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

Medical Case Overview: Early Detection and Treatment of a Rare Aggressive Lymphoma in a 30-Year-Old Male

This case report highlights the diagnostic journey and successful treatment of anaplastic large cell lymphoma (ALCL) in a young adult male. While rare, this aggressive form of non-Hodgkin lymphoma can progress rapidly if not identified early. The patient presented with seemingly common symptoms—persistent fever and a neck mass—which initially masked the severity of his condition. After thorough evaluation and biopsy, a definitive diagnosis was made, leading to an effective multimodal treatment strategy involving chemotherapy and autologous stem cell transplantation.

Patient Profile & Clinical Presentation

Age: 30 yearsGender: MaleMedical History: Occasional smoking, chronic sleep deprivationPresenting Symptoms: Recurrent fever for one month, newly detected neck mass for one week

The patient first experienced unexplained fevers exceeding 39.0°C without accompanying respiratory symptoms such as cough or sore throat. He had been treated at a local clinic for presumed bronchopneumonia with third-generation cephalosporins, but showed no sustained improvement. One week prior to referral, he noticed a painless lump on the left side of his neck during self-examination. Concerned about its persistence, he sought specialized care at Guangzhou Medical University Affiliated Hospital's oncology department.

Initial Diagnostic Workup

Upon admission, a comprehensive assessment was conducted:

Blood tests: Complete blood count revealed normal white blood cell levels, ruling out acute bacterial infection.
Chest X-ray: No signs of pulmonary abnormalities.
Neck ultrasound: Identified multiple enlarged lymph nodes bilaterally, with the largest measuring 3.0 × 2.5 cm.

These findings pointed toward reactive lymphadenopathy or underlying systemic disease. Given the lack of response to antibiotics and progressive symptoms, further investigation was warranted. A surgical consultation led to a partial excisional biopsy of the affected cervical lymph node under local anesthesia.

Definitive Diagnosis: ALK-Positive Anaplastic Large Cell Lymphoma

Histopathological analysis confirmed the presence of malignant T-cell lymphocytes characteristic of anaplastic large cell lymphoma (ALCL), with positive immunostaining for ALK (anaplastic lymphoma kinase). This biomarker is associated with a more favorable prognosis compared to ALK-negative cases.

To determine disease extent, staging evaluations were initiated. Bone marrow aspiration and biopsy showed no evidence of marrow infiltration. However, due to high clinical suspicion of widespread involvement, a whole-body PET/CT scan was recommended despite its cost and limited insurance coverage. After informed discussion with the patient and family, consent was obtained.

Staging Results and Final Diagnosis

The PET/CT imaging revealed hypermetabolic activity in multiple lymph node groups throughout the body, including cervical, mediastinal, abdominal, and pelvic regions. Based on these findings, the disease was classified as Stage IIIB, indicating advanced but potentially treatable lymphoma.

Final diagnosis: Anaplastic large cell lymphoma, ALK-positive, Stage IIIB.

Treatment Strategy: Intensive Chemotherapy Followed by Stem Cell Rescue

Given the aggressive nature of the disease, a robust therapeutic approach was necessary. The patient was started on the CHOEP regimen, a potent chemotherapy protocol commonly used for aggressive lymphomas:

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

Each cycle spans 21 days, and the full plan included six cycles followed by consolidation therapy. After completing induction chemotherapy, the patient underwent autologous hematopoietic stem cell transplantation (auto-SCT), which involved harvesting his own stem cells prior to high-dose chemotherapy to restore bone marrow function afterward.

Response to Therapy and Clinical Outcomes

The patient demonstrated a strong response to treatment:

After two cycles, fever resolved completely.
By three cycles, physical examination could no longer detect palpable lymph nodes in the neck.
Imaging studies (contrast-enhanced CT of neck, chest, and abdomen) after three cycles showed significant regression of previously enlarged lymph nodes, meeting criteria for partial remission (PR).
Following completion of six chemotherapy cycles, restaging indicated continued improvement, with plans for post-transplant monitoring to assess long-term remission.

Ultimately, the overall treatment outcome was evaluated as complete remission (CR), marking a successful intervention that brought the aggressive cancer under control.

Post-Treatment Care and Long-Term Monitoring

While achieving remission is a major milestone, ongoing vigilance remains critical due to the risk of relapse. Patients diagnosed with ALCL must remain proactive in their recovery process. Key recommendations include:

Regular self-examinations of common lymph node areas—neck, axillae (armpits), supraclavicular, and inguinal regions—for new or enlarging masses.
Daily temperature monitoring to catch any unexplained fevers early.
Tracking weight changes; unintentional weight loss may signal disease recurrence.
Maintaining a balanced diet rich in high-quality proteins, low in fat, and easy to digest. Avoid spicy, greasy, or contaminated foods that may compromise immunity.
Strict adherence to follow-up appointments with the oncologist for blood work, imaging, and clinical assessments.

Long-term survivorship requires both medical oversight and personal responsibility. Open communication between patient, family, and healthcare providers enhances outcomes and supports mental well-being during recovery.

Clinical Insights and Public Health Implications

Anaplastic large cell lymphoma, though uncommon, represents a highly aggressive subtype of T-cell lymphoma. Its nonspecific early symptoms—such as fatigue, intermittent fever, and painless lymphadenopathy—often lead to misdiagnosis or delayed detection. As seen in this case, initial treatment for presumed infections failed because the root cause was malignant rather than microbial.

Early diagnosis significantly improves survival rates, especially in ALK-positive cases where targeted therapies and intensive regimens yield better responses. Unfortunately, many patients present at advanced stages (III–IV), reducing curative potential.

The Role of Physicians in Raising Awareness

Healthcare professionals play a vital role in educating the public about warning signs of hematologic malignancies. Encouraging timely specialist referrals when symptoms persist despite standard treatments can make a life-saving difference. Moreover, fostering trust through transparent discussions—especially around costly but essential diagnostics like PET/CT—helps secure patient cooperation and informed decision-making.

In conclusion, this case underscores the importance of clinical suspicion, accurate pathology, and aggressive yet personalized treatment in managing rare cancers. With modern oncology tools and multidisciplinary coordination, even aggressive lymphomas like ALCL can be effectively controlled, offering hope for long-term survival and quality of life.