Young Man with Neck Mass and Fever Diagnosed with Anaplastic Large Cell Lymphoma

Medical cases involving young adults presenting with persistent fever and unusual swelling can often lead to surprising diagnoses. This is the story of a 30-year-old male who came in with a neck mass and recurrent fevers—symptoms initially mistaken for a common infection but later revealed to be a rare and aggressive form of lymphoma. Through timely diagnosis and comprehensive treatment, including chemotherapy and stem cell transplantation, he achieved complete remission. His journey underscores the importance of early detection and advanced diagnostic tools in managing complex hematologic malignancies.

Understanding Anaplastic Large Cell Lymphoma (ALCL)

Anaplastic large cell lymphoma is a rare type of non-Hodgkin's lymphoma that primarily affects T-cells. It accounts for approximately 2–3% of all lymphomas and tends to occur more frequently in younger individuals, including children and young adults. While uncommon, ALCL is known for its rapid progression if left untreated. The ALK-positive subtype, which this patient was diagnosed with, generally carries a better prognosis compared to ALK-negative cases, especially when caught early and treated aggressively.

Early Symptoms Often Mimic Common Infections

In the early stages, symptoms such as unexplained fever, fatigue, night sweats, and swollen lymph nodes are frequently mistaken for viral or bacterial infections. This can delay proper diagnosis, particularly when imaging and blood tests don't immediately raise red flags. In this case, the patient had been treated with third-generation cephalosporins for suspected bronchopneumonia without improvement—highlighting the need for further investigation when standard therapies fail.

Patient Profile & Initial Presentation

The patient was a 30-year-old male with a history of smoking and chronic sleep deprivation. He presented at Guangzhou Medical University Affiliated Hospital in January 2022 with a one-month history of intermittent high-grade fever (peaking above 39°C) and a newly discovered lump on the left side of his neck. Notably, there were no respiratory symptoms like cough or sore throat, which ruled out typical upper respiratory tract infections.

Initial evaluations included a complete blood count, chest X-ray, and cervical ultrasound. Blood work showed normal white blood cell levels, while imaging confirmed multiple enlarged lymph nodes bilaterally in the neck, with the largest measuring 3.0×2.5 cm. These findings prompted hospital admission under suspicion of malignant lymphadenopathy.

Diagnostic Pathway: From Biopsy to Full Staging

A partial excisional biopsy of the affected lymph node was performed under local anesthesia by a general surgery team. Histopathological analysis confirmed the diagnosis: anaplastic large cell lymphoma, ALK-positive. This crucial step differentiated it from other types of lymphoma and guided subsequent therapy.

The Role of PET/CT in Accurate Staging

To determine disease extent, a whole-body PET/CT scan was recommended despite its high cost and lack of insurance coverage. After thorough discussion with the patient and family about its clinical value, informed consent was obtained. The scan revealed widespread lymph node involvement across multiple regions, leading to a final staging of Stage IIIB. Bone marrow biopsy confirmed no bone marrow infiltration, which was a favorable finding.

Treatment Strategy: Intensive Chemotherapy Followed by Stem Cell Rescue

Given the aggressive nature of the disease, a multimodal approach was initiated. The patient received six cycles of CHOEP regimen:

• C – Cyclophosphamide
• H – Doxorubicin (Hydroxydaunorubicin)
• O – Vindesine (a vinca alkaloid)
• E – Etoposide
• P – Prednisone

Following completion of chemotherapy, the patient underwent autologous hematopoietic stem cell transplantation—a procedure designed to rescue bone marrow function after high-dose chemo and reduce relapse risk. He remained hospitalized for about a month during this phase.

Response to Treatment: Achieving Complete Remission

Clinical response was closely monitored through physical exams and serial imaging. By the end of the second cycle, the patient's fever resolved completely. After three cycles, the previously palpable neck masses were no longer detectable on examination.

Follow-up contrast-enhanced CT scans of the neck, chest, and abdomen showed significant regression of enlarged lymph nodes, meeting criteria for partial remission (PR). Upon completing six full cycles, further evaluation indicated continued improvement, ultimately leading to a status of complete remission (CR)—the best possible outcome in lymphoma treatment.

Long-Term Outlook and Monitoring Plan

While achieving CR is highly encouraging, anaplastic large cell lymphoma has a notable risk of recurrence. Therefore, long-term surveillance is essential. Patients must remain vigilant for warning signs such as:

• Unexplained weight loss
• Persistent low-grade or high fevers
• New lumps in the neck, armpits, or groin
• Night sweats or extreme fatigue

Lifestyle and Recovery Support After Treatment

Post-treatment recovery involves more than just medical monitoring—it requires lifestyle optimization. Dietary recommendations include:

• High-protein, low-fat foods to support tissue repair
• Easily digestible meals to aid gastrointestinal recovery
• Avoidance of spicy, greasy, or heavily processed foods
• Maintaining strict food hygiene to prevent infections

The Importance of Doctor-Patient Communication

This case highlights how effective communication between healthcare providers and patients can influence outcomes. Explaining the necessity of expensive but critical tests like PET/CT helped gain trust and cooperation. Similarly, educating patients about symptom tracking empowers them to take an active role in their care.

As clinicians, we must also advocate for broader awareness of rare cancers like ALCL. Early recognition of subtle symptoms—especially prolonged fever and unexplained lymphadenopathy—can make a life-saving difference. Public education, combined with access to advanced diagnostics, plays a pivotal role in improving survival rates.

Final Thoughts: Hope Through Modern Oncology

This young man's journey from misdiagnosis to full remission reflects the power of modern cancer care. Though anaplastic large cell lymphoma is aggressive, advances in chemotherapy protocols and stem cell transplantation have significantly improved prognoses—particularly for ALK-positive cases.

His successful outcome serves as both a clinical success story and a reminder: even rare diseases demand attention, awareness, and prompt action. With early intervention, coordinated treatment, and ongoing support, many patients can not only survive but thrive after a lymphoma diagnosis.