Fine needle aspiration cytology of an endotracheal mass report of a case with an unusual presentation of anaplastic large cell lymphoma

Background: Anaplastic large cell lymphoma (ALCL) is an uncommon hematolymphoid neoplasm characterized by malignant lymphocytes of T-cell phenotype. It usually affects young patients and may involve a variety of tissues and organs. We herein describe a case of ALCL that presented as an endotracheal mass with associated hilar lymphadenopathy. To the best of our knowledge this is the first case in the literature arising in the trachea. In this location the diagnosis of ALCL can be especially difficult as its pleomorphic cytomorphology mimics that of a carcinoma, which is a more typical neoplasm arising in the trachea. Case: A 26-year-old male presented with hemoptysis and paroxysmal chest pain. Imaging revealed an endotracheal mass and multiple lytic bone lesions. Fine needle aspiration biopsy of the endotracheal mass revealed discohesive malignant cells with abundant, pale cytoplasm and cerebriform, donut-shaped and horseshoe-shaped nuclei. Immunohistochemical studies confirmed the diagnosis of ALCL. Conclusion: ALCL may have an unusual presentation and involve diverse sites, including the trachea. While its cytologic features are straightforward, a high index of suspicion is necessary to ensure accurate diagnosis when it presents in unusual locations.