Cervical Node Biopsy Research Articles

Diagnostic accuracy of fine needle aspiration biopsy of cervical lymph node: a study of 580 cases

Study on the diagnostic accuracy of fine needle aspiration biopsy of cervical lymph nodes and to discuss the reasons of making a misdiagnosis. Five hundred and eighty cases of cervical lymph node fine needle aspiration biopsy were reviewed retrospectively. Among them, histologic findings were available in 161 cases. The cytologic and histologic diagnoses were compared. There were altogether 226 cases of reactive lymphoid hyperplasia, 202 cases of specific inflammation, 45 cases of malignant lymphoma and 107 cases of metastatic carcinoma. The concordance rate between the cytologic and corresponding histologic diagnoses was 94.4%. The primary foci of most cases with metastatic carcinoma could be delineated by reviewing the clinical and pathologic finding. Inadequate cellularity was the main reason of making misdiagnosis and useful diagnostic clues might be obtained by careful study of the clinical findings. Fine needle aspiration biopsy of cervical lymph node carries a high diagnostic accuracy. It provides important clues in guiding subsequent clinical management. However, for detailed subtyping of certain disease entities such as malignant lymphoma, surgical biopsy for histologic and immunohistochemical studies are required.

Kikuchi-Fujimoto Disease: A case report and review of the literature

Kikuchi-Fujimoto Disease is a rare benign, condition of necrotising histiocytic lymphadenitis. A case of a 55 year old gentleman is described here. He presented with fevers, weight loss and tender cervical lymph nodes. Kikuchi-Fujimoto disease was diagnosed after cervical lymph node biopsy. Symptomatic treatment was provided and an uneventful full recovery was made. Of significant note, this patient's daughter had Kikuchi-Fujimoto disease almost a decade earlier. Although Kikuchi-Fujimoto disease has been reported widely, we believe this is the first familial report in the literature of a case of Kikuchi-Fujimoto disease occurring in a parent and child.

A rare case of sarcoid osteitis in a child with response to methotrexate

Sarcoidosis is a disease of unknown origin characterised by noncaseating granuloma and can involve any tissue or organ. Osseous involvement in sarcoidosis is rare in children and long tubular bone involvement is even rarer. We present a case histologically proven as sarcoid osteitis of radius and humerus that had a dramatic response to methotrexate. A 9 year old Jamaican boy with known sarcoidosis, diagnosed in Kingston by cervical lymph node biopsy initially presented to us with high grade pyrexia, peripheral lymphadenopathy and painful shiny swelling in both shin. Tentative diagnosis made was sarcoid related osteitis. X-ray of legs (Figure ​(Figure1)1) showed periosteal reaction in leg bones. He was treated with subcutaneous methotrexate. Figure 1 X-ray of legs showing periosteal reaction in leg bones. After 3 years of drug-induced remission, methotrexate was stopped. Eight months after stopping methotrexate he presented with painful swelling of left arm and forearm. Radiograph showed circumferential lesion with periosteal reaction and MRI scan confirmed surrounding oedema suggestive of acute lesion. Sarcoid osteitis was confirmed on biopsy by the presence of characteristic non caseating granuloma with giant cells. He was restarted on methotrexate upon which the lesions resolved in a few weeks. Authors conclude that long bone involvement in a child with sarcoidosis is rare but we should have low threshold for biopsy in known case of sarcoidosis presenting with radiological feature of osteitis to confirm the diagnosis and for treatment. In our case there was excellent response to methotrexate.

SINUS HISTIOCYTOSIS WITH MASSIVE LYMPHADENOPATHY (ROSAI DORFMAN'S DISEASE): A RARE CAUSE OF LYMPHADENOPATHY IN CHILDREN

Sinus histiocytosis with massive lymphadenopathy also called as Rosai-Dorfman’s disease is a benign self limiting rare histiocytic disorder with very few case reports in Pakistani literature. This case report describes a young boy of nine years age who presented with progressive, asymptomatic bilateral cervical lymphadenopathy for eight months. Open cervical lymph node biopsy confirmed the diagnosis on classical histopathological features. As the patient was asymptomatic, we kept him on observation, with follow-up. He shown remarkable reduction in cervical lymphadenopathy.

