Neutrophil-rich anaplastic large cell lymphoma of T-cell lineage - A report of two cases arising in HIV-positive patients

Neutrophil-rich anaplastic large cell lymphoma (ALCL) is an uncommon morpho logic variant of ALCL. We report 2 cases of neutrophil-rich T-cell ALCL tha t presented as scalp masses in HIV-positive men. Histologically, the neopla stic cells extensively infiltrated the dermis and subcutaneous tissue. The neoplastic cells strongly expressed CD30 and were of T-cell lineage positiv e for CD3 and CD45RO, and negative for CD20 The neoplastic cells were negat ive for anaplastic lymphoma kinase-1. Numerous admixed neutrophils also wer e present, representing up to 70% of all cells in some microscopic fields. Neither patient had peripheral blood leukocytosis. One patient had relative neutrophilia, 79% (0.79; reference range, 50%-70% [0.50-0.70]). The absolu te CD4 counts were 160 cells/mu L (160 x 10(6)/L) and 150 cells/mu L (150 x 10(6)/L), respectively (reference range, 431-1,623/mu L [431-1,623 x 10(6) /L]). Both patients were treated with multiagent chemotherapy but died of P neumocystis carinii pneumonia within 6 months of diagnosis. In our review o f the literature, we identified 5 similar T-cell cases including I in an HN -positive patient. Neutrophil-rich T-cell ALCL is a rare morphologic varian t of ALCL that should be considered in the histologic evaluation of neutrop hil-rich biopsy specimens.