ALK+ Anaplastic large cell lymphoma with extensive cardiac involvement: A rare case report and review of the literature

Figures

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  Figure 1. A – Gross view of the mesentery showing multiple enlarged lymph nodes (arrow); B – Gross view of the enlarged mediastinal and hilar lymph nodes (arrow). The cut surface of the lymph node is solid, and tan-yellow; C and D – Photomicrographs of a lymph node ; C– showing diffuse and sinusoidal pattern of infiltration by neoplastic lymphoid cells (H&E, 40X); D -The tumor cells are large round with abundant eosinophilic cytoplasm and enlarged hyperchromatic to vesicular nuclei. The inset shows characteristic hallmark cells with horseshoe and multilobed nuclei (H&E, 200X).

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  Figure 2. Photomicrographs of the lymph node. The tumor cells show diffuse expression of CD45 (A, 200X), CD5 (B, 200X), CD30 (C, 200X) and ALK1 (nucleocytoplasmic, D) (400X).

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  Figure 3. Gross view of the heart in A– Anterior view with multiple solid firm nodular tumor deposits involving both the ventricles and atria; B– View of left ventricular inflow tract showing a segment of the lateral wall with the near-complete replacement of normal myocardium (arrow) by the tumor (arrowhead); C– View of right ventricular inflow tract showing multiple nodular tumor infiltration involving right atrium and ventricle. A polypoidal mass of tumor (arrowhead) was seen in the right atrial cavity above the septal leaflet of the tricuspid valve (arrow); D – Microscopic image shows predominantly tumor cells infiltrating the cardiac myocytes (H&E, 200X).

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  Figure 4. A– Gross image of the cut surface of the anterior mediastinal mass showing solid, tan-brown tumor (left) and lobulated normal-looking thymus (arrow); B– Microscopic image from normal-looking areas showing Hassall’s corpuscles and small lymphocytes (H&E, 200X); C– PanCK immunostain highlighting the epithelial network of the thymus (IHC, 100X); D– Infiltration of the thymic parenchyma (left) by the tumor cells (right) (H&E, 200X).

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  Figure 5. A– Gross image of the lungs showing pleural dullness and patchy consolidated areas. A single tan-yellow tumor deposit is also noted in the lower lobe (arrow); B– Closer view of a solid, yellowish subpleural tumor deposit; C– Microscopic image showing infiltration of the tumor cells in the alveolar cavity as well as the interstitium (H&E, 100X); D– The overlying visceral pleura is also infiltrated by the neoplastic cells (H&E, 100X).

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  Figure 6. Gross view of: A– single yellowish tumor nodule in the medulla of the kidney (arrows); B– The pancreas is bulky and the peripancreatic lymph nodes are enlarged (arrows); C– The serosal surface of the stomach is irregular and shows yellowish-brown tumor deposit (arrow); D– The visceral peritoneum of small intestine and mesentery show tiny tumor deposits (arrows)

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  Figure 7. A– Photomicrograph of the spleen showing increased histiocytes and hemophagocytosis (arrowhead) (H&E, 200X); B– Photomicrograph of the bone marrow showing hemophagocytosis (arrowhead) (H&E, 1000X).