Hammering home the sickle: an instructive case of endobronchial anaplastic large cell lymphoma



  • Mohammad Abu-Hishmeh | memaad@hotmail.com Division of Pulmonary, Critical Care, and Sleep Medicine, Baystate Medical Center, Springfield, MA, United States. https://orcid.org/0000-0002-6338-0325
  • Laura Miranda Division of Pulmonary, Critical Care, and Sleep Medicine, Westchester Medical Center, Valhalla, NY, United States. https://orcid.org/0000-0003-2973-5695
  • Fouzia Shakil Department of Pathology, Westchester Medical Center, Valhalla, NY, United States.
  • Tauseef Ahmed Division of Medical Oncology, Westchester Medical Center, Valhalla, NY, United States.
  • Oleg Epelbaum Division of Pulmonary, Critical Care, and Sleep Medicine, Westchester Medical Center, Valhalla, NY, United States.


It is extremely unusual for primary pulmonary lymphoma, an uncommon occurrence in any form, to be of T-cell origin and to manifest as an endobronchial lesion. Each of these characteristics is rare individually, so cases that combine them are exceptional. We report a patient in whom primary pulmonary anaplastic large cell lymphoma, a T-cell neoplasm, presented with obstruction of the left upper lobe bronchus, resulting in left upper lobe atelectasis and creating the radiographic luftsichel sign. We briefly discuss anaplastic large cell lymphoma as a whole, place our case in the context of previously published literature on endobronchial anaplastic large cell lymphoma, and review the genesis of the luftsichel sign.     



PlumX Metrics


Download data is not yet available.


Pan Z, Xu ML. T-cell and NK-cell lymphomas in the lung. Semin Diagn Pathol 2020;37:273-82. DOI: https://doi.org/10.1053/j.semdp.2020.04.003

Solomonov A, Zuckerman T, Goralnik L, et al. Non-Hodgkin's lymphoma presenting as an endobronchial tumor: report of eight cases and literature review. Am J Hematol 2008;83:416-9. DOI: https://doi.org/10.1002/ajh.21112

Kligerman SJ, Franks TJ, Galvin JR. Primary extranodal lymphoma of the thorax. Radiol Clin North Am 2016;54:673-87. DOI: https://doi.org/10.1016/j.rcl.2016.03.002

L'Hoste RJ Jr, Filippa DA, Lieberman PH, Bretsky S. Primary pulmonary lymphomas. A clinicopathologic analysis of 36 cases. Cancer 1984;54:1397-406. DOI: https://doi.org/10.1002/1097-0142(19841001)54:7<1397::AID-CNCR2820540728>3.0.CO;2-4

Cadranel J, Wislez M, Antoine M. Primary pulmonary lymphoma. Eur Respir J 2002;20:750-62. DOI: https://doi.org/10.1183/09031936.02.00404102

Sammassimo S, Pruneri G, Andreola G, et al. A retrospective international study on primary extranodal marginal zone lymphoma of the lung (BALT lymphoma) on behalf of International Extranodal Lymphoma Study Group (IELSG). Hematol Oncol 2016;34:177-83. DOI: https://doi.org/10.1002/hon.2243

Rush WL, Andriko JA, Taubenberger JK, et al. Primary anaplastic large cell lymphoma of the lung: a clinicopathologic study of five patients. Mod Pathol 2000;13:1285-92. DOI: https://doi.org/10.1038/modpathol.3880235

Kim DH, Ko YH, Lee MH, Ree HJ. Anaplastic large cell lymphoma presenting as an endobronchial polypoid mass. Respiration 1998;65:156-8. DOI: https://doi.org/10.1159/000029248

Chand T, Bansal A, Dua H, Sharma K. Endotracheobronchial lymphoma: Two unusual case reports and review of article. Lung India 2016;33:653-6. DOI: https://doi.org/10.4103/0970-2113.192873

Von Ende E, Kauffman T, Munoz PA, Martinez-Jiménez S. Primary pulmonary anaplastic large cell lymphoma: A rare malignancy and rare cause of the luftsichel sign. Case Rep Radiol 2018;2018:8574642. DOI: https://doi.org/10.1155/2018/8574642

Carvalho J, Marques DP, Oliveira I, Claudino C. A rare case of primary pulmonary anaplastic large cell lymphoma. Eur J Case Rep Intern Med 2019;6:001249. DOI: https://doi.org/10.12890/2019_001249

Blankenbaker DG. The luftsichel sign. Radiology 1998;208:319-20. DOI: https://doi.org/10.1148/radiology.208.2.9680553

Day K, Oliva I. Signs in cardiopulmonary imaging: luftsichel sign. J Thorac Imaging 2015;30:W1. DOI: https://doi.org/10.1097/RTI.0000000000000151

Eyre TA, Khan D, Hall GW, Collins GP. Anaplastic lymphoma kinase-positive anaplastic large cell lymphoma: current and future perspectives in adult and paediatric disease. Eur J Haematol 2014;93:455-68. DOI: https://doi.org/10.1111/ejh.12360

Leventaki V, Bhattacharyya S, Lim MS. Pathology and genetics of anaplastic large cell lymphoma. Semin Diagn Pathol 2020;37:57-71. DOI: https://doi.org/10.1053/j.semdp.2019.12.002

Chiarle R, Voena C, Ambrogio C, et al. The anaplastic lymphoma kinase in the pathogenesis of cancer. Nat Rev Cancer 2008;8:11-23. DOI: https://doi.org/10.1038/nrc2291

Vose J, Armitage J, Weisenburger D, International T-Cell Lymphoma Project. International peripheral T-cell and natural killer/T-cell lymphoma study: pathology findings and clinical outcomes. J Clin Oncol 2008;26:4124-30. DOI: https://doi.org/10.1200/JCO.2008.16.4558

Horwitz S, O'Connor OA, Pro B, et al. Brentuximab vedotin with chemotherapy for CD30-positive peripheral T-cell lymphoma (ECHELON-2): a global, double-blind, randomised, phase 3 trial. Lancet 2019;393:229-40. Erratum in: Lancet 2019;393:228.

Gambacorti-Passerini C, Messa C, Pogliani EM. Crizotinib in anaplastic large-cell lymphoma. N Engl J Med 2011;364:775-6 DOI: https://doi.org/10.1056/NEJMc1013224

Gambacorti Passerini C, Farina F, Stasia A, et al. Crizotinib in advanced, chemoresistant anaplastic lymphoma kinase-positive lymphoma patients. J Natl Cancer Inst 2014;106:djt378. DOI: https://doi.org/10.1093/jnci/djt378


Pneumology - Case Reports
primary pulmonary lymphoma, anaplastic large cell lymphoma, luftsichel sign
  • Abstract views: 79

  • PDF: 28
How to Cite
Abu-Hishmeh, Mohammad, Laura Miranda, Fouzia Shakil, Tauseef Ahmed, and Oleg Epelbaum. 2021. “Hammering Home the Sickle: An Instructive Case of Endobronchial Anaplastic Large Cell Lymphoma”. Monaldi Archives for Chest Disease, April. https://doi.org/10.4081/monaldi.2021.1601.