Central nervous system relapse in a pediatric anaplastic large cell lymphoma patient with CLTC/ALK translocation treated with alectinib: A case report

Figure 1 Skin rashes (A) before treatment and (B) after chemotherapy.

Figure 2 Images at diagnosis. A and B: Computed tomography of the chest (A) and abdomen (B); C: Positron emission tomography/computed tomography scan of the whole body.

Figure 3 Wright–Giemsa-stained bone marrow smear. A: 100 ×; B and C: 1000 ×. Anaplastic lymphoma cells differed in size and shape. They had eccentric nuclei, prominent nucleoli, and abundant cytoplasm containing prominent vacuoles.

Figure 4 Histological and immunophenotypic results. A: Hematoxylin–eosin-stained section of a lymph node; B: Hematoxylin–eosin-stained section of bone marrow biopsy; C: Positive CD30 staining; D: Positive ALK staining in a cytoplasmic pattern.

Figure 5 The sample at the diagnosis time-point showing the expected 270 bp CLTC-ALK reverse transcription-polymerase chain reaction product (three bands represent three repetitions) (A) and direct sequencing results of polymerase chain reaction products (B). The arrow shows the translocation breakpoint (B).

Figure 6 Central nervous system recurrence after 13 mo of treatment. A: Yellow cerebral spinal fluid (a) and tumor cells on cytospin of cerebral spinal fluid (b); B: Magnetic resonance imaging images. a: New lesions in the brain parenchyma and enlarged bilateral optic nerves; b: The involvement of the brain and optic nerves shrank after 2 mo of chemotherapy and alectinib treatment; c: Complete remission after 4 mo of treatment.