Nodal CD 30⁺p80⁺anaplastic large cell lymphoma with positive urine cytology-A case report

Abstract

A case of nodal CD 30⁺p 80⁺ anaplastic large cell lymphoma (ALCL) with positive urine cytology is described. A 22-year-old Japanese male presented with CD 30⁺p 80⁺ ALCL, involving bilateral cervical lymph nodes. Expression of CD 30 antigen on the lymphoma cells was identified, but there were no antigens associated with T, B and NK cells. However, DNA analysis revealed gene rearrangements of TCR β and δ. Both examinations showed that the lymphoma cells were of null phenotype and T cell genotype. Although no metaphases were seen of cytogenetic analysis, p 80^NPM/ALK protein, indicating the presence of t (2; 5)(p 23; q 35), was retrospectively examined immunohistochemically and was positive for lymphoma cells. The tumor responded adequately to the initial chemotherapy, but he relapsed with a huge retroperitoneal mass compressing the left kidney, with an aggressive clinical course. At this time, atypical large cells were seen in the urine making it difficult to distinguish lymphoma cells from carcinoma cells only by Papanicolaou and Giemsa staining because of cellular degeneration. As immunohistochemical examination of the cells in the urine smear revealed the large atypical cells to be positive for CD 30 and p 80 but negative for LCA and cytokeratin, a final cytological diagnosis of invasive lymphoma cells in the urinary tract was made. Despite additional chemotherapy and irradiation, the patient died 47 months after the onset.