There is a dense nodular infiltrate of atypical lymphoid cells, extending through all levels of the dermis into the subcutis. Epidermotropism is an inconsistent feature. The morphologic hallmarks are large, bizarre cells with irregularly shaped nuclei and one or more nucleoli and an abundant clear or eosinophilic cytoplasm
(Fig. 2). Tumor cells usually grow in dense cohesive sheets, reminiscent of nodular malignant melanoma or undifferentiated carcinoma, and may be multinucleated (Fig. 2). Mitoses are frequent.M Clusters of small reactive lymphocytes are found within and around the tumor. Eosinophils, plasma cells, and dendritic cells are usually few in ALCL. The lymphoma can also present with an extensive infiltrate of neutrophils and is then described as neutrophil-rich or pyogenic CD30+ ALCL (N-ALCL) (10,11). Clinically, N-ALCL is characterized by ulceration and purulent secretion due to formation of small abscesses within the tumor tissue. Remarkably, these lymphomas are almost exclusively limited to the face. Small aggregations or scattered CD30+ medium to large pleomorphic lymphoid cells are found within a diffuse mixed-cellular infiltrate with numerous neutrophilic abscesses.
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