Metastatic insular thyroid carcinoma in the pediatric patient

Objectives The clinical history of a pediatric patient with metastatic insular thyroid carcinoma will be reviewed. Previously reported cases will be examined to allow for comparison of prognosis. Methods A 4-year-old female with the complaint of chronic cough, progressive shortness of breath, and weight loss for 2 months underwent cervical lymph node biopsy. The biopsy revealed metastatic thyroid carcinoma. Preoperative imaging was suspicious for miliary metastatic spread to the lungs. Results Surgical intervention included total thyroidectomy with bilateral paratracheal and modified radical neck dissections. The right internal jugular vein and recurrent laryngeal nerve were removed at the time of surgery because of gross tumor invasion. Final pathologic finding revealed papillary thyroid carcinoma with insular variant features and bilateral regional metastasis. Postoperatively, the patient underwent radioactive iodine I 131 treatment. Conclusion Pediatric metastatic insular thyroid carcinoma is an uncommon form of thyroid malignancy requiring aggressive surgical treatment and adjuvant radioactive iodine.

Biopsy of cervical lymph node

Objective This report examines 60 non-cancer patients who underwent a cervical lymph node biopsy, and discusses the value of the cervical lymph node biopsy as a diagnostic tool. Methods Sixty patients with cervical lymph node enlargement who had lymph node biopsies at the Juntendo University between 2004 and 2007 were examined. The clinical parameters including age, size of the lymph node, white blood cell (WBC), C reactive protein (CRP), lactate dehydrase (LDH), soluble interleukin-2 receptor (sIL-2r) were measured at initial examination. Fine needle aspiration cytology was carried out in all patients. The patients were divided into 2 groups, including the malignant lymphoma (ML) group and the benign disease group. These groups were compared based on the patient's clinical parameters. Results Serum levels of LDH, sIL-2r, age and lymph node size in the ML group were significantly higher than in the benign group. WBC and CRP showed no significant differences. Simple regression analysis showed that there are correlation between the size of enlargement lymph node and serum levels of LDH and sIL-2r in ML group. Conclusion The results of this study suggest that a biopsy should be considered early to patients with an advanced age, large swollen lymph nodes or high levels of serum sIL-2r or LDH.

Unusual Features of Malignant Pleural Mesothelioma Metastatic to the Mediastinal Lymph Nodes

Malignant pleural mesothelioma (MPM) is a rare cancer that metastasizes to mediastinal lymph nodes (MLNs). The diagnosis of MPM metastatic to MLNs may not be straightforward. We describe 3 cases to highlight unusual entities of MPM metastatic to MLNs as follows. One patient with a history of T3N1M0, poorly differentiated esophageal adenocarcinoma and malignant melanoma presented with shortness of breath, mediastinal lymphadenopathy, and pleural effusion; metastatic disease was clinically suspected. Unexpectedly, immunohistochemical studies supported the diagnosis of MPM metastatic to the MLN on biopsy. In another case, mesothelial cell inclusions were initially diagnosed based on the light microscopy, immunohistochemistry, and lack of pleural thickening on computed tomography studies. Subsequent fine needle aspiration of an enlarged cervical lymph node found an atypical mesothelial proliferation, and metastatic mesothelioma was strongly suspected. Video-assisted thoracoscopic examination showed small visceral nodules, and pleural biopsy was diagnosed as malignant epithelioid mesothelioma. The mediastinal and cervical lymph node biopsies were reinterpreted as positive for MPM. In the last case, MLN biopsy showed a malignant epithelioid cell proliferation. Calretinin, CK5/6, WT-1, D2-40, p63, and CD5 were immunohistochemically detected in the tumor but epithelial markers and TTF-1 were negative. Metastatic mesothelioma was considered based on immunohistochemistry and computerized tomography finding of pleural thickening even though p63 and CD5 positivity were unusual. In summary, MPM may present as mediastinal lymphadenopathy with metastases or it may be a concurrent neoplasm with other malignancies or shows an unusual immunohistochemical staining pattern. Caution should be used when diagnosing mesothelial cell inclusions in MLNs.

