Published online Jun 6, 2021. doi: 10.12998/wjcc.v9.i16.4016
Peer-review started: January 9, 2021
First decision: February 11, 2021
Revised: February 22, 2021
Accepted: March 24, 2021
Article in press: March 24, 2021
Published online: June 6, 2021
Processing time: 116 Days and 0.3 Hours
Primary anaplastic large cell lymphoma of the lung represents a diagnostic challenge due to diverse manifestations and non-specific radiological findings, particularly in cases that lack extra-pulmonary manifestations and lung biopsy.
A 40-year-old woman presented with a 6-d history of fever, dry coughing, and dyspnea. Her white blood cell count was 20100/mm3 with 90% neutrophils. PaO2 was 60 mmHg and SaO2 was 90% when breathing ambient air. Chest computed tomography (CT) identified a solid nodule, 15 mm in diameter, with a poorly defined boundary in the upper right lung, and several smaller solid nodules throughout both lungs. Pulmonary artery CT and subsequent bedside X-ray showed diffuse patchy shadows throughout both lungs. Repeated cultures of blood samples and alveolar lavage failed to identify any pathogen. Due to the mismatch between clinical and imaging features, we conducted a bone marrow biopsy, and the results showed proliferation along all three lineages but no atypical or malignant cells. The patient received empirical antibacterial, antiviral, and antifungal treatments, as well as corticosteroids. The patient’s condition deteriorated rapidly despite treatment. The patient died 6 d after hospitalization due to respiratory failure. Post-mortem lung biopsy failed to show inflammation but identified widespread infiltration of alveolar septum by anaplastic lymphoma kinase (ALK)-positive anaplastic cells.
ALK-positive anaplastic large cell lymphoma could present as a primary pulmonary disease without extra-pulmonary manifestations.
Core Tip: Primary anaplastic large cell lymphoma of the lung represents a diagnostic challenge due to diverse manifestations and non-specific radiological findings. We report a case of rapidly progressing anaplastic lymphoma kinase (ALK)-positive primary pulmonary anaplastic large cell lymphoma (ALCL) with bilateral multiple pulmonary consolidations, presenting initially as an acute lung infectious disease. ALK-positive ALCL could present as a primary pulmonary disease without extra-pulmonary manifestations.