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| Mediastinal gray zone lymphoma with Hodgkin-type morphology. The intermediate nature manifests as atypical, HRS-type cell groups in a mixed inflammatory environment, as well as partial LCA, CD 30 and CD20 expression (growthx40).
Source publication
Even though information about the pathophysiology and clinical features of grey-zone lymphoma, an entity intermediate between classical Hodgkin lymphoma and diffuse large B-cell lymphoma, is growing, there are still a number of unanswered questions. The disease has no easily reproducible diagnostic criteria, which makes identification challenging....
Citations
... Diagnosis confirmation was done by CD15 staining, to differentiate Hodgkin lymphoma (CD15+ve) from anaplastic large cell lymphoma (usually CD15-ve). In the present case, a strong cytoplasmic reaction was detected which is in agreement with Zsófia Simon et al. 9 However, Liziane Cattelan Donaduzzi et al. found that the neoplastic cells expressed immunopositivity for CD20 and Ki67 (100%) and immunonegativity for CD3 and CD15 so the histopathology and immunohistochemistry investigation were both confirm the DLBCL diagnosis. 10 In contrast to previously mentioned IHC markers, CD3 revealed scanty immunoreaction which indicates that T-cells are not present in the stroma which in accordance with Liziane Cattelan Donaduzzi et al. also. ...
... Cancer staging and treatment are also challenging in pregnancy because of the risk that threatens the mother and fetus [10]. Currently, the R-CHOP regimen is the prefered treatment for gray zone lymphoma [11]. chemotherapy without Rituximab was started for the patient because the evidence showed CHOP regimen is safe beyond the first trimester [12]. ...
Background
Mediastinal gray zone lymphoma is a newly recognized rare B cell neoplasm, which is challenging in diagnosis and treatment.
Case presentation
In the current study, we aimed to report a 25-year-old pregnant woman at 25 weeks of gestation who presented with chronic cough and progressive shortness of breath, hypotension, tachycardia, and tachypnea. A large circumferential pericardial effusion with compressive effect on the right atrium and right ventricle and a large extracardiac mass with external pressure to mediastinal structures were seen on trans thoracic echocardiography. The emergency pericardiocentesis was performed with the diagnosis of cardiac tamponade. Also, CMR revealed a huge heterogeneous anterior mediastinal mass, and the pathology and the immunohistochemistry of the mass biopsy revealed gray zone lymphoma with positive CD3, CD20, CD30, CD45, PAX5, and negative CD15 expression. Three courses of chemotherapy with the CHOP regimen were performed with an acceptable response every three weeks before delivery. A caesarian section was performed at 37 weeks without any problem for the patient and fetus, and chemotherapy will be started three weeks after delivery.
Conclusion
Cardiac tamponade as an emergency condition occurred in this pregnant patient by malignant pericardial effusion and mediastinal mass pressure. Accurate diagnosis and on time interventions caused a significant improvement and a successful delivery.
... Cancer staging and treatment are also challenging in pregnancy because of the risk that threatens the mother and fetus (9). Currently, the R-CHOP regimen is the treatment of choice for gray zone lymphoma (10). chemotherapy without Rituximab was started for the patient because the evidence showed CHOP regimen is safe beyond the rst trimester (11). ...
Background: Mediastinal gray zone lymphoma is a newly recognized rare B cell neoplasm, which is challenging in diagnosis and treatment.
Case presentation: In the current study, we aimed to report a 25-year-old pregnant woman at 25 weeks of gestation who presented with chronic cough and progressive shortness of breath, hypotension, tachycardia, and tachypnea. A large circumferential pericardial effusion with compressive effect on the right atrium and right ventricle and a large extracardiac mass with external pressure to mediastinal structures was seen on trans thoracic echocardiography. The emergency pericardiocentesis was performed with the diagnosis of cardiac tamponade. Also, CMR revealed a huge heterogeneous anterior mediastinal mass, and the pathology and the immunohistochemistry of the mass biopsy revealed gray zone lymphoma with positive CD3, CD20, CD30, CD45, PAX5, and negative CD15 expression. Three courses of chemotherapy with the CHOP regimen were performed with an acceptable response every three weeks before delivery. An elective caesarian section was performed at 37 weeks without any problem for the patient and fetus. She had an appropriate health status, and chemotherapy will start three weeks after delivery.
Conclusion: Cardiac tamponade as an emergency condition occurred in this pregnant patient by malignant pericardial effusion and mediastinal mass pressure. Accurate diagnosis and on time interventions caused a significant improvement and a successful delivery.
... If the tumor cells are CD20+, the addition of rituximab to the chemotherapy regimen should be considered [22]. R-CHOP or dose-adjusted etoposide, prednisolone, vincristine, cyclophosphamide, doxorubicin, and rituximab (DA-EPOCH-R) regimens are recommended [23][24][25]. ...
Background:
B-cell lymphoma, unclassifiable, with features intermediate between diffuse large B-cell lymphoma and classical Hodgkin lymphoma (BCLu-DLBCL/cHL), also referred to as gray zone lymphoma (GZL), is known to share features with cHL and DLBCL. However, GZL is often difficult to diagnose. There is no consensus regarding the optimal therapeutic regimen. Most reported cases of GZL have been in Caucasian and Hispanic individuals, and its incidence is lower in African-American and Asian populations, including the Japanese population.
Case summary:
A 69-year-old female presented at our hospital with a growing mass on the right side of her neck. An elastic, soft mass measuring 9 cm × 6 cm was palpable in the right cervical region. Laboratory analyses showed pancytopenia, increased serum lactate dehydrogenase levels, and markedly increased levels of soluble interleukin-2 receptor. Enhanced computed tomography (CT) and fluorodeoxyglucose positron emission tomography (PET)/CT revealed multiple lesions throughout her body. She was diagnosed with GZL based on the characteristic pathological findings, the immunophenotype [CD20+, PAX5+, OCT2+/BOB1 (focal+), CD30+, CD15-], and the strong positive expression of neoplastic programmed cell death protein ligand 1 (PD-L1) in her lymphoma cells. The lymphoma was stage IV according to the Lugano classification and high-risk according to the International Prognostic Index for aggressive non-Hodgkin lymphoma. The patient received cyclophosphamide, doxorubicin, vincristine, prednisolone, and rituximab (R-CHOP) chemotherapy because the tumor cells were CD20+. She has remained in complete remission for 3 years.
Conclusion:
GZL was diagnosed based on histopathology and immunophenotyping with ancillary PD-L1 positivity. R-CHOP chemotherapy was an effective treatment.
