A case of anaplastic large cell lymphoma with central nervous system involvement at initial diagnosis

Abstract

We report the case of a 5-year-old boy with an anaplastic large cell lymphoma (ALCL) associated with central nervous system infiltration, which entered remission after chemotherapy, intrathecal injection, and irradiation. At admission, the lymphadenopathy extended from his left neck to the supraclavicular fossa. MRI showed a tumor in the brain, and the cerebrospinal fluid cytology was positive for tumor cells. PET-CT images revealed many abnormal accumulations in the bone and in the subcutaneous and intracranial masses (in addition to the primary lesion). The bone marrow examination showed normal findings. The pathological findings of a cervical lymph node biopsy led to a diagnosis of ALK-positive ALCL, stage IV. The patient received chemotherapy with the ALCL99 protocol regimen and a regimen containing high doses of methotrexate and cytarabine. Ten intrathecal injections were administered; after the third injection, the cytology became negative. Craniospinal irradiation (18 Gy in 12 fractions) was also performed. He has remained in remission for 51 months after diagnosis and 31 months after the end of treatment.