HISTORY:  
70 yrs male with B CLL/SLL diagnosed in threpine in 2006 (80% of the space; IH: CD20+, CD23+, CD5+). Therapy: Leukeran + chemo. Due to progression in the last half of a year: FMC. LDH borderline. Febrility for a month. Infections tests were negative. CRB 230mg/L. BLOOD test: Leucocytes 4,7, neutrophils 2,6, lymphocytes 1,78, Hb 82, thrombocytes 144. Axillary lymphadenpathy (firm): 8cm. Hepato- splenomegaly: absent.  
2009 09 28 Threpine: 40% of the space identical CLL/SLL.  
2009 10 01 Core biopsy from LN (due to clinical status it's difficult to arrange LN biopsy).  
HISTO: B CLL/SLL (CD5+CD20+Pax5+ CD23-) and cHL (CD30+ CD15+ EBV LMP1+) combination.  
VISTUAL SLIDES: Apperio.  
PICTURES: JPG from Virtual slides.  
 
PROPOSAL: B CLL/SLL with Richter's transformation (cHL like).  
 
Thank you for patience. Trying do my best.

tzankov 2009-10-12 13:25	Nicely documented case with the typical history of Fludara exposition (FMC)... I fully agree with your diagnosis.     I allowed myself to attach a paper of ours dealing with that issue. attachment: 38. British Journal of Haematology Hodgkin's lymphoma in CLL.pdf
ugnius 2009-10-12 14:25	Thank you, dr. Alex for both actions:)
hurwitz 2009-10-19 19:12	Thanks Ugnius for sharing with us this excellent case and well documented case. There is nothing to add to your diagnosis, therefore we can close it.