Objective: Anaplastic large cell lymphoma(ALCL) which was described in 1985, is rare subtype among non-hodgkin lymphomas with rate of 2%. ALCL is located’ mature T and NK neoplasms’ group in 2016 WHO’ mature lymphoid, histiocytic and dendritic neoplasms’ classification. Besides ALCL subdivided into anaplastic lymphoma kinase (ALK) negative (−), ALK positive (+), primary cutaneous, group of associated with breast implant. CD30 and ALK are key molecules at pathology, diagnosis, treatment of ALCL. ALK (+) ALCL has a better prognosis than ALK (−) ALCL. Peripheral and mediastinal-abdominal lymphadenopathies (LAP), appears in more than half of patients. Approximately 60% of patients have extranodal involvement. The most common extranodal involvement sites are; skin, bone, liver, lung, spleen, bone marrow and soft tissue. Rare involvement occurs in the central nervous system and gastrointestinal tract. We wanted to our patient with ALK (−) ALCL diagnosed with tongue root biopsy in order to contribute to the literature.
Case report: It was learned that a-60-year old female patient applied to the otolaryngology department with the complaint of swelling in the neck, and in her detailed examination, tonsillectomy and tongue root biopsy was performed due to suspicious mass. The patient direct to us on the reporting of tongue root biopsy pathology as ALK(−) ALCL. PET-CT was taken for staging. As a result of PET-CT: left submandibular 15mm×8mm LAP (SUVmax: 4.15), right submandibular 14mm×10mm LAP (SUVmax: 6.32), left jugular 27mm×37 LAP (SUVmax: 15.91), left deep servical 11mm×8mm (SUVmax: 10.35), left supraclavicular 13mm×10mm (SUVmax: 15.08) was detected and there was no involvement in bone marrow biopsy. The patient was considered stage ll ALK (−) ALCL. A total of 6 cure of CHOEP (cyclophosphamide 100mg/day, vincristine 2mg/day, adriamycin 85mg/day,etoposide 150mg/day and methlylprednisole 100mg/day) were planned. In the evaluation after 6 cure chemotherapy:the patient with complete remmision was followed up.
Conclusion: Although ALCL is rare, it is a disease that needs to be diagnosed and treated quickly due to its clinical course. Although skin, bone, liver, lung, spleen, bone marrow and soft tissue involvement are common, it should be kept in mind that it can be seen rare cases such as central nervous system, gastrointestinal system and tongue root as that our case. Protocols containing anthracycline such as CHOP/CHOEP (cyclophosphamide, doxorubucin, vincristine, prednisone/cyclophosphamide, doxorubucin, vincristine, etoposide, prednisone) form the basis of treatment. Non-CHOP induction strategies:ifosfamide, carboplatin, etoposide (ICE), autologous stem cell transplant/allogeneic stem cell transplant after ICE plus intrathecal methotrexate. Despite this protocols and new treatment agents (pralatrexate, ibrutinib, etc.) early diagnosis is very important at ALCL.
