A 46-year-old male smoker presented with a history of dry cough and moderate-grade pyrexia, responding to antipyretic since 3 months. History regarding other system involvement did not suggest any other abnormality. There were no other systemic symptoms. Examination revealed decreased breath sounds at the right lung base. There was no lymphadenopathy or organomegaly. With these symptoms, the patient was provisionally diagnosed as a case of tuberculosis and started on the anti-tubercular therapy. He did not show any improvement and was referred for further management. The blood investigations were within normal range and imaging [Figure 1] of the thorax showed a mass lesion in the upper lobe of the right lung and abdominal scans were within normal range. Fine needle aspiration biopsy from the lesion showed atypical cells suggestive of malignancy. For further confirmation, Immunohistochemical (IHC) markers were performed on cell block, which suggested LCA positive, CK (cytokeratin) negative, other markers were inconclusive. The cytogenetics from the lesion suggested t (2 : 5) though Anaplastic Lymphoma Kinase (ALK) was negative. Staging evaluation suggested that it was extranodal lymphoma stage I B E (bone marrow examination showed no involvement). The primary anaplastic large cell lymphoma of lung was the final diagnosis made and patient was started on combinational chemotherapy consisting of cyclophosphamide, adriamycin, vincristine and prednisolone. After six cycles of chemotherapy, the patient is in complete remission.
CT scan showing right upper lobe mass.