A case report: axillary ALK-positive anaplastic large-cell lymphoma mimicking an infectious abscess in an adolescent
- 1Department of Wound Healing, Tongji Hospital, Tongji University School of Medicine , ,
- 2Department of Pathology, Tongji Hospital, Tongji University School of Medicine , ,
Abstract
Background: Abscess-like presentations are common in surgical practice, but malignant soft-tissue and lymphoid disorders can occasionally imitate infection and delay definitive treatment. Anaplastic large-cell lymphoma (ALCL) is a CD30-positive T-cell lymphoma that may involve skin, lymph nodes, or soft tissue and can show extensive necrosis, inflammatory change, and systemic symptoms.
Case presentation: A 17-year-old female student presented with a 3-week history of progressive painful erythema and swelling of the left axilla after ineffective intravenous antibiotic treatment elsewhere. On admission, the lesion was large, indurated, tender, and clinically suspicious for a soft-tissue infection with possible abscess formation. Incision and drainage yielded only scant purulent fluid but abundant friable nodular tissue, and cultures were negative. Persistent fever, local progression, lymphadenopathy, and poor response to antimicrobial therapy prompted multidisciplinary reassessment. Histopathology of the solid tissue demonstrated large pleomorphic lymphoid cells, and immunohistochemistry showed strong CD30 and ALK expression, establishing ALK-positive ALCL. The patient was transferred to hematology and received initial cytoreductive therapy with brentuximab vedotin and short-course zeprumetostat, after which the local tumor burden decreased and delayed wound closure was performed. She subsequently received five cycles of brentuximab vedotin plus CHP and chidamide maintenance after complete remission.
Conclusion: A presumed abscess that yields little pus but contains solid friable tissue should not be managed as infection alone. In refractory, culture-negative, or biologically discordant soft-tissue lesions, early biopsy of the cavity wall and solid components may help reduce diagnostic delay and redirect care toward malignancy-specific treatment.
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BibTeX
@article{wang2026case,
title = {{A case report: axillary ALK-positive anaplastic large-cell lymphoma mimicking an infectious abscess in an adolescent}},
author = {Zhanwei Wang and Liuhong Yuan and Xudong Guan and Xiaohui Liu and Yuanting Song and Kun Tao and Tao Dai},
journal = {Frontiers in oncology},
year = {2026},
month = oct,
doi = {10.3389/fonc.2026.1915361},
url = {https://europepmc.org/article/PMC/PMC13671954},
note = {CC BY},
}
RIS
TY - JOUR
TI - A case report: axillary ALK-positive anaplastic large-cell lymphoma mimicking an infectious abscess in an adolescent
AU - Zhanwei Wang
AU - Liuhong Yuan
AU - Xudong Guan
AU - Xiaohui Liu
AU - Yuanting Song
AU - Kun Tao
AU - Tao Dai
PY - 2026
DA - 2026/10/02
JO - Frontiers in oncology
DO - 10.3389/fonc.2026.1915361
UR - https://europepmc.org/article/PMC/PMC13671954
AB - Background: Abscess-like presentations are common in surgical practice, but malignant soft-tissue and lymphoid disorders can occasionally imitate infection and delay definitive treatment. Anaplastic large-cell lymphoma (ALCL) is a CD30-positive T-cell lymphoma that may involve skin, lymph nodes, or soft tissue and can show extensive necrosis, inflammatory change, and systemic symptoms. Case presentation: A 17-year-old female student presented with a 3-week history of progressive painful erythema and swelling of the left axilla after ineffective intravenous antibiotic treatment elsewhere. On admission, the lesion was large, indurated, tender, and clinically suspicious for a soft-tissue infection with possible abscess formation. Incision and drainage yielded only scant purulent fluid but abundant friable nodular tissue, and cultures were negative. Persistent fever, local progression, lymphadenopathy, and poor response to antimicrobial therapy prompted multidisciplinary reassessment. Histopathology of the solid tissue demonstrated large pleomorphic lymphoid cells, and immunohistochemistry showed strong CD30 and ALK expression, establishing ALK-positive ALCL. The patient was transferred to hematology and received initial cytoreductive therapy with brentuximab vedotin and short-course zeprumetostat, after which the local tumor burden decreased and delayed wound closure was performed. She subsequently received five cycles of brentuximab vedotin plus CHP and chidamide maintenance after complete remission. Conclusion: A presumed abscess that yields little pus but contains solid friable tissue should not be managed as infection alone. In refractory, culture-negative, or biologically discordant soft-tissue lesions, early biopsy of the cavity wall and solid components may help reduce diagnostic delay and redirect care toward malignancy-specific treatment.
SN - 2234-943X
ER -