International Journal of Clinical Case Reports 2015, Vol.5, No. 33, 1-3
2
of those two diseases is unique and divert from the
same malignant clone even if the immunoglobulins
have different phenotypes. In fact, any cell lineage has
the potential to differentiate into other lineages in the
absence of a master gene expression (Graf, 2002). In
transgenic mice model of NPM-ALK, development of
thymic T cell lymphomas was associated with clonal
B cell plasma cell neoplasms (Chiarle, 2003).
It is reported that pro-B cells have pluripotent
differentiation potential and can differentiate into many
other different lineages (Nutt, 1999). Authors found
that multiple myeloma cells could be induced to
differentiate into multiple cell types, including T cells
(Liu, 2009; Jiang, 2013).This concludes that the
occurrence of myeloma and anaplastic lymphoma in
our case is probably due to the multilineage
differenciation of pro B or plasma cell.
Anaplastic large-cell lymphoma, T, is a rare disease,
accounting for less than 5% of all cases of
non-Hodgkin’s lymphoma (Weisenburger, 2001). It
occurs predominantly in adults. As in our patient, it
mainly appears as solitary or localized skin lesion.
Extra cutaneous dissemination is a rare event.
Expression of EMA by anaplastic T lymphocytes in
our patient raises the possibility of primary nodal
origin. However, lack of expression of Ki-1 antigen
argues for the primary cutaneous nature as it is
consistently negative at this location and is present in
the majority of systemic Anaplastic Large T Cell
Lymphoma (Decoteau, 1996; Weedon, 2006). According
to the Dutch Cutaneous Lymphoma Group, chemoth-
erapy is indicated for patients presenting an
extracutaneous dissemination (Bekkenk, 2000). In our
patient, polychemotherapy was indicated because he
was considered at metastatic stage with lymph node
invasion. To the best of our knowledge, we report the
fifth case which associates a multiple myeloma to a
cutaneous anaplastic large cell lymphoma (Wickenhauser
1999; Quian, 2006; Nassiri, 2009; Tangour, 2011)
In summary, our case demonstrated a rare event of
metachronous development of lymphoproliferative
neoplasms of B and T-cell lineage in the same patient
with poor response to therapy and fatal outcome.
Compilation of additional cases with molecular
studies will be helpful to investigate further the
pathogenesis of these two neoplasms.
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