80 yrs male with core biopsy of axillary lymph node. Previously was diagnosed as DLBCL in 2003 and refuse treatment (for 13 yrs NOT TREATED at all).  
HISTO 1 (primary 2003) 03/1/1012: Large and small (involuted Castlemann like) follicles with immunoblastic cell aggregates. Massive polytypic IgG+ plasmacytosis like in plasma cell variant of Castlemann (IgG4/IgG scattered only, <1/10).  
IH1 (large cells): CD20+; EBER(-); CD10(-); Bcl2(+/-); CMYC+; Bcl6/Mum1+; CD23/CD21/CD138/CD30/CD5(-); HHV8(-); Ki67 up to 80%; IgM/IgD/Ig kappa/Ig lambda(-).  
HISTO 2 (relapse 2015) B15-18682: Core with NO NODULAR architecture, scattered "lacunar" and interstitial large cell aggregates with more irregular lobated nuclei and similar IH.  
IH2 (large cells): CD20/Pax5+; CD30/CD5/CD23/CD21/Cyclin D1(-); Ki67 up to 90%.  
DIFFERENCES (IN IH, 2003 old blosk restained): Higher Ki67? More Bcl2+ ? Diffusse? The same ABC: CD10(-) Bcl6+Mum1+ CMYC+...  
MOLECS: NOT CLONAL, borderline quality from 2003, scant 2015...  
DIAGNOSTIC VERSION: FL (3b), "treated" by biopsy (with "germinothropic DLBCL" or Castlemann DLBCL features) with progression into DLBCL (enriched by T cells).  
LAST CT: Right biceps assimetry, possibly infiltration. Small right lung nidus S6. Axillar conglomerate of LN. Liver S4a small calcinate in the surface. Spleen: several small focci. Left adrenal with infiltration. Rektosigma: polypoid lesion.  
 
Thank you for your attention and kind heart/brain.

tzankov 2015-06-04 11:24	I fully agree with you, FL G3b in 2003, now probable progression, can you stain both biopsies for FDC (CD21, 23, 35 or D2-40) in order to see if he now still has follicles?
ugnius 2015-06-04 11:41	In 2003 ruptured network in periphery of follicles, now- CD21/CD23 abscent at all. Unfortunatelly I cannot get clone from PCR...
tzankov 2015-06-04 12:24	OK, thanks - then DLBCL type progression can be diagnosed now... interesting clinical history. what does the actual staging CT show now?
ugnius 2015-06-04 16:30	Requested data (about stage now). I'll be back.
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