Anaplastic large cell lymphoma of T-cell phenotype in acquired immunodeficiency syndrome

Anaplastic large cell lymphoma (ALCL) is an uncommon non-Hodgkin's lymphoma in the general population as well as in HIV-infected patients. Ordinarily, ALCL expresses T-cell phenotype, but lymphoproliferative disorders derived from T cells rarely occur in acquired immunodeficiency syndrome (AIDS). We describe a white male homosexual with AIDS who had bilateral pleural effusions. Examination of the pleural fluid revealed ALCL positive for Ki-1 (CD30), LCA (CD45), UCHL-1 (CD45RO), CD43, CD3, and epithelial membrane antigen. The lymphoma was negative for the B-cell marker L26 (CD20) and for Leu-M1 (CD15). The T-cell origin was also confirmed by the monoclonal rearrangement of the T-cell receptor beta chain gene. A review of other cases of ALCL in HIV-positive individuals shows variability in clinical presentation and biologic behavior of this lymphoma type. It also points to the potential contribution of gene rearrangement studies for recognition of phenotype. In addition, the role of determination of the presence of t(2;5) and the corresponding gene product is discussed.