PMC4446009_01
The images of CT and cystoscopy in a patient with ALK-positive ALCL involving the urinary bladder.. Notes: (A) Enhanced CT scan showing an exophytic broad-based nodular lesion (white arrow) on the left bladder wall; (B) Cystoscopy revealing an irregularly shaped nodule with congestive and hemorrhagic appearance (black arrow).. Abbreviations: CT, computed tomography; ALK, anaplastic lymphoma kinase; ALCL, anaplastic large-cell lymphoma.
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A computed tomography (CT) scan showed an exophytic mass in the urinary bladder (Figure 1A), as well as a left kidney hydronephrosis and abdominopelvic lymphadenopathy. The patient underwent cystoscopy, which revealed an exophytic broad-based mass measuring 4.5 cm x3.6 cm on the left wall of the urinary bladder (Figure 1B).
H&E and IHC staining in the urinary bladder sample of ALK-positive ALCL.. Notes: (A) Diffuse infiltration of tumor cells in the lamina propria of bladder (200x, H&E); (B) Tumor cells with pleomorphic nuclei, prominent nucleoli, and brisk mitotic activity (400x, H&E); (C) Strong immunoreactivity of CD30 with membrane staining pattern in neoplastic cells (400x, IHC); (D) A diffuse cytoplasmic and nuclear staining for ALK protein (400x, IHC); (E) Negative expression of AE1/AE3 in tumor cells (200x, IHC); (F) Tumor cells exhibiting negative expression for synaptophysin (200x, IHC).. Abbreviations: H&E, hematoxylin-eosin; IHC, immunohistochemical; ALK, anaplastic lymphoma kinase; ALCL, anaplastic large-cell lymphoma.
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Histologically, the lamina propria of the bladder was diffusely infiltrated by pleomorphic large cells (Figure 2A). The majority of tumor cells had pleomorphic nuclei, prominent nucleoli, and brisk mitotic activity (Figure 2B). IHC staining showed that tumor cells were diffusely and strongly positive for CD30 (Figure 2C), ALK (Figure 2D), EMA, and vimentin. They were negative with AE1/AE3 (Figure 2E), CK20, CK7, CK5/6, P63, SMA, HMB-45, pan-Melan, S-100, Myo D1, synaptophysin (Figure 2F), CD56, desmin, CD15, CD20, Pax-5, and CD3.