PMC10176192_01
Images at diagnosis of primary and recurrent diseases. a Computed tomography (CT) imaging before scraping surgery at another hospital 12 months before admission showing a maxillary sinus lesion with bone destruction (left). CT 8 months after scraping surgery, which turned normal (right). b Contrast-enhanced MRI on admission to our hospital. The lesion was up to 30 x 30 mm in diameter on the left fifth rib. T2-weighted images were hypointense.
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A head CT scan showed a left maxillary lesion with bone destruction (Fig. 1a, left). After the gingival granulation tissue was scraped, the patient recovered from fever, and a second CT scan 8 months after scraping revealed normal findings (Fig. 1a right). The tumor was hypointense on both T1- and T2-weighted images (Fig. 1b).
Histology at diagnosis of primary and recurrent diseases. a Hematoxylin and eosin-stained section of the lesion on the left fifth rib. Atypical large cells with densely stained and swollen nuclei and abundant eosinophilic cytoplasm with occasional mitotic figures were observed. b Immunostained section of the lesion on the left fifth rib. The tumor cells were immunoreactive for CD30, and the nucleus and cytoplasm were positive for ALK1. c Hematoxylin and eosin-stained section of the lesion of the maxillary bone. A sheet-like proliferation pattern of large cells with a round, oval, kidney- or horseshoe-shaped nucleus and abundant cytoplasm wa observed. d Immunostained section of the lesion of the maxillary bone. The tumor cells were positive for CD30 and ALK1 (nuclear and cytoplasmic).
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These tumor cells were immunoreactive for CD30 (Fig. 2b), epithelial membrane antigen, and granzyme B. Their nuclei and cytoplasms were positive for ALK1 immunostaining (Fig. 2b) and negative for CD20 and CD79a. Reexamination of the pathological specimen of the left maxillary bone lesion revealed a sheet-like proliferation pattern of large cells with round, oval, kidney- or horseshoe-shaped nuclei and abundant cytoplasm (Fig. 2c). CD30 and their nuclei and cytoplasms were positive for ALK1 immunostaining (Fig. 2d). Considering these pathological results, we diagnosed the patient with recurrent systemic ALK-positive ALCL in the left fifth rib, at the primary site of the left maxillary bone.