SHM Converge Scientific Abstract ePoster Gallery-Cannonball: A Rare Transformation of Alk-Negative Primary Cutaneous Anaplastic Large Cell Lymphoma to Systemic Alcl With Pulmonary Metastases

Cannonball: A Rare Transformation of Alk-Negative Primary Cutaneous Anaplastic Large Cell Lymphoma to Systemic Alcl With Pulmonary Metastases

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This case describes a rare and aggressive transformation of primary cutaneous anaplastic large cell lymphoma (pcALCL) into systemic ALCL with lung metastases in a 60-year-old immunosuppressed woman who had previously undergone simultaneous pancreas-kidney transplant. She initially presented with a chronic, non-healing right lower leg wound. Biopsy of the lesion showed CD30-positive pcALCL, and she had a partial response to localized radiation therapy. Two months later, she developed progressive dyspnea and a non-productive cough. Chest CT demonstrated multiple bilateral pulmonary nodules with a classic “cannonball” appearance, raising concern for metastatic disease.<br /><br />She was transferred to a tertiary center, where bronchoscopy with endobronchial ultrasound-guided biopsy confirmed pulmonary metastases of CD30-positive, ALK-negative anaplastic large cell lymphoma, indicating transformation from a primary cutaneous to systemic process. She was started on systemic therapy with brentuximab-vedotin plus CHEP (cyclophosphamide, doxorubicin, etoposide, prednisone). Her hospital course was complicated by tumor lysis syndrome, toxic/metabolic encephalopathy, and infectious issues including bacteremia and C. difficile colitis, though she remains clinically stable and has resumed therapy after a brief delay.<br /><br />The authors note that systemic spread of pcALCL is extremely uncommon, occurring in fewer than 2% of cases. This report is notable as the first documented transformation of pcALCL to systemic ALCL in a transplant recipient. The case highlights the potential role of immunosuppression, ALK-negative status, and rapid pulmonary progression as poor prognostic factors. It underscores the importance of early recognition of transformation and timely escalation to aggressive systemic treatment in post-transplant patients.

Asset Subtitle

Aneesha Raj

Meta Tag

Author List Andrew Para, Aneesha Raj, Tessa Lavorgna

Category Clinical Vignettes

Concept Primary Cutaneous Anaplastic Large Cell Lymphoma

Concept Immunosuppression

Concept Systemic Dissemination

Concept Systemic Anaplastic Large Cell Lymphoma

Concept Transplant Patient

Distinguished Non-Finalist

Presenter Organization University of Miami

Presenting Author Aneesha Raj

Track Adult

Keywords

primary cutaneous anaplastic large cell lymphoma

systemic ALCL

lung metastases

immunosuppressed transplant recipient

pancreas-kidney transplant

CD30-positive

ALK-negative

cannonball pulmonary nodules

brentuximab vedotin

tumor lysis syndrome

Primary Cutaneous Anaplastic Large Cell Lymphoma

Immunosuppression

Systemic Dissemination

Systemic Anaplastic Large Cell Lymphoma

Transplant Patient