86 yrs male.  
HISTORY:  
EPISODE 1:  
In 2017 November resected caecum adenocarcinoma (mucinous, G2, pT3 N0(26). Microasatelitte stable/no MS protein loss. Molecs not performed.  
Incidental non-metastatic nodes were detected: DLBCL + Mantle cell lymphoma (predominant mantle pattern; conventional cytology).  
IH MCL: CD20+; CD5+; Cyclin D1+.  
DLBCL (GCB; heterogenous)(1 node): CD20+; CD10+/bcl6+; Cyclin D1+; CD5(-); cMYC(-); MUM1+; Ki67 proliferacinis aktyvumas iki 95%.  
CLONALITY:  
2 clonally unralated profiles: IGH locuses FR1-3, D-J and IGK V/JC-Kde.  
IGL, TCRB, TCRG ir TCRD polyclonal.  
FISH:  
DLBCL: No CCND1 (11q13) and MYC (8q24) break. MYC/IGH CEP8 fusion absent too.  
MCL: CCND1 (11q13) break in mantle zones.  
 
EPISODE 2:  
2018 February:  
Threpine biopsy/staging: reactive changes (IH for lymphoma only).  
NO THERAPY APPLIED!  
 
EPISODE 3:  
2019 February threpine biopsy:  
Panyperplasia with architectural damage, erythroid hyperplasia/dysplasia, megakariopoietic hyperplasia/dysplasia (CD7/CD34+), CD34+ blast count up to 5%, reticulin fibrosis MF1: high grade MDS with multilineal dysplasia and sideroblasts (MDS-MD-RS-F).  
Complex karyotype (SNP): Dels 5q, 7q, 12p, 16q, 17p and trisomy 8.  
 
DIAGNOSTIC QUESTION:  
1. CRC+ 3 different clonal diseases. Fragile genome?  
2. Clinically "silent" DLBCL+ MCL without treatment for 2 yrs.  
3. No clonal or IH relationships between CD5+ CyclinD1+ MCL and CyclinD1+ DLBCL (GCB).  
4. HETEROGENEITY and BLASTOID appearance of DLBCL.

tzankov 2019-04-05 14:17	incredible case, there is little to add, except for suggesting you to personelly revise the FISH of both lymphoma compounds to be 100% sure tha the "CCND1+ (and SOX11+!!!) DLBCL" is indeed not CCND1 rearranged.
ugnius 2019-04-05 14:33	Thanx. Readress FISH quest to our FISH-mans, but signals will be lost (old case enough)...
yoolioos 2019-04-05 19:26	I have reviewed both areas of DLBCL and of MCL. DLBCL was not rearranged.   Interestingly MDS has trisomy 8. I'll try to check if the MYC FISH slides are still alive. Maybe there is increase in copy number of MYC genes.