Commentary on: Anaplastic Large Cell Lymphoma of the Breast Arising in a Burn Cicatrix.
Anaplastic large cell lymphoma (ALCL) presents as one of 4 forms; systemic ALCL Anaplastic Lymphoma Kinase (ALK)-positive, systemic ALCL ALK-, cutaneous ALCL or breast implant associated ALCL (BIA-ALCL) 1. The latter 3 disease entities are all negative for ALK which is expressed in ALK-positive disease as the consequence of a chromosomal translocation1,2. Naturally, cutaneous disease is associated with skin presentation which is not an unusual feature of systemic disease but in the former case, disease is limited to the skin. In this publication, the authors report a case of ALCL associated with a burn scar on the breast whereby a palpable mass, nodules and papules were detected, with histopathology confirming an infiltration of large CD30+ cells with abundant clear cytoplasm and pleomorphic nuclei consistent with a diagnosis of ALCL (ref). The lack of ALK expression in this malignancy as well as the absence of breast implants places it firmly in the ALCL, ALK- category although an inability to detect nodal disease, involvement of the skin and a good response to therapy perhaps aligns it more with the cutaneous rather than systemic form of ALCL, yet palpable masses were seen (ref).