Superior vena cava syndrome in children

Superior vena cava syndrome (SVCS) is rare in childhood. 18 cases of SVCS were seen in children ranging from 3-14 years with a mean age of 8.8 years. There were 15 males and 3 female children. Diagnosis could be confirmed in 17 cases as one child succumbed to severe respiratory distress without a definitive diagnosis. The commonest cause of SVCS was lymphoma. Non-Hodgkin's lymphoma (NHL) was more common than Hodgkin's disease. In two cases the final diagnosis was tuberculosis of mediastinal lymph nodes. The diagnosis was confirmed by cervical lymph node biopsy in 6 cases, mediastinal biopsy in 6 cases and bone marrow aspiration in the remaining 5 cases. Intravenous Dexamethasone provided relief of symptoms in 13 patients. None of the children received emergency radiotherapy. Anti-tubercular treatment produced complete cure in the two patients with tubercular mediastinal lymphadenopathy.

頸部リンパ節の腫脹をきたす疾患の鑑別診断（口腔外科から）

Many differential diagnoses must be considered in the diagnosis of cervical lymphadenopathy. Lymph nodes, which are responsible for the production of lymphocytes, are crucial to the body's defense mechanism and are responsible for the immune response to bacteria, viruses, toxins, and other materials that invade the lymph vessels. They are also susceptible to metastasis of malignant tumors. Therefore, cervical lymphadenopathy may indicate a variety of disorders. In addition to interviews, visual inspection, and palpation, blood tests and diagnostic imaging such as X-ray, CT, MRI, and ultrasound are also essential. In cases where a diagnosis can not be made based on these tests, biopsy of the swollen lymph node must be performed. Cervical lymph node biopsy requires the utmost care in addition to the patient's informed consent. Many nerves and blood vessels are present in the neck region, and accidental injury to these nerves and blood vessels may result in serious sequelae, which in many cases incur medical malpractice lawsuits. Therefore, cervical lymph node biopsy should not be performed unassisted by inexperienced surgeons. Herein, we present the lymph node disorders and diagnostic methods that are important for differential diagnosis, and describe the points of caution regarding lymph node biopsy.

Malpractice Litigation After Surgical Injury of the Spinal Accessory Nerve

To review the background, case characteristics, and outcomes of malpractice litigation resulting from surgical injury of the spinal accessory nerve. Retrospective review of indemnity insurance cases (part 1) and court trials (part 2) between January 1, 1985, and January 1, 2007. In part 1, records of the Medical Liability Mutual Insurance Company identified 41 lawsuits in New York State; part 2 was a review of a national legal database (WestLaw) that identified 81 court trials. Case details were analyzed, and awards were adjusted for inflation. For part 1, of 41 indemnity insurance cases, 39 (95%) involved a posterior triangle lymph node biopsy. Defendants were mainly general surgeons and otolaryngologists. Most lawsuits against surgeons (22 of 34 [65%]) were settled before trial, and only 4 of 34 (12%) were discontinued. Of these 34 cases, 28 (82%) ultimately compensated the plaintiff. The mean inflation-adjusted pretrial settlement was $264 395, and the mean settlement at trial was $443 538. Cases reaching trial received significantly higher settlements (P = .01). For part 2, 81 cases of alleged surgical injury to the spinal accessory nerve were identified. Defendant physicians were mainly general surgeons and otolaryngologists. Most operations were cervical lymph node biopsies (55 [68%]), followed by sebaceous cyst excisions (6 [7%]), neck dissections (4 [5%]), and other procedures (12 [15%]). Morbidity included weakness (81 patients [100%]), pain (30 patients [37%]), inability to work (20 patients [25%]), need for a nerve repair procedure (16 patients [20%]), deformity (9 patients [11%]), and numbness (4 patients [5%]). Types of malpractice alleged included negligent surgical technique (79 cases [98%]), lack of informed consent (17 cases [21%]), and failure to diagnose the injury (16 cases [20%]). Thirty-seven cases (46%) were decided for the defendant, 32 (40%) were decided for the plaintiff, and 12 (15%) were settled (percentages do not total 100 because of rounding). The mean inflation-adjusted settlement was $356 132, and the mean jury award was $515 968. Jury awards were significantly higher than settlements (P = .003). Unintended injury to the spinal accessory nerve after head and neck surgery is a significant source of malpractice litigation. Timely diagnosis and treatment of this complication are essential. Regardless of whether the medical community considers careful surgical technique and nerve preservation to be the standard of care, the legal system clearly treats it as such, awarding compensation in 82% of cases. Strategies for optimal surgical care and litigation risk reduction are discussed.

