Anaplastic large T-cell Lymphoma presenting as obstructive jaundice: Revisiting the pathologist's role

An 18-year-old female presented with obstructive jaundice and significant weight loss for 2 months with acute cholangitis. Examination revealed pallor, icterus, left supraclavicular lymphadenopathy, and hepatosplenomegaly. USG of the neck showed a supraclavicular lymph node of size 6 × 5 × 3 cm. MRCP suggested Dilated CBD and IHBRs with an abrupt cut-off at the cut off at the distal end. CECT chest and abdomen showed cervical, mediastinal, and peri-pancreatic lymphadenopathy, which was causing distal CBD obstruction. EUS-guided FNAC from peri-pancreatic lymph nodes was taken, followed by ERCP-guided CBD stenting was done to relieve acute cholangitis. On FNAC, there was a suspicion of non-Hodgkin lymphoma. An excision biopsy from the left supraclavicular lymph node was taken, which revealed ALK-positive Anaplastic Large T-Cell Lymphoma (ALCL). The patient was given appropriate chemotherapy, which showed significant clinical as well as radiological response.