86 yrs male.  
HISTORY:  
EPISODE 1:  
In 2017 November resected caecum adenocarcinoma (mucinous, G2, pT3 N0(26). Microasatelitte stable/no MS protein loss. Molecs not performed.  
Incidental non-metastatic nodes were detected: DLBCL + Mantle cell lymphoma (predominant mantle pattern; conventional cytology).  
IH MCL: CD20+; CD5+; Cyclin D1+.  
DLBCL (GCB; heterogenous)(1 node): CD20+; CD10+/bcl6+; Cyclin D1+; CD5(-); cMYC(-); MUM1+; Ki67 proliferacinis aktyvumas iki 95%.  
CLONALITY:  
2 clonally unralated profiles: IGH locuses FR1-3, D-J and IGK V/JC-Kde.  
IGL, TCRB, TCRG ir TCRD polyclonal.  
FISH:  
DLBCL: No CCND1 (11q13) and MYC (8q24) break. MYC/IGH CEP8 fusion absent too.  
MCL: CCND1 (11q13) break in mantle zones.  
 
EPISODE 2:  
2018 February:  
Threpine biopsy/staging: reactive changes (IH for lymphoma only).  
NO THERAPY APPLIED!  
 
EPISODE 3:  
2019 February threpine biopsy:  
Panyperplasia with architectural damage, erythroid hyperplasia/dysplasia, megakariopoietic hyperplasia/dysplasia (CD7/CD34+), CD34+ blast count up to 5%, reticulin fibrosis MF1: high grade MDS with multilineal dysplasia and sideroblasts (MDS-MD-RS-F).  
Complex karyotype (SNP): Dels 5q, 7q, 12p, 16q, 17p and trisomy 8.  
 
DIAGNOSTIC QUESTION:  
1. CRC+ 3 different clonal diseases. Fragile genome?  
2. Clinically "silent" DLBCL+ MCL without treatment for 2 yrs.  
3. No clonal or IH relationships between CD5+ CyclinD1+ MCL and CyclinD1+ DLBCL (GCB).  
4. HETEROGENEITY and BLASTOID appearance of DLBCL.