Anaplastic large cell lymphoma (ALK positive): encircling right brachial plexus

Case contributed by Domagoj Kretic

Presentation

Presented with pain in his right shoulder after doing his regular series of push-ups. Some radial nerve palsy was detected by orthopedist who recommended shoulder US.

Patient Data

Age: 40 years
Gender: Male

Large lobulated hypoechogenic mass in right subpectoral region, together with muscle edema and enlarged lymph nodes.

CT after administrated contrast in arterial phase is showing large lesion in right subpectoral area encircling right subclavian artery. Artery is somewhat compressed but clearly without significant stenosis or occlusion.

Lymphadenopathy is seen in right axillary region.

MRI sequences show a large heterogeneous lobulated mass in the right subpectoral region, encircling the subclavian artery and brachial plexus. This mass measures 10.5 x 9.5 x 11.0 cm. It is isointense in T2, hyperintense in T2 FS and enhances heterogeneously after contrast administration.

There is also significant intermuscular and soft tissue edema and lymphadenopathy.

Case Discussion

After US findings with a large mass in the right subpectoral region, MRI was performed and showed large lobulated heterogeneous mass encircling right subclavian artery and brachial plexus.

FNAC was performed with a result of PNET, after noticing fast growth and ongoing progression of symptoms, radical cervicosternothoracotomy was performed with removing mass, brachial plexus and subclavian artery, which was replaced with PTFE graft.

Histopathology result was ALK+ ALCL, or anaplastic lymphoma kinase positive anaplastic large cell lymphoma.

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