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CORRESPONDENCE
Year : 2019  |  Volume : 64  |  Issue : 1  |  Page : 83-84
Cutaneous abscess: An isolated manifestation of disseminated anaplastic large-cell lymphoma in a child


1 Department of Pediatrics, Division of Pediatric Hemato Oncology, Sri Ramachandra University, Chennai, Tamil Nadu, India
2 Department of Pediatrics, Sri Ramachandra University, Chennai, Tamil Nadu, India
3 Department of Pathology, Sri Ramachandra University, Chennai, Tamil Nadu, India
4 Division of Pediatric Hemato Oncology, Sri Ramachandra University, Chennai, Tamil Nadu, India

Date of Web Publication7-Jan-2019

Correspondence Address:
Dr. Latha M Sneha
Department of Pediatrics, Division of Pediatric Hemato Oncology, Sri Ramachandra University, Chennai, Tamil Nadu
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ijd.IJD_514_16

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How to cite this article:
Sneha LM, Ramaswamy S, Shalini S, Scott J. Cutaneous abscess: An isolated manifestation of disseminated anaplastic large-cell lymphoma in a child. Indian J Dermatol 2019;64:83-4

How to cite this URL:
Sneha LM, Ramaswamy S, Shalini S, Scott J. Cutaneous abscess: An isolated manifestation of disseminated anaplastic large-cell lymphoma in a child. Indian J Dermatol [serial online] 2019 [cited 2019 Mar 23];64:83-4. Available from: http://www.e-ijd.org/text.asp?2019/64/1/83/249544




Anaplastic large-cell lymphoma (ALCL) is a rare large-cell malignant non-Hodgkin's lymphoma and accounts for 10%–15% of pediatric non-Hodgkin's lymphoma. Systemic ALCL manifesting as isolated skin abscess with no hepatomegaly or lymphadenopathy in the pediatric age group is very rare.

A 4-year-old boy, immunized for age, with no previous history of any serious illness presented with complaints of fever for 3 months and nonhealing abscess over the left gluteal region for 2 months. The child was initially seen by a general physician, a pediatrician, and a dermatologist for the skin lesion. Repeated incision and drainage and multiple courses of oral antibiotics had no effect. The abscess had progressed to a chronic ulcer when the child came to us. On examination, his anthropometric indices were appropriate for age, and he had no hepatosplenomegaly or lymphadenopathy. A 5 cm × 4 cm ulcer was seen over the left gluteal region [Figure 1]. Blood investigations were normal. Gram stain and culture of the ulcer revealed no infectious etiology. Regular dressing and intravenous antibiotics had no healing effect on the ulcer. The child continued to have high-grade fever spikes, and all infectious etiological investigations were negative. Biopsy of the ulcer revealed cells with high mitotic index, and immunohistochemistry was suggestive of anaplastic lymphoma kinase (ALK)-positive ALCL [Figure 2]. The metastatic evaluation revealed disseminated disease. The child became afebrile, 48 h after starting chemotherapy, and there was a complete healing of the ulcer after 2 cycles of chemotherapy [Figure 3]. Isolated skin abscess as the presenting feature of disseminated ALCL in the pediatric population is rarely reported.
Figure 1: Ulcer over the left gluteal region

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Figure 2: Anaplastic lymphoma kinase positivity (Immunohistochemistry, ×10)

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Figure 3: Completely healed ulcer after 2 cycles of chemotherapy

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Among all subtypes of non-Hodgkin's lymphoma, ALCL has been found to have more of primary cutaneous origin (10%).[1] ALCL has two subtypes: primary cutaneous in which tumor is confined to the skin and systemic ALCL which presents with systemic disease. ALK-positive ALCL is a systemic disease and frequently involves the extranodal sites. The extranodal lesions involved are skin (21%), bone (17%), soft tissue (17%), lungs (11%), and liver (8%).[2] In the pediatric population, 18%–25% of systemic ALCL will develop skin manifestations during the disease, and this has been considered as a poor prognostic marker.[3] The common cutaneous manifestation of systemic ALCL is solitary or multiple red papules or nodules. Two-thirds of pediatric ALCLs present with systemic disease at diagnosis, including the extranodal tissues such as skin.[4] Mora et al. had reported 52 pediatric patients with large-cell lymphoma, of them 9 showed skin involvement.[5] Isolated cutaneous involvement by lymphomas is infrequent in children, and presentation can be confused with tuberculosis clinically. Only biopsy of the lesions would help in diagnosis.

Abscess is a common finding in the pediatric population, and hence, a chronic cutaneous lesion not responding to conventional treatment, with systemic manifestation such as fever, should alert the physician to look for other differential diagnoses. General physicians and dermatologists should be aware of the cutaneous manifestation of lymphomas in the pediatric population.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
   References Top

1.
Mendiratta V, Gandhi N, Rana S, Shukla S, Ramchander. Isolated cutaneous involvement in a child with nodal anaplastic large cell lymphoma. Indian J Dermatol Venereol Leprol 2016;82:53-6.  Back to cited text no. 1
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2.
Willemze R, Jaffe ES, Burg G, Cerroni L, Berti E, Swerdlow SH, et al. WHO-EORTC classification for cutaneous lymphomas. Blood 2005;105:3768-85.  Back to cited text no. 2
    
3.
Le Deley MC, Reiter A, Williams D, Delsol G, Oschlies I, McCarthy K, et al. Prognostic factors in childhood anaplastic large cell lymphoma: Results of a large European intergroup study. Blood 2008;111:1560-6.  Back to cited text no. 3
    
4.
Cho KH, Choi WW, Youn CS, Kim CW, Heo DS. Skin is the frequent site for involvement of peripheral T-cell and natural killer cell lymphomas in Korea. J Dermatol 2000;27:500-7.  Back to cited text no. 4
    
5.
Mora J, Filippa DA, Thaler HT, Polyak T, Cranor ML, Wollner N. Large cell non-Hodgkin lymphoma of childhood: Analysis of 78 consecutive patients enrolled in 2 consecutive protocols at the Memorial Sloan-Kettering Cancer Center. Cancer 2000;88:186-97.  Back to cited text no. 5
    


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  [Figure 1], [Figure 2], [Figure 3]



 

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