Small Cell Variant of Anaplastic Lymphoma Kinase-Positive Anaplastic Large Cell Lymphoma of the Dura Mimicking Tentorial Meningioma.

Abstract

BACKGROUND:

Primary central nervous system (CNS) anaplastic large cell lymphoma (ALCL) is an uncommon type of brain tumor, usually treated with a regimen that includes high-dose methotrexate (MTX). Only a few cases of primary CNS anaplastic lymphoma kinase (ALK)-positive ALCL have been reported so far, with no reported cases of a small cell variant.

CASE DESCRIPTION:

A 26-year-old man presenting with headache and visual field impairment was found to have a supratentorial mass mimicking meningioma. Craniotomy was performed for tumor resection, and postoperative histologic examination revealed atypical cells that were nonenlarged lymphocytes with irregularly shaped and enlarged nuclei; these cells were cluster of differentiation 30 and ALK-positive, leading to the diagnosis of a small cell variant of ALK-positive ALCL. In this case, the tumor exhibited an aggressive behavior with MTX resistance with metastases in the pelvis but responded well to cytarabine and etoposide (CYVE).

CONCLUSIONS:

In general, CNS ALK-positive ALCL responds well to MTX, but small cell variants show aggressive behavior and may be resistant to MTX. For small cell variants of ALCL that are resistant to MTX therapy, as in this case, CYVE therapy may be an effective treatment.

• Authors: Yudai Hirano, Satoru Miyawaki, Michiaki Satou, Kazuki Taoka, Kazuhiro Toyama, Masako Ikemura, Ryo Tanaka, Shunsaku Takayanagi, Shota Tanaka, Hirofumi Nakatomi, Mineo Kurokawa, Nobuhito Saito
• Journal: World neurosurgery (World Neurosurg) Vol. 138 Pg. 169-173 (06 2020) ISSN: 1878-8769 [Electronic] United States
• PMID: 32151774 (Publication Type: Case Reports)
• Copyright: Copyright © 2020 Elsevier Inc. All rights reserved.

Chemical References

• Antineoplastic Agents
• Cytarabine
• Etoposide
• Anaplastic Lymphoma Kinase
• Methotrexate

Topics

• Adult
• Anaplastic Lymphoma Kinase
• Antineoplastic Agents (therapeutic use)
• Cytarabine (therapeutic use)
• Diagnosis, Differential
• Etoposide (therapeutic use)
• Humans
• Lymphoma, Large-Cell, Anaplastic (diagnosis, drug therapy, pathology)
• Male
• Meningeal Neoplasms (diagnosis, pathology)
• Meningioma (diagnosis, pathology)
• Methotrexate (therapeutic use)
• Supratentorial Neoplasms (diagnosis, drug therapy, pathology)