To the Editor: Anaplastic large cell lymphoma (ALCL) presenting with bone marrow (BM) involvement is not common [1]. We report a child of systemic ALCL whose clinical presentation was more akin to acute leukemia and the initial diagnosis was made on the BM biopsy.A 12-month-old girl presented with marked pallor and fever of 2 months duration. On examination she had hepatosplenomegaly bilateral small cervical and axillary lymphadenopathy. A clinical diagnosis of acute leukemia was suggested. Complete blood count revealed haemoglobin of 8.0g%, leukocyte count of 16´10 9 /cm 2 and platelet count of 82´10 9 /cm 2 . Serum uric acid and calcium were normal, and she was sero-negative for human immunode®ciency virus. Peripheral blood smear revealed normocytic normochromic red cell morphology. Dierential count revealed a shift to the left with 5% myelocytes, 3% metamyelocytes. Blasts were not seen. BM aspirate showed a normocellular marrow with normal hemopoietic cells. Atypical cells were not seen. BM trephine biopsy was normocellular, but showed a focus of large, atypical tumor cells with multilobated, pleomorphic, embryolike nuclei, prominent nucleoli, and moderate to abundant agranular cytoplasm. The tumor cells showed positivity for CD30, CD45, CD45RO (UCHL1), ALK-1 and epithelial membrane antigen. ALK-1 expression was seen both in the cytoplasm and in the nucleus (Fig. 1). Immunostains for cytokeratin, CD68, CD3, CD20, and CD15 were negative (antibodies were procured from DAKO, Denmark). A diagnosis of systemic ALCL was made. Following the BM biopsy, a cervical lymph node (LN) biopsy was performed. The LN revealed involvement of the sinuses and perifollicular regions by cells with similar cytological and immunophenotypic characteristics. The child's general condition rapidly deteriorated and she died within the week.