A Case of Colonic ALK-Positive Anaplastic Large Cell Lymphoma
Bibliographic record
Abstract
Background: Primary colonic lymphoma is rare, comprising 0.2 - 1.2% of colonic malignancies1, the majority are cecal diffuse large b cell lymphoma. Gastric lymphoma is the most common gastrointestinal lymphoma followed by the small intestine. Anaplastic Large Cell Lymphoma (ALCL) is a peripheral T-Cell lymphoma divided into primary cutaneous or systemic. Systemic ALCL is further categorized by the presence of a surface protein Anaplastic Lymphoma Kinase (ALK). ALK positive ALCL denotes a better prognosis.3 Here we report a case of colonic ALK positive ALCL. Case Presentation: A previously well 23-year-old male presented with three weeks of non-bloody diarrhea, sweats, nausea and vomiting. Upon presentation to hospital, the patient was tachypnic and requiring O2. Physical examination revealed bibasilar crackles, his abdomen was tender throughout, he did not have hepatosplenomegaly, nor lymphadenopathy. He was admitted with presumed aspiration pneumonia secondary to gastroenteritis and started on empiric antibiotics. His WBC was 28 x 10ˆ9/L, lactate 3.3 mmol/L, CRP 421. CT showed multiple enlarged abdominal lymph nodes. He had positive EBNA serology in keeping with prior EBV infection. Colonoscopy showed small erosions and polypoid lesions in the transverse colon. He was transferred to a tertiary care center because of increasing O2 requirements and multi-organ failure requiring intubation, ECMO and dialysis. Pathology of the colonic polypoid lesion revealed ALK positive ALCL. CHOP chemotherapy began during his ICU stay, vincristine and doxorubicin were held because of deteriorating liver dysfunction. With treatment, his organ failure improved and within days he was extubated, dialysis and ECMO were stopped and he was transferred to the hematology ward where he continues with chemotherapy.Figure: Enhanced coronal CT scan demonstrating massive abdominal lymphadenopathy.Figure: Enhanced axial CT scan demonstrating massive abdominal lymphadenopathy.Figure: Enhanced sagittal CT scan demonstrating massive abdominal lymphadenopathy.Discussion: Lymphoma is an important diagnosis to consider when evaluating a patient with diarrhea and lymphadenopathy. Few cases report ALCL involving the gastric mucosa, most include the stomach in isolation or the colon.4,5,6 Despite active cancer being a relative contraindication to ECMO, the severity of this patient's presentation necessitated this intervention. There have been case series reporting the use of ECMO in patients with active hematologic malignancies, where ECMO preceded the diagnosis of malignancy7. This case illustrates the importance of a high index of suspicion for lymphoma given diffuse adenopathy and taking biopsies.
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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 | 0.004 |
| Meta-epidemiology (narrow) | 0.002 | 0.001 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.003 | 0.003 |
| Science and technology studies | 0.003 | 0.002 |
| Scholarly communication | 0.002 | 0.002 |
| Open science | 0.002 | 0.002 |
| Research integrity | 0.006 | 0.004 |
| Insufficient payload (model declined to judge) | 0.004 | 0.002 |
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".