Objective: Anaplastic large cell lymphoma (ALCL) is a relatively rare form of non–Hodgkin lymphoma in children constituting 10–15%of this entity. The aim of this study was to describe the role of Fine needle aspiration cytology(FNA) in diagnosing Alk positive ALCL at rare sites by combining cell block and ancillary tests.

Materials and Methods:Five paediatric cases of Alk positive ALCL were retrieved from the cytology register. All were boys, youngest aged 11months and oldest being 13yrs. Theypresented at rare sitesinvolving oro–nasopharyngeal, mediastinal, thigh, arm, supraorbital&scalp. FNA and cell block was done & one case of mediastinal lesion FNA was performed under ultrasound guidance. The clinical and cytomorphological features including ancillary testswere reviewed.

Results:Cytomorphology of all the five cases revealed high grade lymphoma withlarge lymphoid cells with abundant cytoplasm, horseshoe shaped nuclei and wreath–like multinucleated giant cells.

Conclusion:ALCL is very aggressive high grade T cell lymphoma. It can occur at rare sites as highlighted in our cases.ALCL can be accurately diagnosed by FNA cytomorphology, along with ancillary tests on cell block. This study emphasizes the need forclinicians and pathologists to maintain a high index of suspicion for ALCL when patients present at such rare sites.