Anaplastic Large Cell Lymphoma Misdiagnosed as Systemic Lupus Erythematosus: A Report of a Rare Case

Abstract

Non-Hodgkin lymphomas are a diverse group of lymphoproliferative disorders rising from the lymphocytes with a broad spectrum of histological characteristics and clinical manifestations that often complicate accurate diagnosis. Autoantibodies have been observed at higher frequencies in lymphoproliferative diseases, yet the precise role of the immune system and the underlying causative factors remain enigmatic. Anaplastic large cell lymphoma (ALCL), an aggressive non-Hodgkin's lymphoma variant, commonly presents in a manner akin to other aggressive lymphomas, featuring swift progression of peripheral and/or retroperitoneal adenopathy, accompanied by systemic symptoms like fever, night sweats, and weight loss. This case report delves into a histologically verified instance of ALCL, which strikingly emulates systemic lupus erythematosus. This report's objective is to underscore the concept that lymphoma can manifest clinical or biological features reminiscent of autoimmunity.

Keywords: autoimmune disorders; lymphadenopathy; misdiagnosis; multidisciplinary collaboration; non-hodgkin lymphoma; systemic lupus erythematosus.

Figure 1. Multiple brown-to-black patches and hypopigmented macules on hands.

Figure 2. Correlated Inguinal ultrasound shows multiple prominent bilateral oval-shaped inguinal lymph nodes with preserved fatty hilum.

Figure 3. Selected image of axial contrast-enhanced abdominal CT scan showing multiple enlarged pelvic lymph nodes, the largest measures about 24 x 14 mm noted at the left external iliac group.

Figure 4. Selected cut of enhanced axial abdominal CT scan showing multiple enlarged para-aortic lymph nodes, the largest measures about 19 x 12 mm noted at the left para-aortic group at the level of the left kidney hilum.

Figure 5. Selected image of axial contrast-enhanced abdominal CT scan showing multiple prominent bilateral inguinal lymph nodes.

Figure 6. (A) Monomorphic to pleomorphic large lymphocytes with prominent nucleoli and abundant eosinophilic cytoplasm (H&E: 20x); (B)Tumor infiltration of lymph node sinuses. Some of the large cells have horseshoe or doughnut-shaped nuclei (hallmark cells) (H&E: 40x); (C) Diffusely positive CD30 immunostaining.

H&E: hematoxylin and eosin; CD: cluster of differentiation