78 yrs old woman with clinical diagnosis: "Ca ovariorum". Symptoms: cough, wight loss, subfebrility, abdominal pain. MRI: 6.5x 9.8x 8cm tumor in the small pelvis with necrosis, arising probvably from sigmoid colon. Tumor in the uteral frontal wall/isthmus (mts?). Paraaortal lymphadenopathy and ureteral compression. Left hidrothorax (punctated later: no tumor cells found).  
2014 March:  
1) tumor between uterus and rectum was (core) biopsied: not informative material (necrosis of uncertain (tumor?) cells).  
2) repeated core biopsy (abdominal wall/ right mesogastrium tumors): DLBCL. IH: CD20+, Bcl2+ 30% (heterogenous), Bcl6+, CD10+, cMyc+ 30% (negative), MuM1+, Ki-67 90% IH double hit).  
3) due to ileus laparoscopy was performed (ileostoma) and mesenterium node (on the pictures NODE 1,4) and epiploica (on the pictures NODE 5) biopsy were taken.  
Due to "septic" situation (Acinetobacter bauanii) and age not accepted to hemato dept and steroids only (!) were administered and in relatively good condition the patient go home and unfortunatelly deceased from uncertain reasons in a short time (follow up and full hemato-evaluation was not performed).  
HISTO (last open biopsy): DLBCL (small cell variant), but in some areas histological picture with more "low grade" appearance.  
DLBCL (NODE 1, 4): CD20+; Bcl6+; CD10+ (weak); LMO2+; Bcl2(+)(weak heterogenous 30%); Ig lambda+; CD5(-); CMYC+ 20% (NEGATIVE); Ki67 80%.  
Less cellular zone (NODE 5): heterogenous: B enreached zones with evolving Bcl2+ CD20+ co-positivity, but retained Bcl6+ LMO2+ Mum1+ mixt programme.  
T enreached zones with small cell population" low grade B NHL like. IH: Ki67 70%; Bcl6/Mum1+; CD10(+/-)(weak) 15%; CyclinD1 (-)(singles +?); Bcl2+ 80%; IgM/OgD+; Ig lambda+; CD138(-); CD30(-).  
Some plasmacytoid differenciation prominent, marginal follicles seems to be occupied by Bcl2+ Bcl6+ Mum1+ population(CD23+ FDC absent).  
CD21/CD23+ FDC network absent.  
MOLECS/FISH: Bcl2 break, MYC break and CCND1/IgH fusion NEGATIVE.  
Bcl6 break, GCET1/FOXP1 and co pending for better illustration.  
 
DIAGNOSTIC QUESTION: DLBCL (as in previous core biopsy)(small cell variant) vs transformation from low grade B NHL/ B MZL (with aberant LMO2/Bcl6 programme)? or just FL with marginal/plasmoid diff.  
 
Thank you for beeing close.