International Journal of Clinical Case Reports 2015, Vol.5, No. 33, 1-3
1
A Letter Open Access
Metachronous Cutaneous Anaplastic Large T Cell lymphoma and Multiple
Myeloma in the Same Patient
Bel Feki N. , Ben Ghorbel I., Ben Salem T., Houman M. H.
Department of Internal Medicine, University hospital of La Rabta, Tunis, Tunisia
Corresponding author email
International Journal of Clinical Case Reports, 2015, Vol.5, No.33 doi: 10.5376/ijccr.2015.05.0033
Received: 16 Jun., 2015
Accepted: 18 Jul., 2015
Published: 14 Aug., 2015
Copyright
©
2015 Feki et al., This is an open access article published under the terms of the Creative Commons Attribution License, which permits unrestricted use,
distribution, and reproduction in any medium, provided the original work is properly cited.
Preferred citation for this article:
Bel Feki N., Ben Ghorbel I., Ben Salem T., and Houman M. H., 2015, Metachronous Cutaneous Anaplastic Large T Cell lymphoma and Multiple Myeloma in
the Same Patient, International Journal of Clinical Case Reports, 5(33) 1
-
3 (doi
Abstract
Metachronous lymphomatous proliferations of B and T lineage in the same patient are a very rare event. We report the
case of a 48-year-old male patient presenting with stage IIIb multiple myeloma treated with first line chemotherapy who developed
six months later erythematosus and ulcerated nodule in the anterior aspect of the thigh related with metastatic cutaneous anaplastic
large T cell lymphoma.
Keywords
Multiple myeloma; Cutaneous Anaplastic Large T Cell lymphoma
Introduction
Occurrence of multiple myeloma and another
hematpoietic disorder in the same patient is well
known and is usually attributed to coincidence
(Bruyant, 1982). All the cases reported in the English
language literature are described as case reports and
usually associate mycosis fungoides (MF) or Sezary
syndrome (SS) (Carton, 1999) to a multiple myeloma
(MM) (Venencie, 1984; Gernone, 2002) or to a
monoclonal gammopathy of undetermined significance
(MGUS) (Ruffieux, 1984).
We report the clinical, histological, and laboratory
features of an unusual case of multiple myeloma
followed by a cutaneous anaplastic large cell lymphoma.
Case
A 48-year-old male came to our attention for lower
back pain of several weeks duration with fatigue and
anorexia. Physical examination revealed no apparent
abnormality. His temperature was 37°C, pulse 90/min,
and blood pressure 120/70. Laboratory data showed
hemoglobin of 10.3 g/dl, creatinine 20 mg/l, calcium
147 mg/l, and gamma globulin peak on serum protein
electrophoresis. Immunofixation on serum showed the
spike to be IgG kappa. The test of distinctive tumor
markers showed no abnormalities. Furthermore,
skeletal surveys showed multiple and diffuse lytic
lesions of lumbar vertebra. Vertebral biopsy showed a
plasma cell infiltration. The cells expressed CD138+.
Bone marrow cytomorphological examination showed
that dystrophic plasma cells were about 20%. The
diagnosis of multiple myeloma Stage III-b was made.
The patient was treated with thalidomide-dexamethasone
and received calcitonine as symptomatic treatment for
hypercalcaemia. Three months later, the patient was
better, serum electrophoresis, calcium level, and cell
blood count were normal. Six Months later, he
developed a raised erythematosus and ulcerated
nodule in the anterior aspect of the thigh. The patient
denied any constitutional symptoms as fever, weight
loss or night sweats. A contrast CT of chest, abdomen,
and pelvis revealed magma of lymphadenopathy in the
right groin. The skin and lymph node biopsies showed
a dense and diffuse infiltrate made of large cells with
irregular shaped nuclei, prominent nuclei and
abundant eosinophilic cytoplasm. Tumour cells were
admixed with small reactive lymphocytes and plasma
cells. Immunohistochemical study showed that tumor
cells stained positive with CD30, EMA, bcl2, CD45,
and negative for CD3, CD8, CD5, CD20, CD79a,
CD 138 and anaplastic lymphoma kinase (ALK)
protein. The diagnosis of a metastatic cutaneous
anaplastic large cell lymphoma was retained. Therapy
was started by CHOP (Cyclophosphamide, Adriamycin,
Oncovin, Prednisone) chemotherapy. Unfortunately,
the patient died of a heart attack after his fourth CHOP
cure.
Discussion
This case is striking because anaplastic lymphoma
coincided with myeloma. We suppose that the origin
