Case Series
Year : 2026 Month : October Volume : 15 Issue : 4 Page : PS06 - PS13 Full Version

Anaplastic Large Cell Lymphoma: A Series of Four Cases
M Sindhu, K Chandramouleeswari, M Dougul Regis, Umadevi Srinivasan
1. Postgraduate Student, Department of Pathology, Madras Medical College, Chennai, Tamil Nadu, India. 2. Professor and Head, Department of Pathology, Institute of Child Health and Hospital for Children, Chennai, Tamil Nadu, India. 3. Assistant Professor, Department of Pathology, Institute of Child Health and Hospital for Children, Chennai, Tamil Nadu, India. 4. Assistant Professor, Department of Pathology, Institute of Child Health and Hospital for Children, Chennai, Tamil Nadu, India.
 
Correspondence Address :
M Dougul Regis,
A Block, Lab No.15, Institute of Child Health and Hospital for Children, Tamil Salai,
Egmore, Chennai-600008, Tamil Nadu, India.
E-mail: dougulregis@gmail.com
 
ABSTRACT
: Anaplastic Large Cell Lymphoma (ALCL) is a distinct subtype of mature T-cell lymphoma characterised by uniform and strong CD30 expression across all neoplastic cells, along with wide clinicopathological heterogeneity. It encompasses biologically and prognostically distinct subtypes, namely Anaplastic Lymphoma Kinase (ALK)-positive and ALK-negative ALCL, in addition to the primary cutaneous variant. Despite sharing certain morphological and immunophenotypic features, these subtypes differ considerably in their clinical behaviour, treatment response and overall prognosis. This case series aims to illustrate the diverse clinicopathological manifestations of ALCL encountered in routine diagnostic practice and to highlight the challenges faced in reaching a timely and accurate diagnosis. This retrospective case series includes four patients (3 males, 1 female) diagnosed with ALCL at a tertiary care Government Medical College Hospital over a defined study period. Clinical presentation, haematological and biochemical laboratory parameters, radiological findings, histopathological features and Immunohistochemistry (IHC) results were systematically analysed and documented. The patients ranged from eight to 63 years of age, reflecting the broad age distribution seen in ALCL. Clinical presentations were varied and included prolonged fever with bilateral cervical lymphadenopathy, enlarging soft-tissue swellings, non healing cutaneous ulcers and an ulceroproliferative lesion involving the lip. Extranodal involvement was a prominent feature in three out of four cases. Notably, one paediatric patient fulfilled the established diagnostic criteria for secondary Haemophagocytic Lymphohistiocytosis (HLH), an uncommon but life-threatening complication. Histopathological examination revealed variable morphology with sheets of large pleomorphic cells showing hallmark cell morphology in the majority of cases. On immunohistochemistry, all four cases demonstrated strong CD30 positivity; two cases were ALK-positive and two were ALK-negative. This series underscores the importance of maintaining a high index of suspicion for ALCL across diverse clinical scenarios and age groups and reiterates the indispensable role of integrated histopathological and immunohistochemical evaluation in establishing a definitive diagnosis. The novelty of the present case series is that it highlights the protean clinical and pathological manifestations of ALCL encountered in routine practice. The inclusion of an ALK-negative ALCL with retained CD3, CD5 and CD8 expression which is seen in less than 50% of Alk-negative ALCL, alongside cases with varied extranodal presentations and HLH-associated disease, underscores the diagnostic challenges posed by this lymphoma and emphasises the need for careful clinicopathological correlation and comprehensive immunohistochemical workup for accurate diagnosis. ALCL demonstrates marked clinicopathological heterogeneity and frequently masquerades as other disease entities. Adequate tissue sampling and immunohistochemistry are essential for early and accurate diagnosis.
Keywords : Anaplastic lymphoma kinase, Diagnostic challenge, Immunohistochemistry, Morphologic heterogeneity, T-cell lymphoma
DOI and Others : DOI: 10.7860/NJLM/2026/88297.3006 Date of Submission: Feb 16, 2026 Date of Peer Review: May 12, 2026 Date of Acceptance: Jun 11, 2026 Date of Publishing: Oct 01, 2026 AUTHOR DECLARATION: • Financial or Other Competing Interests: None • Was informed consent obtained from the subjects involved in the study? Yes • For any images presented appropriate consent has been obtained from the subjects. Yes PLAGIARISM CHECKING METHODS: • Plagiarism X-checker: Feb 20, 2026 • Manual Googling: Jun 04, 2026 • iThenticate Software: Jun 10, 2026 (1%) ETYMOLOGY: Author Origin EMENDATIONS: 6
 
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