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Dual ALK and MYC Rearrangements Leading to an Aggressive Variant of Anaplastic Large Cell Lymphoma

Anaplastic lymphoma kinase (ALK) and MYC are oncogenes often dysregulated in pediatric lymphomas. NPM-ALK/t(2;5)(p23;q35) is a genetic hallmark of ALK+ anaplastic large cell lymphoma (ALCL). MYC gene translocations are frequently detected in high-grade B-cell lymphomas. ALK+ALCL cases with concurrent MYC translocation are exceedingly rare and are more aggressive and chemoresistent compared with other ALK+ALCL. We report a patient who presented with ALK+ALCL possessing coexistent MYC rearrangement, massive tumor dissemination, and early widespread relapse. This case underscores the importance of recognition of close correlation between dual ALK and MYC rearrangements and the characteristic clinical features in this unusual ALCL variant.