A Case of Thyroid Cancer Combined with Pulmonary Sarcoidosis

Sarcoidosis is a systemic granulomatous disease that primarily affects the lung and lymphatic system of the body. Since Brincker first noted a statistically significant increase of malignant tumors among sarcoidosis patients, there have been several reports on simultaneously developed sarcoidosis and malignancy. A 30-year-old man was admitted to our hospital because of multiple enlarged mediastinal lymph nodes. The patient had been well until approximately 10 days before admission, when he developed a cough. Chest X-ray and computed tomography (CT) of the chest that were performed at the outpatient department revealed multiple enlarged mediastinal lymph nodes. Cervical lymph node biopsy revealed both non-caseating granuloma and metastatic papillary carcinoma, whereas the mediastinal lymph node showed only non-caseating granuloma. The thyroid gland surgical specimen showed papillary carcinoma. We report here on a case of a 30-year-old man who had sarcoidosis and thyroid cancer, and we include a review of the literature. (Tuberc Respir Dis 2008;65:52-56)

Autoimmune lymphoproliferative syndrome in a patient with a new minimal deletion in the death domain of the FAS gene

We present a case of autoimmune lymphoproliferative syndrome (ALPS) caused by a previously undescribed minimal deletion in the death domain of the FAS gene. ALPS is an uncommon disease associated with an impaired Fas-mediated apoptosis. The patient presented with a history of splenomegaly since 4 months of age, associated with cervical lymphadenopathy, which improved with oral corticosteroid treatment. Relevant laboratory findings were the presence of anemia, thrombocytopenia, and positive direct and indirect Coombs tests. He was not an offspring of consanguineous parents. Two cervical lymph node biopsies were performed, at 4 years and at 6 years of age. In both lymph nodes, there was marked paracortical expansion by lymphocytes in variable stages of immunoblastic transformation and a very high cell proliferating index. Some clear cells were also present, raising the suspicion of malignant lymphoma. In one of the lymph nodes, there was also a focus rich in large histiocytes with round nuclei and emperipolesis, consistent with focal Rosai-Dorfman disease. Immunostaining showed numerous CD3+ cells, many of which were double-negative (CD4- CD8-) and expressed CD57, especially around the follicles. Molecular studies of the lymph node biopsy showed a point deletion (4-base pair deletion) in exon 9 of the FAS gene (930del TGCT), which results in 3 missense amino acids.

Immunohistochemical diagnosis of abdominal and lymph node tuberculosis by detecting Mycobacterium tuberculosis complex specific antigen MPT64

BackgroundThe aim of this study was to evaluate the diagnostic potential of immunohistochemistry using an antibody to the secreted mycobacterial antigen MPT64, in abdominal and lymph node tuberculosis.MethodsWe used formalin-fixed histologically diagnosed abdominal tuberculosis (n = 33) and cervical tuberculous lymphadenitis (n = 120) biopsies. These were investigated using a combination of Ziehl-Neelsen method, culture, immunohistochemistry with an antibody to MPT64, a specific antigen for Mycobacterium tuberculosis complex organisms. Abdominal and cervical lymph node biopsies from non-mycobacterial diseases (n = 50) were similarly tested as negative controls. Immunohistochemistry with commercially available anti-BCG and nested PCR for IS6110 were done for comparison. Nested PCR was positive in 86.3% cases and the results of all the tests were compared using nested PCR as the gold standard.ResultsIn lymph node biopsies, immunohistochemistry with anti-MPT64 was positive in 96 (80%) cases and 4 (12.5%) controls and with anti-BCG 92 (76.6%), and 9 (28%) respectively. The results for cases and controls in abdominal biopsies were 25 (75.7%) and 2 (11.1%) for anti-MPT64 and 25 (75.7%) and 4 (22%) for anti-BCG. The overall sensitivity, specificity, positive and negative predictive values of immunohistochemistry with anti-MPT64 was 92%, 97%, 98%, and 85%, respectively while the corresponding values for anti-BCG were 88%, 85%, 92%, and 78%.ConclusionImmunohistochemistry using anti-MPT64 is a simple and sensitive technique for establishing an early and specific diagnosis of M. tuberculosis infection and one that can easily be incorporated into routine histopathology laboratories.

Apoptosis is a major cause of so-called “caseous necrosis” in mycobacterial granulomas in HIV-infected patients

Aim:To demonstrate that so-called “caseous necrosis” is the result of apoptosis and investigate the association of B and T cells, and macrophages with the granulomas and their relationship to some...

