STORY: 49 yrs old male with 2013 diagnosed T/H rich LBCL in lymph node (photos).  
Treated R-CHOP-14 up to 2014 April. Progression in 2 months: small lymph node and BM (photos). Administered DHAP chemo.  
HISTO: Vaguelly nodular pattern with sattelite encapsulated nodules, focal Ma enriched pattern, obliterated sinuses. Population heterogenous: small- medium T lymphos (pleomorphic as usual), plasmacytes, scattered medium- large cells CD20+ (in part CD30+).  
HISTO BM: Focal lymphohistiocytic infiltrate: CD3+ dominant with scattered CD20 cells and CD68+ histiocytes.  
IH: Retained focally CD21/CD23+ FDC networks, creating nodular architecture (contra T/H rich LBCL). Scattered EBER+ cells (probably B). CD3+ back with interstitial clusters of CD20+ CD30+ CD79a+ Pax5+ BOB1/Oct2+ LCA+ B cells.  
MOLECS: TCR gama clonal in polyclonal back; IgH/K and TCR beta polyclonal.  
 
NOW: restaging threpine: In BM haemophagocytosis and slight interstitial T lymphocytic infiltration only (not included there).  
 
PROPOSAL: T NHL (AILT?) with prominent reaction of epithelioid histiocytes vs original diagnosis (T/H rich LBCL: pure or from NLP HL).  
 
Thankyoubeeinginline.

tzankov 2014-08-18 10:29	Dear Ugnius,     very difficult case. I am more on the AITL side...   -B-cells displaced towards the subsinusoidal compartment   -FDC proliferations   -Some patent sinuses   -B-blasts, partially CD30+ (not a feature of TCRBCL) and parteially EBER+     Is it possible to perform PD1/KI67 doublestains?
ugnius 2014-08-18 10:47	Thanx. Due to our lab rigid politics NO DOUBLE stains are possible now: maybe in a short future...   ARCHITECTURALLY I stick to AILT, but quantitativelly ans cytologically its difficult to say.   So I'm more and more trying to find more argues CONTRA B process (contra T/H LBCL, as stated primarily)...
tzankov 2014-08-18 11:11	well actually there are no arguments for TCRBCL. also the background cells are CD4+ and not CD8-skewed. there are at least 5 arghuments contra TCRBCL
ugnius 2014-08-18 12:34	Thanx a lot.
ugnius 2014-08-21 09:55	Just a note: Bcl2 weakness as possible sign of neoplasticity of T cells (appended)?
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