26yr male presented 1 year ago with generalized adenopathy ,Lymph node biopsy was done,H/E(1st 4 slides),was CD20 negative,CD5 positive(IHC slides not available currently,was treated as CD20 negative NHL got 8 cycles pf CHOP,Lymphnode sizes reduced but not completely.Comes again few months ago with generalized adenopathy and B symptoms. H/E show nodular pattern with large histiocytic like cells, CD3,CD20 markers done.Need your comment

ACGreen 2020-09-01 23:42	- In the original biopsy, was there a nodular pattern, and were the background lymphocytes T- or B-cells?   - I wonder on CD3 in this case if there is a suggestion of rosetting of T-cells around the large cells. Do you have any higher power images of CD3?   - Do you have any FDC marker (CD21/CD23)?   - Are these large, CD20(+) cells expressing other B-cell markers and do they express CD30?
lotodo 2020-09-02 03:44	Thank you for your comments, the initial biopsy(1st 4 slides)had diffuse pattern, no other Bcell markers were done, CD21 or CD23 is not available in our lab, we have ordered for CD15/CD30,CD20 on both blocks, can ask them to add more Bcell markers, There was no rosetting around the large cells by Tcells but will send higher magnification of CD3
tzankov 2020-09-08 16:59	I agree with the prevois comments. It is for sure lymphoma, and has an appearance reminscient of Hodgkin lymphoma. The dim CD20 expression may fit, and the presence of CD20+ small B-cells as well as the T-cell psucity are not fitting with T-cell/histiocyte-rich large B-cell lymphoma. We need some additional stainings: CD15, CD30, EBV, CD45, as well as e.g. BCL6, MUM1, PAX5, PD1, CD57, IgD any of them would help.
lotodo 2020-09-09 03:54	Thank you Dr.Tzankov, we have ordered for CD15 and CD30,we may not access the other markers due to cost implications. Will post once we receive the slides
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