53 yrs old female with NHL suspition. Coeliac lymph node biopsy was taken together with threpine biopsy.  
HISTO: Vagually nodular pattern consisting of epithelioid histiocytes nodules and diffuse monotonous T cell back.  
THREPINE: Focal identical infiltrates in BM.  
IH: T population: CD3/CD5+; CD7/PD1/CD8/GranzymB/CK56(-); CD57(+/-); CD4+; Ki67 <5%.  
Flow (BM): Lympho population~5% (small lymphos). T lymphos (CD3+) ~ 95%, Th:Tc = 3,3. ~62% of lymphos: abberant: CD45+, CD2+, CD3+, CD4+, CD5+, TCR alfa beta+, CD7-, CD8-, CD16-, CD56-, CD57-, TCR gama delta-. T LPD possible.  
 
DIAGNOSIS: Peripheral T cell lymphoma: "lymphoepithelioid lymphoma" aka Lennert's lymphoma: nodal and BM involvement.

tzankov 2014-08-18 10:13	I bascially agrre with your diagnosis. Most Lennert's ly are CD8+, but TIA1+ can be considered surrogate. Did you subtract the CD4+ macrophages/histiocytes to assign CD4 positivity for the lymphoma? CD57 is - on flow, but +/- on histo... could you add images of CD57 and CD4? Does the patient has an LGL lymphocytosis in the PB?
ugnius 2014-08-18 10:45	1. Thanx a lot for comment.   2. Please find add photos: CD57+ sligthly more than CD4+ (BM).   3. Absolute lymphocytosis in PB absent, so flow was not done (only from BM: CD57(-) in neo population here).
tzankov 2014-08-18 11:10	can you add CD57, CD4 and CD8 form the lymph node? does the patient has visible LGL cells in the PB (even w/o lymphocytosis)?
ugnius 2014-08-18 12:36	It will be performed in day. Up to date no data about PB smear: i've asked about. In BM population CD57(-) after flow. Maybe admixture (reactive?) too small.
ugnius 2014-08-19 11:17	1) Add info (flow): PB small lymphos, some with scant granular cytoplasm. FLOW: ~23% small lymphos.   ~62% with phenotype: CD3+CD4+CD7-; CD16/CD57(-).   Subpopulation of CD3+CD57+ (strong) ~ 26%.   Phenotype not compatible with T LGL.   2) CD57+ in majority of LN T lymphos: will be scanned soon.
tzankov 2014-08-19 16:02	the case gets more intriguing. what about those 26% CD57+/CD3+ lymphocytes, are they LGL or not? Are they CD8+ or CD4+?
ugnius 2014-08-19 16:14	Flow comments readressed.   Please find add requested CD4+ CD57+ CD8(-) in the node.
tzankov 2014-08-19 16:49	did you ver stained the case fpr ALK1?
ugnius 2014-08-20 08:18	ALK will be done in day (I'm sorry: why?).     FLOW comment: CD4/CD8 was not analyzed (and CD57+ population at first glance was missed, I guess) in this tube. So I cannot comment on that more.
tzankov 2014-08-20 12:54	well the problem is that the lymphoma does not perfectly fit into the cathegory of Lennert's, bacuse of the CD4 excess and lacking obvious atypia of the CD8+ cells. TIA1 is expressed on a major poupulation of CD4+ cells and I fear missing a small cell variant of ALKoma. In addition there is a 26% population of CD57+ cells in the periphery (CD57 can be expressed on Lennert's lymphoma cells) and we have to take care of all these findings to assign the proper name for this T-cell lymphoma. I still agree that your idea is probably the best one, but we have to exclude all possible DDs.
ugnius 2014-08-20 13:37	Agree. I will add all mentioned notes about re-screening of BM for LGL additionally. We will proceed with CD30 soon. Thanx for your time and big heart.
ugnius 2014-08-20 14:48	ALK negative, CD30 will appear later.
ugnius 2014-08-21 11:48	CD30+ single lymphos. Really all done. NOTE about CD57+ population (LGL CD4+ CD57+ possibility) added. Thanx a lot.
tzankov 2014-08-21 12:12	well now we can diagnose:     mature peripheral T-cell lymphoma, specially Lennert's lymphoma
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