Elsevier

World Neurosurgery

Volume 88, April 2016, Pages 688.e13-688.e16
World Neurosurgery

Case Report
Anaplastic Lymphoma Kinase–Negative Anaplastic Large Cell Lymphoma Manifesting as a Scalp Hematoma After an Acute Head Injury—a Case Report and Literature Review

https://doi.org/10.1016/j.wneu.2015.11.020Get rights and content

Background

Anaplastic large cell lymphoma (ALCL) is a malignant non-Hodgkin lymphoma, typically associated with anaplastic lymphoma kinase (ALK) expression. In some cases, lack of ALK translocation correlated with a more unfavorable prognosis.

Case Description

We describe a case of ALK ALCL that manifested as a progressive, enlarged, swollen mass on the scalp after an acute head injury in an 84-year-old man. Neither palpable lymph nodes nor any B symptoms were noted on admission. Brain computed tomography showed a hematoma in the right posterior occipital region of the scalp as the only remarkable finding. Débridement and biopsy were performed. Histologic and immunohistochemical analysis of the specimen revealed an ALK ALCL of the scalp. The lymphoma was resistant to bendamustine-containing chemotherapies, ultimately leading to the patient's death within 2 months.

Conclusions

This case report highlights the importance of recognizing the possibility of an ALCL manifesting as a focal inflammatory swelling mass on the scalp.

Introduction

Anaplastic large cell lymphoma (ALCL) that is anaplastic lymphoma kinase (ALK)–negative is categorized as a rare aggressive hematopoietic malignancy that originates from cytotoxic T cells. It accounts for 2%–3% of non-Hodgkin lymphomas and 12% of T cell non-Hodgkin lymphomas.1 ALK ALCL is clinically characterized by the presence of B symptoms, including fever, night sweats, and weight loss. Lymph node involvement is present in >50% of patients, and elevated lactate dehydrogenase (LDH) levels in serum are often observed on laboratory investigations.2

A common traumatic scalp hematoma eventually being identified as a highly malignant lymphoma is very rarely seen in clinical practice or the published literature.3, 4 We present a case of ALK ALCL masked by an accidental scalp hematoma, which is an unexpected clinical presentation.

Section snippets

Case Description

An 84-year-old man fell and hurt his head on a closet 5 days before visiting our hospital. The right posterior occipital region of his head began to swell and grew into an intolerably painful mass with an ulcerated lesion, and a severe headache had persisted since then (Figure 1A). Brain computed tomography revealed a right posterior occipital scalp hematoma (Figure 1B). Secondary infectious cellulitis was believed to be present, and nonsteroidal antiinflammatory drugs and antibiotic agents

Discussion

ALCL is a rare, aggressive malignancy that accounts for 2%–3% of non-Hodgkin lymphomas and 12% of T cell non-Hodgkin lymphomas.2 It is typically associated with the genetic rearrangement of ALK and is characterized by strong expression of CD30. However, some cases lack ALK translocation. ALK ALCL demonstrated a worse prognosis with 5-year survival rates of only 40%–60% compared with 70%–90% for ALK+ ALCL.5

In contrast to ALK+ ALCL, ALK ALCL primarily affects older adults. The median patient

Conclusions

A local swelling mass on the scalp after an acute head injury might be generally treated as an inflammation or infection, and intracranial hemorrhage, trauma, and skull fracture can be ruled out by routine examinations. Nevertheless, factors such as old age, a traumatic persisting scalp mass with ulceration, and the mottled density of this lesion on computed tomography images should provide clues to a differential diagnosis, such as a rare type of lymphoma might lurk underneath. This case

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  • Conflict of interest statement: The authors declare that the article content was composed in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

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