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新潟県厚生農業協同組合／本文／２１

厚生連医誌

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2008.01.21 09.32.36

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１号 ９３〜９５ ２００８

Brief report

Case report : A case of cytokeratin-positive B-cell anaplasticlarge cell lymphoma（B-ALCL）
Nagaoka Central General Hospital, Department of pathology ; Pathologist

Toshihiko Ikarashi
As anaplastic large cell lymphoma of B cell lineage（BALCL）the immunological stainability as lymphocytes wasvarious and uncertain（1, 2, 3）. B-ALCL could be also
misdiagnosed as undifferentiated carcinoma or so-called
carcinosarcoma because both vimentin, as a immunological mesenchymal marker, and cytokeratins, CAM 5.2 andcytokeratin 8/18 positive in simple epithelia of most secretory and parenchymatous cells, were found in B-ALCL（3, 4）. The use of polymerase chain reaction（PCR）-based
molecular genetic demonstration of clonal immunoglobulin heavy chain（IgHVDJ）
gene rearrangement was the
only method to conclude these tumors as B-ALCL（1, 2,3）.
We reported a case of B-ALCL with immunohistochemistry and gene analysis discussed（5）.
A 70-year-old female patient was admitted because ofmultiple tumors in left chest wall, manubrium of sternum,
and subclavicular areas, up to 11.5cm indiameter. Core
needle biopsy was done from left chest wall tumor. Microscopically there were undifferentiated large cells of
medullary and diffuse distribution with marked coagulation necrosis. Immunohistochemical results were listed inFig.1 : positive to B cell（Fig.2, 3）, parenchymal（Fig.4）,and mesenchymal markers（Fig.5）. PCR for IgHVDJ generearrangement could not be shown. Based on these pathological findings, this tumor was diagnosed as B-ALCL.
Ambivalent immunohistochemical findings with bothparenchymal and mesenchymal characters bothered pathologists about their histopathological diagnosis. Bothimmunohistochemistry and PCR-based molecular analysis
were important to establish the pathological diagnosis of
B-ALCL.
Key words : B-cell anaplastic large cell lymphoma（BALCL）, cytokeratin-positive, immunohistochemistry, polymerase chain reaction（PCR）-based molecular genetic demonstration of clonal immunoglobulin heavy chain（IgHVDJ）
gene rearrangement
Reference :１．Lasota J, Hyjek E, Koo CH, Blonski J, Miettinen M.

Cytokeratin-positive large-cell lymphomas of B-celllineage. A study of five phenotypically unusual cases
verified by polymerase chain reaction. Am J Surg Pathol.1996 ; 20 : 346-54.
２．Frierson HF Jr, Bellafiore FJ, Gaffey MJ, McCary
WS, Innes DJ Jr, Williams ME. Cytokeratin in anaplastic large cell lymphoma. Mod Pathol. 1994 ; 7 : 317-21.
３．Sarker AB, Akagi T, Yoshino T, Hoshida Y, Takahashi K, Horie Y. Expression of vimentin and epithelial
membrane antigen in human malignant lymphomas.
Acta Pathol Jpn. 1990 ; 40 : 581-7.
４．Gustmann C, Altmannsberger M, Osborn M, Griesser
H, Feller AC. Cytokeratin expression and vimentin content in large cell anaplastic lymphomas and other nonHodgkin s lymphomas. Am J Pathol. 1991 ; 138 : 141322.
５．Ikarashi T, Hasegawa H. Detection of monoclonality
in B-cell lymphoma by polymerase chain reaction（PCR）with the use of DNA extractin kit（Takara DEXPAT）
for formalin-fixed paraffin-embedded tissues. Niigata-ken Koseiren Med J. 2000 ; 10 : 16-20.

短報

症例報告：サイトケラチン陽性 B 細胞性未分化大細胞性リンパ腫の１症例
長岡中央綜合病院、病理部；病理医
五十嵐俊彦
症例は７０才女性、節外性サイトケラチン陽性 B 細胞性未分化大細胞リンパ腫症例であった。左側胸壁・鎖骨下に多発性腫瘍を形成し、免疫組織染色上 CD７９a、bcl-２、CAM５．
２、vimentin が陽性であった。
キーワード：B 細胞性未分化大細胞性リンパ腫、サイトケラチン陽性、免疫グロブリン重鎖 JH 遺伝
子再構成（Ig-H 鎖 JH 再構成）

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Case report : A case of cytokeratin-positive B-cell anaplastic large cell lymphoma（B-ALCL）

Fig. 1. Results of immunohistochemical analysis
lymphocyte

commonCD４５

blastTdT−

B cellCD７９a, MB-１
CD２０, L２６＋−

medium B cellbcl-２CD５＋−

CD１０−

CD３CD４５RO, UCHL１−−

CD８CD４５RO, UCHL１−−

large cell

CD１５, Leu-M１
CD３０, Ki-１
ALK−−−

NK/T, neuroendocrine
leukocyte

CD５６peroxidase−−

macrophagecommonmuscle

CD６８, Kp-１
vimentindesmin−＋−endothelium, stromal cell

α-smooth muscle actin
CD３４−
−

S１００
glial fibrillary acidic protein
HMB-４５CAM５．
２−−−＋

T cell

Hodgkin cell

myelocytic
mesenchymal

nerveparenchymal

melanomacytokeratin

mesotheliumsquamous
proliferation
tumor marker

stromalthyroid

CK７
CK２０calretinin
D２-４０
WT１
p６３
p５３
Ki-６７
c-kit
thyroglobulin
CD９９, MIC-２― 94 ―−−−−−−−−
７０％ ＋＋−−−

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１号 ９３〜９５ ２００８Fig. 2. Immunostain with anti-CD 79 a antibody

Fig. 3. Immunostain with anti-bcl-2 antibody

Fig. 4. Immunostain with anti-CAM 5.2 antibody

Fig. 5. Immunostain with anti-vimentin antibody（２００８／０１／１０ 受付）― 95 ―