Parotid gland involvement, the presenting sign of high grade non‐Hodgkin lymphoma in two patients with Gaucher disease and sicca syndrome

Increased risk of haematological malignancies has been described in Gaucher disease patients; however, high-grade lymphoma has been rarely observed. We report two patients with Gaucher disease and sicca syndrome diagnosed with aggressive lymphoma involving the parotid gland. A 29-year-old woman with Gaucher disease developed tumour of the left parotid gland. She reported chronic arthralgias, xerostomia and xerophthalmia. Parotid gland biopsy disclosed diffuse large B-cell lymphoma. No lymphadenopathy was found. Bone biopsy revealed focal lymphomatous infiltration consistent with stage IV disease. MACOP-B chemotherapy regimen (cyclophosphamide, adriamycin, methotrexate, bleomycin, vincristine, prednisone) resulted in complete remission for 15 years. A 76-year-old patient with Gaucher disease suffered from dry-mouth feeling. He developed a left parotid gland tumour. CT scan disclosed diffuse lymphadenopathy, pleural effusion and multiple lung nodules. A cervical lymph node biopsy revealed mantle cell lymphoma. Fine-needle aspiration of the parotid gland showed lymphoma cells. Immunochemotherapy with fludarabine, cyclophosphamide and rituximab resulted in complete remission. Accumulation of the glucocerebroside in Gaucher disease activates macrophages, inducing release of pro-inflammatory cytokines which may be involved in the pathogenesis of second malignancy. Patients with Gaucher disease bear an increased risk of haematological malignancies; however, aggressive lymphoma has been described only occasionally. In both our patients the presenting sign of lymphoma was tumour of the parotid gland. The patients suffered from sicca syndrome, which increases risk for developing lymphoma. The underlying Gaucher disease and sicca syndrome might be implicated as immunological triggers for lymphoma occurrence and its propensity for the parotid gland in these patients.

Dexmedetomidine Sedation in a Patient With Superior Vena Cava Syndrome and Extreme Needle Phobia

SUPERIOR VENA CAVA SYNDROME (SVCS) is a life-threatening condition associated with high morbidity and mortality. 1 Azarow K.S. Pearl R.H. Zurcher R. et al. Primary mediastinal masses: A comparison of adult and pediatric populations. J Thorac Cardiovasc Surg. 1993; 106: 67-72 PubMed Google Scholar Providing anesthesia for these patients can be particularly challenging. The induction of general anesthesia may be associated with sudden airway obstruction, hemodynamic compromise, and death. 2 Keon T.P. Death on induction of anesthesia for cervical node biopsy. Anesthesiology. 1981; 55: 471-472 Crossref PubMed Scopus (87) Google Scholar The underlying pathogenesis of cardiorespiratory compromise in these patients is caused by extrinsic (or intrinsic) airway (with or without cardiac or major vessel) compression. 3 Bray R.J. Fernandes F.J. Mediastinal tumour causing airway obstruction in anaesthetized children. Anaesthesia. 1982; 37: 571-575 Crossref PubMed Scopus (62) Google Scholar It is particularly concerning that some patients with little or no symptoms of airway compression may develop life-threatening airway obstruction and cardiovascular collapse after the induction of general anesthesia. 4 Viswanathan S. Campbell C.E. Cork R.C. Asymptomatic undetected mediastinal mass: A death during ambulatory anesthesia. J Clin Anesth. 1995; 7: 151-155 Abstract Full Text PDF PubMed Scopus (34) Google Scholar

Focal Bone Marrow Involvement in Multicentric Castleman Disease Demonstrated By FDG PET/CT

Castleman disease is a lymphoproliferative disorder, which usually occurs in the chest. Multicentric Castleman disease with multiple foci involving many anatomic locations is rare. The authors describe a 75-year-old man with a history of fever, shivering, and multiple lymphadenopathies who had a cervical lymph node biopsy which defined the diagnosis as multicentric Castleman disease, hyaline-vascular type, stroma-rich variant. A whole-body F-18 fluorodeoxyglucose (FDG) positron emission tomography/computed tomography (PET/CT) was performed for evaluation of the extent of the disease. The images demonstrated focal areas of intense FDG uptake in multiple foci of enlarged lymph nodes and heterogeneous FDG uptake in the skeleton. Of interest, PET/CT fusion images clearly showed focal areas of more intense FDG uptake in the bone marrow of the right scapula, ribs, right iliac bone, and left acetabulum.

