PMC7225296_01
Cervical lymph node biopsy showed effacement of architecture (A) with atypical cells, often containing "hallmark" cells with kidney-shaped nuclei (B). Immunohistochemical stains showed these neoplastic cells to be weak or negative for CD3 (C) and strongly positive for CD30 (D). ALK1 immunostain showed granular cytoplasmic positivity (E) while TIA1 was variably positive (F). Staining for histiocyte CD68 showed increased histiocytes.
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F1
The neoplastic cells were immuno-reactive against CD30, ALK (diffuse, cytoplasmic), CD2, CD4, granzyme B, and TIA-1 (Figure 1).
Graphical representation of next-generation sequencing translocation analysis. Reads aligned with exon 20 of ALK1 were found to be adjacent with reads aligned with exon 7 of the TRAF1 gene. E-score represents a confidence score whereby lower values reflect higher confidence of sequence alignment in the reads.
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F2
Following confirmation of the diagnosis with NGS translocation analysis (Figure 2), a bone marrow biopsy was performed and showed extensive disease (Figure 3).
Bone marrow biopsy showed diffuse involvement by lymphoma (A). Atypical cells, morphologically similar to those seen in the lymph node biopsy, were also present (B).
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F3
Following confirmation of the diagnosis with NGS translocation analysis (Figure 2), a bone marrow biopsy was performed and showed extensive disease (Figure 3).