Abstract
IntroductionALK-negative anaplastic large cell lymphoma (ALCL) is a peripheral T-cell lymphoma that usually involves lymph nodes or extranodal sites. Leukemic phase of ALK-negative ALCL is exceedingly rare and often carries a poor prognosis. Androgenic steroids have gained popularity among the young, and at higher doses, it can result in immune dysregulation and may be potentially carcinogenic. Case presentation: A 30-year-old gentleman of Malay ethnicity presented to the hematology department with night fevers, loss of weight and bony pain for the past 6 weeks. He is a gymnasium instructor with a history of chronic usage of intramuscular testosterone enanthate. Physical examination revealed ecchymosis over the left elbow and hepatomegaly. A complete blood count depicted anemia, thrombocytopenia and leucocytosis. An 18-Fluorodeoxyglucose positron emission tomography (18-FDG PET/CT) imaging showed a hypermetabolic anterior mediastinal mass of 6.8 × 7.0 × 6.5 cm with diffuse hypermetabolism in the liver, spleen and axial skeleton. The bone marrow trephine and mediastinal tissue histology were consistent with leukemic ALK-negative ALCL. He was treated with CHOEP (cyclophosphamide, doxorubicin, vincristine, etoposide, prednisolone) induction chemotherapy in which he required intensive antibiotic and blood support. He progressed with worsening B symptoms and new diffuse lymphadenopathies suggesting rapid dissemination of the disease. He subsequently succumbed to multiorgan failure with disseminated intravascular coagulopathy at the intensive care unit. Conclusion: Leukemic phase ALK-negative ALCL often carries a complex karyotype and requires early intensive polychemotherapy. Use of anabolic steroids depletes the ability of defending lymphocytes to remove tumour producing cells.
Highlights
ALK-negative anaplastic large cell lymphoma (ALCL) is a peripheral T-cell lymphoma that usually involves lymph nodes or extranodal sites
ALCL is defined as proliferation of large atypical pleomorphic lymphoid cells, known, as hallmark cells which contain horseshoe nuclei and often strongly expresses CD30 [2]
This case-study describes an aggressive leukemic phase ALKnegative ALCL in a young male adult who has been on chronic use of androgenic steroids
Summary
ALK-negative anaplastic large cell lymphoma (ALCL) is a peripheral T-cell lymphoma that usually involves lymph nodes or extranodal sites and affects predominantly older adults. ALCL is defined as proliferation of large atypical pleomorphic lymphoid cells, known, as hallmark cells which contain horseshoe nuclei and often strongly expresses CD30 [2]. Anabolic androgenic steroids are artificial agents which function via the androgen receptors and have gained popularity among the general public and athletes At higher doses, it can result in many undesirable effects such as liver malignancy, thrombotic events, immune dysregulation and is potentially carcinogenic [4]. It can result in many undesirable effects such as liver malignancy, thrombotic events, immune dysregulation and is potentially carcinogenic [4] This case-study describes an aggressive leukemic phase ALKnegative ALCL in a young male adult who has been on chronic use of androgenic steroids
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