Imprint cytology facilitating the diagnosis of primary cutaneous anaplastic large cell lymphoma of iliac fossa
A 59-year-old man presented in skin department with large beefy red ulcerofungative mass in the left iliac fossa measuring 6×4×1 cm which was a small nodule 2 months back.\nComputed tomography (CT) scan showed the presence of soft tissue mass with irregular outlines arising from the skin. There was no nodal or any other organ involvement in the body. With high clinical suspicion of squamous cell carcinoma, biopsy of the mass and imprint smears were taken.\nThe imprint smears were stained with Giemsa and showed isolated tumor cells. The tumor cells were predominantly round in shape having moderate to abundant cytoplasm with a well-defined cytoplasmic membrane and accentuated cell borders. At places, cytoplasmic blebbing was seen. The nuclei were central to eccentric showing variation in size and shape, had irregular nuclear membranes with fine chromatin and variably prominent nucleoli []. The smears also showed characteristic hallmark cells with horseshoe shape/reniform nuclei [], plasmacytoid cells, occasional hand mirror cells with eccentric nucleus and elongated cytoplasm [] and occasional doughnut cells []. Background showed neutrophils, macrophages, lymphocytes, apoptotic cells, mitosis, and sparse lymphoglandular bodies. Keeping in view the above findings cytological diagnosis of non-Hodgkin lymphoma with high possibility of ALCL was made.\nHistologically, the sections showed ulcerated squamous epithelium. Dermis showed diffuse population of tumor cells especially arranged around blood vessels. Individual tumor cell showed round to pleomorphic nuclei with an irregular nuclear membrane and conspicuous nucleoli. Many reniform/horseshoe shaped nuclei, mitotic figures and apoptotic bodies were also seen. There was no necrosis in the biopsy tissue examined []. Histopathological features were suggestive of high grade non-Hodgkin lymphoma, ALCL. On immunohistochemistry (IHC), the tumor cells were positive for CD 45 and CD 30 [, Inset] which favored the diagnosis of CD 30+ primary cutaneous anaplastic large cell lymphoma.