HISTORY: 63 YRS OLD MALE. HIV negative.

EPISODE 1: B10-12754 THREPINE (clin. dgn.: MDS): Changes compatible with low risk MDS (not included).
 
EPISODE 2: B10-25858 GASTRO BIOPSY: Adenocarcinoma G3, mixed by Lauren.
 
EPISODE 3: B10-2702 LYMPH NODE BIOPSY (Clin dgn.: Adenoca G3. Lymphoma?): Peripheric T cell lymphoma NOS in the node.
 
EPISODE 4: B10-28518 GASTRIC RESECTION: PRELIMINARY: Adenocarcinoma G3 in the stomach with mts in single node and high grade lymphoma spread in perigastric lymph nodes.

IH: ADENOCARCINOMA and NODAL MTS: EBER+; PanCK+; AB+ (in tubular component). LYMPHOMA: IgM+; Mum1+; CycolinD1(-); Pax5(-); CD79+/- (faint); Ig lambda+ (single cells); CD20(-); CD3+ (abberant); CD4/CD8/CD2/CD5/CD7/GranB/CD30/CD15/EMA(-). MOLECS: IgH clonal; TCR beta clonal; IgK/TCR delta/gama polyclonal. HHV8 PCR pending (I have no IH markers for HHV8).
 
AFTER REVIEW COMPLEX DIAGNOSIS: 1. Gastric EBV+ lymphoepithelial like carcinoma (G4) with rest of adenocarcinoma (G3): pT1b. Mts in the single perigastric node. 2. Hemophagocytosis in perigastric nodes. 3. High grade B plasmablastic lymphoma in peripheral and perigastric nodes: so called "germinothropic lymphoma", Possibilities: HIV asociation? extracavitary PEL? DLBCL, plasmablastic, multicentric Castlemann disease asociated?

SPECIAL QUESTS: Plasmablastic "germinothropic" lymphoma differential: extracavitary PEL ? MCD asociated? Other?

By my knowledge EBV+ LELC and extracavitary PEL/MCD asoc. DLBCL combination are extremelly rare (and with CD3+ abberancy).