CASE'PRESENTATION'OF'MEDIASTINAL'GRAY'ZONE'LYMPHOMA'(MGZL)'
POSTER'25'
SUCCESSFULY'TREATED'WITH'RIBEACOPP'PLUS'RADIOTHERAPY'
'
Nerses!Ghahramanyan1,2,!Artem!Oganesyan3!and!Yervand!Hakobyan1,3!
!
(1)R.! Yeolyan! Hematology! Center,! Yerevan,! Armenia,! (2)Yerevan! State! Medical! University,! Yerevan,!
Armenia,!(3)National!Institute!of!Health,!Yerevan,!Armenia!
!
A!31JyearJold!man!presented!to!the!hematology!center!with!the!complaints!of!shortness!of!
breath! and! palpable! axillary! and! supraclavicular! nodes! bilaterally.! Complete! blood! count!
with!differential!showed!no!significantly!abnormal!findings.!Full!body!CT!scan!demonstrated!
a! conglomerate! of! lymph! nodes! in! the! mediastinum! (13x12cm,! hypoechogenic! with!
abnormal! structure)! and! lymph! node! enlargements! (3.0J3.5cm)! in! supraclavicular,! axillary,!
and! posterior! mediastinal! and! mesenteric! regions.! The! patient! underwent! lymph! node!
biopsy,! the! histological! investigation! of! which! demonstrated! the! following! findings! from! 2!
different!laboratories.!
The!first!laboratory!found!many!disseminated!tumor!cells,!with!the!morphology!of!Hodgkin!
and!ReedJSternberg!cells!(HRS),!mummification,!lacunar!cells,!and!a!smaller!number!of!small!
lymphocytes.!CD20:!focal,!mild!expression!on!cell!membrane!of!HRSJlike!huge!atypical!cells,!
more! intensive! membrane! expression! on! B! lymphocytes.! Lymphocyte! CD15:! weak!
cytoplasmic! expression! on! all! HRSJlike! tumor! cells;! CD30:! intense! membranoJcytoplasmic!
expression!on!HRSJlike!large!atypical!tumor!cells;!BCL2:!moderate!cytoplasmic!expression!on!
mature!disseminated;!BCL6:!negative!reaction;!MUM1:!moderate!nuclear!expression!on!all!
HRSJlike!atypical!tumor!cells;!Ki67=65%;!Pax5:!negative!reaction;!CD23:!moderateJintensity!
membrane! reaction! on! HRSJlike! atypical! tumor! cells;! CD79a,! CD45:! negative! reaction! on!
HRSJlike!tumor!cells.!
The! second! laboratory! could! not! identify! lymphatic! follicles! but! only! a! few! fragments! of!
follicles!in!the!subcapsular!space.!Lymph!node!parenchyma!was!presented!with!an!infiltrate!
comprising!of!mediumJ!and!largeJsized!lymphoid!cells,!histocytes,!plasma!cells.!Many!huge!
cells! appeared! with! large! nuclei! and! clear! eosinophilic! nucleoli! (with! detectable! mitoses,!
including! atypical).! Tumor! cells! with! two! nuclei! were! also! noted.! CD30:! intensive! positive!
membrane!staining!of!tumor!cells;!CD15:!positive!cytoplasmic!reaction!on!tumor!cells;!CD20:!
weak,!clear!membrane!reaction!on!tumor!cells;!MUM1:!positive!nuclear!reaction!on!tumor!
cells;! CD15:! positive! cytoplasmic! reaction! on! tumor! cells;! IMPJ3:! positive! cytoplasmic!
reaction!on!tumor!cells;!Ki67=60J65%;!HGAL,!CD10!&!CD5:!negative!reaction.!
After! several! consultations! with! local! and! international! experts,! the! diagnosis! of! BJcell!
lymphoma,!unclassifiable,!with!intermediate!features!between!classic!Hodgkin's!lymphoma!
and! diffuse! large! BJcell! lymphoma! (III! B! stage),! bulky! disease:! Mediastinal! Gray! Zone!
Lymphoma:!was!made.!Patient!further!was!treated!with!6!cycles!of!RJBEACOPP.!An!interim!
PET/CT!scan!showed!6.7cm!mediastinal!residual!mass!with!Deauville!2/3!metabolic!activity.!
Upon! uneventful! completion! of! planned! treatment,! the! patient! was! PET! negative! (5.7cm!
mediastinal! mass! with! Deauville! 2! score).! Furthermore,! the! patient! also! underwent!
mediastinal!radiotherapy!and!is!in!complete!remission!ever!since!(2.5!years!since!diagnosis).!
! !
SCIENTIFIC PROGRAMME
SESSION I
HODGKIN’S DISEASE
DEBATE I
IS THERE STILL A ROLE
FOR COMBINED MODALITY
THERAPY FOR EARLY
STAGE CHL?
SESSION II
T-CELL LYMPHOMA
ROUNDTABLE I
FUTURE DIRECTIONS IN
T-CELL LYMPHOMA
SESSION III
FOLLICULAR LYMPHOMA
DEBATE II
CAN WE AVOID
CHEMOTHERAPY IN
THE MANAGEMENT OF
FOLLICULAR LYMPHOMA?
SESSION IV
RARE LYMPHOMAS –
MARGINAL ZONE
LYMPHOMA AND
WALDENSTRÖM M
ACROGLOBULINEMIA
ROUNDTABLE II – WHERE
TO GO IN RARE B-CELL
LYMPHOMAS
SESSION V
MANTLE CELL LYMPHOMA
SESSION VI
DIFFUSE LARGE B-CELL
LYMPHOMA
DEBATE III
DO WE STILL NEED ASCT
IN MCL?
SESSION VII
NOVEL THER APEUTIC
CONCEPTS IN B-CELL
LYMPHOMAS
SELECTED ABSTRACTS
FOR AN ORAL
PRESENTATION
SELECTED ABSTRACTS
FOR A POSTER
PRESENTATION
DISCLOSURES