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There are four different types of ALCL. How to diagnose them to avoid misdiagnosis?
There are many types of malignant lymphoma, among which anaplastic large-cell lymphoma (ALCL) is an important category of non-Hodgkin's lymphoma. ALCL arises from abnormal T cells and can result in a variety of clinical manifestations. According to the World Health Organization (WHO) classification, ALCL can be divided into four types, each with different genetic abnormalities, prognosis and treatment.
“ALCL is a complex disease that requires precise diagnosis to distinguish between the four different types.”
Four types of ALCL
The four main types of ALCL include: ALK-positive ALCL (ALK+ ALCL), ALK-negative ALCL (ALK− ALCL), primary cutaneous ALCL (pcALCL), and breast implant-associated ALCL (BIA-ALCL). These types differ significantly in clinical presentation and genetic abnormalities.
ALK-positive ALCL
ALK-positive ALCL is more common in children and young adults and usually presents with systemic symptoms such as fever, night sweats, and weight loss. Patients with this type often present with advanced disease at the time of diagnosis, with systemic symptoms present in approximately 75% of cases. This type of diagnosis relies primarily on pathological examination and immunological testing, which usually reveal characteristic "marker cells." These cells strongly express CD30 and ALF fusion proteins on their surface.
"The diagnosis of ALCL not only relies on microscopic examination, but also requires precise molecular testing to determine the type."
ALK-negative ALCL
ALK-negative ALCL is common in middle-aged and elderly patients, and the patients are usually older than ALK-positive ones. Most patients present with advanced disease at the time of diagnosis, and these patients do not have ALK autoantibodies. Although considered to have a poor prognosis, ALK-positive and ALK-negative ALCL have similar prognoses when matched for age and clinical grade.
Primary cutaneous ALCL (pcALCL)
pcALCL is a type of cutaneous T-cell lymphoma that usually appears on the skin of middle-aged and elderly patients, mainly with skin lesions. These lesions may present as single or multiple red masses and in most cases do not metastasize to the lymph nodes or other organs. This type usually has a benign course, but may recur in some cases.
Breast Implant-Associated ALCL (BIA-ALCL)The occurrence of BIA-ALCL is mainly related to breast implants and is usually discovered many years after the implant surgery, with the main manifestations being local deformation and pain.
How to correctly diagnose ALCL?
The diagnosis of ALCL requires a combination of histological and immunohistochemical examinations, especially the detection of CD30 and ALK fusion proteins, to correctly distinguish its types. Additionally, identification of genetic abnormalities in cells helps determine treatment plans.
Conclusion"Gene research is becoming increasingly important in the diagnosis process and can effectively improve the targeting of treatment."
Given the complexity of ALCL, accurate diagnosis is the key factor for successful treatment. The medical team needs to comprehensively evaluate the clinical manifestations and relevant test results to develop an individualized treatment plan. Whether ALCL can be detected and accurately classified in its early stages is the key to improving patients’ chances of survival. This also makes us wonder whether we have more undiscovered risk factors that affect the early diagnosis and treatment of ALCL?
