Anaplastic large cell lymphoma (ALCL) is a
neoplasm of activated lymphocytes, commonly expressing T-cell
antigens and cytotoxic
proteins. Histopathology reveals distinctive infiltration of sinuses and paracortical T-cell-rich regions of lymph nodes by
tumor cells which have abundant cytoplasm and large irregular/convoluted nuclei, and which are frequently multinucleated with prominent nucleoli. ALCL often presents in advanced clinical stages with B symptoms; extranodal disease occurs in 40% of patients. The pathogenesis of systemic ALCL is linked to phosphorylation of a
tyrosine kinase (ALK) resulting in unregulated growth of affected lymphoid cells. ALK is activated through
chromosomal translocations/inversions with any of several partner genes, most commonly
nucleophosmin (NPM). Downstream signal transduction pathway(s) are not fully defined but appear to involve
phospholipase Cgamma,
phosphatidylinositol (PI)3K/Akt, and STAT-3 and STAT-5
proteins. Primary cutaneous ALCL appears to have a different pathogenesis and better prognosis than does systemic ALCL, presenting as one or more skin
tumors, usually localized. Excision or local irradiation is usually effective treatment. A clinically benign variant of primary cutaneous ALCL is
lymphomatoid papulosis (LyP), characterized by recurrent crops of papules/nodules up to 2 cm in diameter which undergo
spontaneous regression. LyP is managed by observation, ultraviolet light
therapy, or low-dose
methotrexate. LyP patients have a predisposition to develop
malignant lymphomas, including
Hodgkin's lymphoma,
mycosis fungoides, and
non-Hodgkin's lymphoma, by as yet unknown mechanisms. The prognosis for patients with LyP is otherwise excellent.