Primary ALK-negative anaplastic large cell lymphoma with extensive bone involvement mimicking multiple myeloma and metastatic carcinoma

Excerpt

A 68-year-old woman presented with a 4-month history of intense and diffuse bone pain, weight loss, and night sweats. Initially, the pain was localized in the right iliac and sacral region, but later it spread to both arms and legs. Physical examination revealed no lymphadenopathy or hepatosplenomegaly. Laboratory tests showed anemia (hemoglobin 8.5 g/dL), leukocytosis (13 × 10⁹/L) with neutrophilia (9 × 10⁹/L), elevated C-reactive protein (68.5 mg/L) and erythrocyte sedimentation rate (127 mm/hr). Other results, including platelets, lactate dehydrogenase, calcium, uric acid, serum protein electrophoresis, immunofixation for monoclonal proteins, and renal, liver, thyroid and parathyroid function testes, were normal. 18-Fluorodeoxyglucose positron emission tomography/computed tomography scanning (¹⁸F-FDG PET/CT, Fig. 1a) showed increased FDG uptake in multiple bone osteolytic lesions with cortical permeation-associated soft tissue components localized in right radio and humerus, right ilium and sacral wing (SUV_max 11.3, Fig. 1b), right and left femur (SUV_max 12.5, Fig. 1c) and proximal third of right fibula.

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