Blood Res 2022; 57(1): 5-5
ALK-positive anaplastic large cell lymphoma that presented as pleural effusion
Do Hwan Kim1, Xiaoping Sun2
Departments of 1Hematopathology and 2Laboratory Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
Correspondence to: Do Hwan Kim, M.D., Department of Hematopathology, MD Anderson Cancer Center, 1515 Holcombe Boulevard, Unit 072 B4.4618, Houston, TX 77030, USA, E-mail:
Received: November 11, 2021; Revised: December 16, 2021; Accepted: January 13, 2022; Published online: March 31, 2022.
© The Korean Journal of Hematology. All rights reserved.

cc This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License ( which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

A 60-year-old male with no prior history of cancer presented with right greater than left bilateral pleural effusion (A) and multiple lymphadenopathies. The pleural effusion cytology showed very large cells with irregular nuclear contours occasionally with central pseudoinclusions (so-called “doughnut” cells, arrows) and plump amphophilic cytoplasm including many vacuoles (B, Wright-Giemsa stain, ×20; C–F, Wright-Giemsa stain, ×50). On concurrent lymph node biopsy sections, the neoplastic cells are positive for ALK and CD30, while negative for keratin 7, keratin 20, MOC-31, and calretinin, confirming the diagnosis of ALK-positive anaplastic large cell lymphoma (ALCL). Nuclear pseudoinclusion, which is an invagination of nuclear membrane but not a true inclusion, can be a clue for several neoplasms, most notably papillary thyroid carcinoma, and others such as medullary thyroid carcinoma, melanoma, meningioma, lung adenocarcinoma especially those with ALK-rearrangement, and ALCL. Although it is highly uncommon for an ALCL to present as pleural effusion, its diagnosis should be considered if the tumor cells are large with frequent nuclear pseudoinclusions in the pleural fluid.


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