PMC9203203_01
Right axillary lymph node biopsy. (a) Proliferation of large, atypical cells with irregular nuclear contours, vesicular chromatin, and moderately abundant eosinophilic cytoplasm, with background small lymphocytes and eosinophils. (b) Proliferation of large, atypical cells alternating with areas of necrosis. (c) Lymphoma cells stain positive for CD30. (d) Lymphoma cells stain negative for ALK. Right chest wall mass biopsy with (e) large lymphoma cells within background fibrosis, small lymphocytes, and eosinophils (f) with associated adjacent necrosis (g) with lymphoma cells staining positive for CD30.
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Ultrasound guided biopsy of right chest wall mass in November 2019 showed a CD30-positive, ALK-negative ALCL which was negative for DUSP22 and TP63 gene rearrangements (Figure 1).
(a) Baseline: (A) axial PET, (B) CT, and (C) fused images from an FDG-PET/CT scan performed at baseline demonstrate a large, infiltrative mass in the right chest wall measuring approximately 13 x 10 x 20 cm. The mass spans the subcutaneous, muscular, and chest wall compartments with extension into the pleural/extrapleural compartments (arrows). (D) A maximum intensity projection (MIP) image shows the large extent of disease. (b) Post treatment: (A) Axial PET after treatment with 6 cycles of CHP/BV, Surgery and XRT, (B) CT, and (C) fused images with stable postsurgical changes showing (d) overall significant positive response with slight interval increase in interstitial opacity in the central right breast with low-grade FDG uptake thought to be related to inflammation post radiation.
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Staging PET-CT showed a dominant, coalescent, and infiltrative 13 x 10 x 20 centimeter mass centered in the right anterior chest wall with extension into the pleural/extrapleural compartment along with involvement of regional lymph nodes and osseous invasion of the ribs consistent with advanced disease (Figure 2(a)). Restaging PET showed a complete metabolic response with SUVmax 3.9 and a Deauville score of 3 (Figure 2(b)).