A child presented with cervical lymphadenopathy. Biopsy of a lymph node showed diffuse involvement by the lymphohistiocytic variant of ALCL. Of note, the neoplastic cells in this variant are often obscured by a benign histiocytic infiltrate. This can result in the incorrect classification of these cases as a reactive inflammatory process. CD30 and ALK IHC can be used to identify the lymphoma cells and are useful tools for avoiding this important pitfall.