Anaplastic large‐cell lymphoma presenting as acute leukemia
Bibliographic record
Abstract
Anaplastic large-cell lymphoma (ALCL) is a highgrade neoplasm of cytotoxic T cells.Defining features of ALCL include large pleomorphic cells with abundant cytoplasm; irregular, often horseshoe-shaped nuclei; consistent expression of CD30; usual expression of anaplastic lymphoma kinase (ALK); and frequent t(2;5) translocation.ALCL can occur in lymph nodes as well as in such extranodal sites as skin, bones, soft tissue, lungs, and liver.However, involvement of blood by ALCL is extremely rare.The case described herein is that of a 52-year-old man with a 3-week history of severe constitutional symptoms, skin rash, extensive generalized lymphadenopathy, and hepatosplenomegaly.The hemoglobin was 10.0 g/dL, the white blood cell count was 15,500 /ml, and the platelet count was 145,000/ml.The peripheral blood film revealed 12-20% irregularly shaped blastlike cells (15-25 mm in diameter) with large, convoluted, and often horseshoe-shaped nuclei.These cells had abundant blue cytoplasm with frequent vacuoles and occasional azurophilic granules (see Image 1).Small numbers of similar cells were also seen in the bone marrow.The cells expressed CD30 (see Image 2), as well as such other markers as CD45, CD2, CD8, CD25, granzyme B, CD43, and CD38.They failed to express CD3, CD20, and ALK.The cells showed a complex karyotypic abnormality with involvement of chromosomes 1, 2, 5, 7, 8, and 15.However, here was no evidence of the t(2;5) translocation, an abnormality that was further excluded by FISH.A lymph-node biopsy verified the diagnosis of ALK-negative, anaplastic large-cell lymphoma (ALCL).The presence of tumor cells in the peripheral circulation is uncommon in patients with ALCL, and a leukemic presentation of ALCL such as seen in this case is extremely rare.Involvement of the blood in ALCL such as in the case described here appears to indicate a very poor prognosis.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.001 |
| Meta-epidemiology (narrow) | 0.001 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.000 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.001 | 0.000 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.009 | 0.003 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".