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Autor*: Monika Antošová, A. Buliková, J. Kissová
Description:
27 years old man comes to hospital with 3 weeks history fever up to 39°C, weakness and fatigue. Clinical picture shows generalised lymphadenopathy and marked hepatosplenomegaly. There is no other extra nodal involvement like skin, lung or central nervous system. Pancytopenia occurs in CBC (leukocytes 3,23 G/l, Hb 85g/l, platelets 111G/l). Bone marrow smears show large to giant tumour cells. Histopathologic examination concludes diagnosis as anaplastic large cell lymphoma lymphohistiocytic variant but in this case without presence of anaplastic large cell lymphoma kinase (ALK) protein.
Zařazení*:
Anaplastic large cell lymphoma
Přílohy*:
Description: Large cell with kidney-shaped nucleus with eosinophilic region in cytoplasm at lower right quadrant of the cell, while another parts of cytoplasm is basophilic. The cytoplasm is abundant. There are some blue nucleoli in the nucleus. The cell size one can estimate to 40 micrometers and more. 
Description: Another example of anaplastic large lymphoma cell. Here is ex-centric, horse-shoe-shaped nucleus. Eosinophilic area of cytoplasm is at 3 o'clock. Nuclear chromatin is fine, nucleus contains several prominent nucleoli. There is bi-lobar late normoblast with internuclear bride at 3 o'clock. 
Description: Two lymphoma cells are in the picture. One of them is large with almost round nucleus with fine chromatin and prominent nucleoli, abundant basophilic cytoplasm converts to more basophilic at the right perinuclear area. Another lymphoma cell is smaller (at 8 o'clock) with ex-centric nucleus. It contains fine chromatin and 2 to 3 small nucleoli. Other cells of the picture belong to neutrophil lineage including one mitosis (at the right from the centre). There is one monocyte above at large lymphoma cell. 
Description: The large cell or one can say almost giant one tumour cell in blood marrow in ALCL and ALK negative T- cell lymphoma. Kidney shape of nucleus is rather typical as also they are multiple nuclei. Cytoplasm is abundant when one compares it with immature nucleus chromatin pattern. 
Description: Bi-nuclear tumour cell in ALCL T- lymphoma. Each nucleus contains few various size dark blue nucleoli. Nuclear chromatin is rather fine of reticular appearance. Cell has abundant moderately basophilic cytoplasm with cytoplasmic protrusions (at right). 
Description: One tumour cell in ALCL (middle right) - large cell with fine nuclear chromatin, prominent nucleolus, abundant cytoplasm which basophilia passes to eosinophilia. There are also three neutrophil myelocytes (upper one is destroyed), one lymphocyte (at 3 o'clock). The last cell in the picture is macrophage (between two myelocytes). These cells are typical component of this lymphohistiocytic variant of the lymphoma . 
Description: Three tumour cells in ALCL. They have pale basophilic cytoplasm, fine reticular nuclear chromatin and few dark blue nucleoli. There are two nuclear fragments in cytoplasm one of them (upper left). At the upper right are two immature neutrophils (upper promyelocyte, lower myelocyte). 
Description: Macrophages (cell at left) are usually seen especially in lymphohistiocytic variant of ALCL. In some cases these cells can mask malignant cells which can be smaller ones than in this case. 
Description: Two closely pressed malignant lymphoma cells with ex-centric nucleus, reticular chromatin pattern, few nucleoli and abundant pale basophilic finely vacuolized cytoplasm. 
Description: Erythrophagocytosis by macrophages is occasionally seen in cases ALCL, especially in lymphohistiocytic variant (in classic variant is rarely seen erythrophagocytosis by malignant cells). 
Description: Tumour cells can be smaller in lymphohistiocytic variant of ALCL - in this case malignant lymphoma cell has cleft or bi-lobar nucleus, abundant vacuolized cytoplasm and cytoplasmic blebs; it is almost comparable in size with immature myelocyte on it's left (both cell at upper right).