Kikuchi‐Fujimoto disease of 16 children in a single center of Korea

Kikuchi-Fujimoto disease (KFD) is subacute necrotizing lymphadenitis characterized by fever, leukopenia and cervical lymphadenopathy. There are few reports on the clinical characteristics and laboratory findings of KFD in the pediatric literature. In this study, we evaluate the characteristics and outcome of KFD in children. A total of 412 patients were studied with fever and peripheral lymphadenopathy at Pusan National University Hospital from January 1998 to December 2003. Among the total 412 there were 16 patients diagnosed with KFD by lymph node biopsy. We analyze the clinical, laboratory and outcome after review of the medical records retrospectively. The mean age of the patients was 10.6 +/- 3.4 yr (range: 4-17 yr). The male to female ratio was 1:1. Almost all patients, except two, had cervical lymph node swelling. The size of the involved lymph node was less than 4 cm in the greatest dimension in 75% of the patients. All the children had fever as the chief complaint and the mean duration of the fever was 17.7 +/- 11.2 days (range: 2-122 days). Approximately 87% of the patients had leukopenia (WBC < 4000/mm(3)) and 43.8% of the patients had a mild increase in the transaminases on liver function testing. A total of 8 out of the 16 patients were initially misdiagnosed as an infectious disease and treated with antibiotics which caused prolonged hospitalization for most patients. Six patients were treated with prednisone and the prolonged fever subsided immediately after steroid therapy. KFD should be considered in the differential diagnosis of prolonged fever in children with cervical lymphadenopathy. Early cervical lymph node biopsy is necessary to minimize inappropriate examinations and treatments in such cases.

Composite splenic marginal zone lymphoma and classic Hodgkin lymphoma – an unusual combination

The simultaneous occurrence of Hodgkin lymphoma with a variety of B-cell Non-Hodgkin lymphomas (composite lymphoma) has been described. We report the first case of composite Hodgkin lymphoma and splenic marginal zone lymphoma occurring simultaneously in the same lymph node of a 64-year-old man who presented with cervical and axillary lymphadenopathy and massive splenomegaly. He had a peripheral blood lymphocytosis and a bone marrow infiltrated by small lymphocytes. However, cervical lymph node biopsy showed classic Hodgkin lymphoma. His splenomegaly showed only a partial response to six cycles of ABVD chemotherapy so he underwent splenectomy with biopsy of remaining nodes. Histology of the spleen and nodes showed splenic marginal zone lymphoma. Review of the original biopsy confirmed the presence of both diseases in the original lymph node.

INFANT ANAPLASTIC LYMPHOMA: Case Report and Review of the Literature

Anaplastic large cell lymphoma (ALCL) is a well-known entity, but there are no data on prognosis according to the age of the patient, especially in infants. A 2-month-old girl was admitted with a 2-week history of coughing, fever, and lymphadenopathy. Physical examination revealed mild respiratory distress, an erythematous macular rash on her trunk, massive cervical lymphadenopathy, splenomegaly, and very mild ascites. Chest radiograph showed bilateral pulmonary infiltrates, pleural effusion, and a mediastinal mass. CBC count showed WBC: 172,000/μL (PMN 40%, lymphocytes 47%, monocytes 3%); hemoglobin concentration: 8.7 g/dL; platelets: 390,000/μL. Cervical lymph node biopsy revealed anaplastic lymphoma with positive staining to ALK 1 and TIA 1. Immunophenotypic analysis of peripheral and bone marrow lymphoid cells showed an aberrant T-cell immunophenotype, including expression of CD3, CD45R0+, CD43+, and CD30+. Cytogenetic analysis performed on blood and bone marrow samples demontrated the translocation t(2;5) (p23;q35), and trisomy 47. After leucophoresis, the child received chemotherapy according to the ALCL-99-EICNHL protocol, and was started on corticosteroids and cyclophosphamide, which resulted in marked improvement. After the second course, WBC decreased to 6000/μL without tumor lysis syndrome, but the child developed bacterial and fungal disseminated infections and died of septic shock with multiorgan failure. This report is of a rare case of infant anaplastic lymphoma and excellent response to treatment. Unfortunately, she did succomb to overwhelming infection. More reports of similar cases may determine the cause and prognosis of such children, helping to tailor therapy according to the age of the child and other prognostic factors, especially bone marrow involvement.