve showed severe tricuspid regurgitation. Contrast-enhanced computed tomography scan thorax showed a large heterogeneously enhancing soft tissue density lesion with multiple hypodense nonenhancing areas involving the anterior, middle, and posterior mediastinum, predominantly on the right with encasement and infiltration of mediastinal vessels, right atrium, right ventricle, trachea, bronchi, and right lung. Ultrasound-guided tru-cut biopsy of the mass showed anaplastic lymphoma kinase (ALK)-negative anaplastic large-cell lymphoma. A rare case of ALK-negative, anaplastic large cell lymphoma mediastinal mass as right heart failure in a young adult is unique.