59 yrs old female with mediastinal open biopsy.  
HISTO: slightly nodular architecture with admixture of T and B cells and interstitial large lobated cells with retained (PM LBCL) B programme.  
IH: more close to PMLBCL: CD20/Pax5+ (strong); CD79a+; CD30+/- (faint); CD15(-); LCA+; EBV LMP1/EBER(-); CD23+; Bcl2/Bcl6+; CyclinD1(-); Mum1+; Oct2/BOB1+; EMA/CD10(-).  
CLONALITY (interesting): IGH clonal/oligoclonal (FR2); IGK polyclonal; TCRB polyclonal; TCRG clonal in polyclonal background.  
 
PROPOSAL: Grey zone lymphoma with PM LBCL (IH) and CHL (histo) features.  
 
Thank you for collaboration.

hoellers 2014-05-21 17:32	Dear Ugnius,     I completely agree with you. In my opinion this is a case of a Primary mediastinal B-cell lymphoma. The cytology and the fiborsis in combination with the phenotype (CD20+, CD79a+ and especially CD23+ and OCT2/BOB1+)fits very well with PMBCL.     with my best regards
tzankov 2014-05-21 20:17	Dear Ugnius,     it is probably a matter of philisophy, but I try to keep the kategory of grey zones as small as possible. In that particular case, I see no reason not to diagnose a PMBL. I would call the case PMBL.
ugnius 2014-05-21 20:52	My Dears, its always Sunday to hear from you. Despite "pure" PMLBCL IH, we deal with exceptionally scattered not confluent pattern (clearly visible in IH except "dirty" CD20) with some nodularity- slightly unusual and chl like. Some zones are enriched with small B'ees, some- with T's.   It was a point. I clearly understand that it do not change therapeutic point of view. Thanx a lot. PMLBCL with typical IH and (slightly atypical picture):)
ugnius 2014-06-06 17:15	CLONALITY (interesting): IGH clonal/oligoclonal (FR2); IGK polyclonal; TCRB polyclonal; TCRG clonal in polyclonal background.
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