The University of Toledo Translation Journal of Medical Sciences 
Internal Medicine Abstract, Department of Medicine Research Symposium UTJMS 2023 May 5; 11(1):e1-e1 

Anaplastic Large Cell Lymphoma Presenting as Ulcerative 
Facial Mass: A Case Report 
Basil Akpunonu1*, H. Knauss1, L. Glosser1, A. Beran1, A. Sidwell1, W. Abdulsattar1, 
R.T. Skeel2

1Division of Internal Medicine, Department of Medicine, The University of Toledo, 
Toledo, OH 43614 
2Division of Haematology and Oncology, Department of Medicine, The University 
of Toledo, Toledo, OH 43614 

*Corresponding author: Basil.Akpunonu@utoledo.edu

Published: 05 May 2023 

Introduction: Anaplastic large cell lymphoma (ALCL) is a rare form of non-Hodgkin lymphoma 
(NHL) that can be aggressive with rapid speed, thus mandating a timely diagnosis to optimize treatment 
and deter progression. NHL classically presents with lymphadenopathy and constitutional symptoms. 
However, ALCL can present with nonspecific cutaneous manifestations with minimal or absent 
constitutional symptoms. The cutaneous involvement may resemble common dermatologic conditions, 
delaying diagnosis. We present a case of an aggressive cutaneous ALCL lesion mimicking facial 
cellulitis that rapidly progressed from a small comedone to a large, exophytic mass over the course of 6 
weeks.    

Case Report: A 59-year-old female with current smoking history (40 pack years) and history of COPD 
presented to the emergency department with a painful enlarging forehead lesion that grew over 6 weeks, 
with later appearance of multiple tender lymph nodes on the head and neck. She had four previous ED 
visits and was treated with empiric intravenous antibiotics for suspected bacterial infection without 
improvement.   Core needle biopsy of the forehead lesion confirmed the diagnosis of anaplastic 
lymphoma kinase-negative ALCL. Chemotherapy with brentuximab vedotin, cyclophosphamide, 
doxorubicin, and prednisone was planned for a total of 6–8 cycles with curative intent. By cycle 5, 
positron emission tomography and computed tomography demonstrated response to therapy with no 
enlarged or metabolically active lymph nodes appreciated. 

Conclusion: Our case report highlights the importance of developing a broad differential diagnosis for 
ulcerative facial masses, particularly when unresponsive to antimicrobial therapies. Lymphomas should 
be included in the differential diagnosis of patients with rapidly growing facial lesions. 

https://dx.doi.org/10.46570/utjms.vol11-2023-677 

https://dx.doi.org/10.46570/utjms.vol11-2023-677
mailto:Basil.Akpunonu@utoledo.edu