Anaplastic large-cell lymphoma of null-cell type with multiple bone involvement

A 21-year-old man who had anaplastic large cell lymphoma (ALCL) of the null -cell type with multiple bone involvement is reported. On admission, he had symptoms of incomplete paraplegia and urinary and rectal incontinence. Wor kup studies for staging revealed para-aortic lymph node swellings and multi ple bone involvement including skull, ribs, left iliac bone, and thoracic/l umbar spine. Because paraplegia was rapidly progressive, a decompression op eration was performed. The biopsy specimen obtained from the lumbar spine r evealed sheetlike proliferation of anaplastic large cells. These cells were positive for CD30 (Ki-1), EMA, vimentin, and p80(NPM/ALK), and negative fo r CD3, CD20 (L26), and CD45 (LCA). Epstein-Barr virus-encoded small RNAs we re not detectable in these cells. Thus, the patient was diagnosed as having ALCL of the null-cell type. He was treated with several courses of combina tion chemotherapy, and finally with total body irradiation plus high-dose c hemotherapy supported by peripheral blood stem cell transplantation. Howeve r, soon after the treatment, the lymphoma cells massively infiltrated his b one marrow. He died of lymphoma 8 months after admission.