PMC5470561_01
- Photomicrography of the lymph node. A - Presence of large, atypical, sometimes multinucleated neoplastic cells (HE, 100X); B - CD30 positive, note the lymph node sinusoidal pattern infiltration (IH, 40X); C - ALK protein positivity (IH, 10X); D - High proliferation rate showed by Ki67 (IH, 10X).
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The proliferation rate, evaluated by Ki67, was positive in 99% of the neoplastic cell population (Figure 1).
PMC5470561_02
- Photomicrography of the bone marrow. A - (HE, 10X); and B - (HE, 100X) showing infiltration by large, atypical, neoplastic cells, with some multinucleated cells in a horseshoe pattern ("hallmark cells"); C - Immunohistochemistry positivity for CD-30 (100X); D - Immunohistochemistry positivity for ALK protein (100X).
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The diagnosis was confirmed by the immunohistochemical report, which showed a profile consistent with ALK+ ALCL: (positive for CD30, ALK, and EMA, and negative for CD20, CD3, CD15, CD43, CD34, CD31, and myeloperoxidase) (Figure 2).
- Photomicrography of the lymph node. A - Effacement of the original architecture due to sinusoidal infiltration by large atypical multinucleated cells (HE, 100X); B - Immunohistochemistry positivity for CD30 (HE, 400X).
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- A - Photomicrography of the liver showing microscopic and multifocal infiltration of the portal tract by large atypical multinucleated cells (HE, 400X); B - Photomicrography of the lung showing focal infiltration of large atypical multinucleated cells in the parenchyma and perivascular. Note hemorrhagic foci and organizing pneumonia (HE, 100X).
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The lungs, liver, and spleen also showed lymphomatous infiltration (Figure 4).