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NOT ALL SWELLING WITH REDNESS AND BAD SMELLY
DISACHRGE IS NECESSARLY AN ABSCESS

• Al-Sharabati, Mohamed Barakat, MD, Pathologist
• Rasheed, Osaid, RN, CNS.

• Al-Ahli Hospital
• ( Dr. Hafiz A-Nabi CE Center ),
• Al-Makassed Hospitals Palestine
• 2009

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General Problem

• A 22 yrs old female recently gave birth at a
  peripheral hospital.
• Since early pregnancy she felt a small nodule at
  the left inguinal region.
• The nodule increased in size and was associated
  with genital progressive swelling with redness
  and very bad smelly discharge, treated with ABs
  without improvement.
• She was discharged home after giving birth.
• Drainage of the mass in an outpatient clinic was
  done for several weeks, accompanied by ABs.

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Clinical History

• The patient was admitted to Al-Ahli Hospital SW,
  few weeks after delivery.
• The CBC showed leukocytosis ( 21,100 ) with 86
  Neutrophil count.
• Provisional Dx was Inguinal Lympho Granuloma ? ,
  Vulval tumor ? , Chronic Abscess ?

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Contd

• An incisional biopsy was taken and sent for the
  pathology department at Al-Ahli Hospital.

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Histopathological Examination
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Histopathological Examination
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Dx LARGE CELL LYMPHOMA
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Confirmation and Immuno Stain

• The tumor cells are positive for EMA, MIB-1,
  CD30, and ALK protein ( Anaplastic Lymphoma
  Kinase ).
• Focally positive for CD3.
• Negative for CD2, and CD10.

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Immunostain CD30 ve
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Immunostain ALK Protein ve
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Immunostain EMA ve
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Immunostain CD3 ve
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Immunostain CD2 -ve
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Final Diagnosis

• Cutaneous Anaplastic Large cell lymphoma , CD30
  ALK Positive.

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Current Status

• The patient is completely cured, 2 years after
  the appearance of the first lesion and 1 year
  after chemotherapy ( M.A.C.O.P-B ).

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Inguinal Region Surgical Scar
Lt Thigh
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Discussion

• C-ALCL affects mainly adults with an MF ratio of
  2-31. ( Bekkenk et al, 2000 )
• Most patients present with solitary cutaneous
  tumor.
• Extra cutaneous dissemination occurs in 10 of
  cases, mainly LNs. ( Liu et al , 2003 )
• Multifocal lesions in 20 of cases. ( WHO / EORTC
  Classification, 2005 )
• ALK pos are diagnostic and favorable prognostic
  markers. ( Delsol et al, 2006 )
• The prognosis is usually favorable with a 10-year
  disease-related survival exceeding 90. ( Delsol
  et al, 2006 )

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Conclusion

• Primary Cutaneous CD30 Lyphoproliferative
  Disorders ( LPDs ).
• This group includes C-ALCL, LyP, and borderline
  cases.
• It is now generally accepted that C-ALCL and LyP
  form a spectrum of disease, and that histological
  criteria alone are often insufficient to
  differentiate between these two ends of this
  spectrum. ( Willemze et al, 2000 and WHO/EORTC
  Classification for CL, 2005 )
• The clinical appearance and course are used as
  decisive criteria for the definite diagnosis and
  choice of treatment. ( WHO/EORTC Classification
  for CL, 2005 )
• The term borderline case refers to cases in
  which, despite careful clinico-pathological
  correlation, a definite distinction between
  C-ALCL and LyP cannot be made.
• Clinical examination during further follow up
  will generally disclose whether the patient has
  C-ALCL or LyP. ( Bekkenk et al, 2000 )

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• Disease is of old and nothing about it has
  changed.
• It is WE who change when we learn to recognize
  what formerly was imperceptible.
• Jean Marie Charcot 1825-1893
• Physician, Salpetriere Hospital, Paris

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