Anaplastic large cell lymphoma differential diagnosis

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Sowminya Arikapudi, M.B,B.S. [2]

Overview

Anaplastic large cell lymphoma must be differentiated from other diseases such as metastatic carcinoma, B cell lymphoma, primary cutaneous T-cell lymphoma, rhabdomyosarcoma, peripheral T-cell lymphoma-not otherwise specified, classical Hodgkin's lymphoma, and diffuse large B cell lymphoma.

Differential diagnosis

• As the appearance of the hallmark cells, pattern of growth (nesting within lymph nodes) and positivity for EMA may mimic metastatic carcinoma, it is important to include markers for cytokeratin in any diagnostic panel (these will be negative in the case of anaplastic lymphoma).
• Other mimics include CD30 positive B-cell lymphomas with anaplastic cells (including Hodgkin lymphomas). These are identified by their positivity for markers of B-cell lineage and frequent presence of markers of EBV.
• Primary cutaneous T-cell lymphomas may also be positive for CD30; these are excluded by their anatomic distribution.
• ALK positivity may also be seen in some large cell B-cell lymphomas and occasionally in rhabdomyosarcomas.
• Peripheral T-cell lymphoma-not otherwise specified (PTCL-NOS)
• Classical Hodgkin's lymphoma
• Diffuse large B-cell lymphoma

Differential Diagnosis	Similar Features	Differentiating Features
Metastatic carcinoma	On diagnostic test, Metastatic carcinoma demonstrates nesting within lymph nodes, positivity for EMA also observed in anaplastic large cell lymphoma.	On diagnostic test, Metastatic carcinoma demonstrates positivity for markers cytokeratin that distinguish it from anaplastic large cell lymphoma.
B-cell lymphoma	On diagnostic test, B-cell lymphoma demonstrates CD30, anaplastic cells, ALK positivity also observed in anaplastic large cell lymphoma.	On diagnostic test, B-cell lymphoma demonstrates positivity for markers of B-cell lineage and frequent presence of markers of EBV that distinguish it from anaplastic large cell lymphoma.
Primary cutaneous T-cell lymphoma	On diagnostic test, Primary cutaneous T-cell lymphoma demonstrates CD30 also observed in anaplastic large cell lymphoma.	On physical exam, Primary cutaneous T-cell lymphoma demonstrates different anatomic distribution that distinguish it from anaplastic large cell lymphoma.
Rhabdomyosarcoma	On diagnostic test, Rhabdomyosarcoma demonstrates ALK positivity also observed in anaplastic large cell lymphoma.	On [physical exam; history; diagnostic test; imaging], [Differential 1] {has; demonstrates} [feature 1], [feature 2], [feature 3] that distinguish it from [disease name].
Differential 5	On [physical exam; history; diagnostic test; imaging], [Differential 1] {has; demonstrates} [feature 1], [feature 2], [feature 3] also observed in [disease name].	On [physical exam; history; diagnostic test; imaging], [Differential 1] {has; demonstrates} [feature 1], [feature 2], [feature 3] that distinguish it from [disease name].