LGG-06. Concurrent WHO grade II astrocytoma and transformed ALCL in a young female with Crohn’s disease: A case report

Abstract This case highlights the rare and complex presentation of concurrent malignancies in a young immunosuppressed patient. A 23-year-old female with Crohn’s disease, managed with infliximab since age 16, initially presented with waxing and waning cutaneous lesions. Biopsy confirmed transformed anaplastic large cell lymphoma (ALCL) arising from lymphomatoid papulosis, with tumor cells demonstrating CD30 positivity and genetic rearrangements, including DUSP22 and ALK gains. This diagnosis, though rare, was further complicated by neurological symptoms, including bifrontal headaches, visual floaters, and progressive right lower extremity numbness and tingling, weakness, and hyperreflexia, raising concerns for CNS involvement. A brain MRI revealed a 5.6 cm expansile left frontal lobe mass with heterogeneous enhancement and central restricted diffusion. Stereotactic biopsy confirmed a WHO grade II astrocytoma, marking an extraordinary coexistence of a primary brain tumor and systemic ALCL in a young patient on chronic immunosuppressive therapy. This dual malignancy underscores the oncogenic risks associated with TNF-α inhibitors such as infliximab, which have been linked to lymphoma (Müller et al., 2021) and, less commonly, CNS tumors, including glioblastomas (Guo et al., 2016). Management involved discontinuation of infliximab and multidisciplinary care between neurology, neurosurgery, and oncology teams. A left frontal craniotomy was performed to resect the astrocytoma, leading to resolution of the patient’s neurological symptoms by postoperative day one. This case represents the first reported instance of concurrent WHO grade II astrocytoma and ALCL in a patient with inflammatory bowel disease treated with infliximab. It underscores the necessity of vigilant malignancy monitoring in immunosuppressed populations and highlights the lifesaving potential of a comprehensive, multidisciplinary approach in identifying and managing rare, complex presentations. Additionally, it emphasizes the importance of a thorough history and physical examination in uncovering clinically significant findings that guide timely intervention.