PMC6487142_01
The tissue from the left axillary lymph node biopsy revealed architectural and cytological features consistent with a diagnosis of grey zone lymphoma (GZL). (a) Effacement of the nodal architecture by scattered large and atypical lymphoid cells with abundant amounts of pale cytoplasm, irregular nuclear contours, vesicular chromatin, and prominent nucleoli. (b) Frequent binucleated and multinucleated forms are also seen. Intermixed are large sheets of histiocytes with abundant cytoplasm. The tissue includes a significant number of neoplastic cells within the stromal background and includes the broad cytological spectrum with marked nuclear pleomorphism and shows strong presence of atypical lymphocytes. Immunohistochemical stains show that these atypical lymphocyte tumor cells are strongly positive for CD20+ (c) and positive for CD30+ (d).
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fig1
While the morphology of the atypical lymphocytes and presence of CD30+ expression were suggestive of cHL, the strong expression of multiple B-cell markers (CD20+, PAX5+, and OCT2+) was not typical (Figure 1).