Is ALK-gene rearrangement overlooked in primary gastrointestinal T-cell lymphomas? About two cases

Wadad S. Mneimneh, Shikhar Gautam Vyas, Liang Cheng, Oscar Cummings, Magdalena Czader

Research output: Contribution to journalArticle

Abstract

A 41-year-old male patient with a history of ankylosing spondylitis and Crohn disease, treated with immunomodulators and disease-modifying drugs, was diagnosed with a primary intestinal T-cell lymphoma that followed a 7.5-year-course. This transmural proliferation lacked cytological characteristics of anaplastic large cell lymphoma (ALCL), and was CD8-positive, and CD30- and anaplastic lymphoma kinase (ALK)-negative by immunohistochemistry (IHC). However, ALK-gene rearrangement (ALK-gr) was detected by fluorescence in situ hybridization (FISH) in both initial and persistent disease. The possibility of indolent T-cell lymphoproliferative disease of the gastrointestinal tract with atypical features (transmural involvement) related to ALK-gr was suggested. A previous case of aggressive 'enteropathy-associated ALCL' in the context of celiac disease was recently reported, which also lacked anaplastic morphology, and where CD30 and ALK expression was incidentally demonstrated by IHC, and ALK-gr subsequently confirmed by FISH. These two recent cases represent two distinct rare entities pertaining to the group of primary intestinal T-cell lymphomas, and they both show unexpected ALK-gr. This suggests that ALK-gr has been overlooked in the group of primary intestinal T-cell lymphomas. Performing IHC and FISH tests for ALK-gr in primary gastrointestinal T-cell lymphomas might be of importance, particularly with the advancement of targeted therapy that could impact treatment and prognosis.

Original languageEnglish (US)
Pages (from-to)666-670
Number of pages5
JournalPathology International
Volume65
Issue number12
DOIs
StatePublished - Dec 1 2015

Keywords

  • Anaplastic large T-cell lymphoma
  • Anaplastic lymphoma kinase
  • Enteropathy associated T-cell lymphoma
  • Indolent T-cell lymphoproliferative disorder of the GI tract
  • Intestinal T-cell lymphoma

ASJC Scopus subject areas

  • Pathology and Forensic Medicine

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