A 50-year-old male presented with cough and breathlessness. A positron emissoin tomography scan revealed FDG (Fluorodeoxyglucose) avid mediastinal mass. Tru-cut biopsy showed fibrotic stromal tissue with cellular infiltrate consisting of abnormal lymphoid cells and few large cells with smudged nucleus. Immunohistochemistry revealed diffuse positivity with CD20, focal positivity for CD30 and rare CD15 positive cells. Histological picture and immune profile showed overlaping features of non-Hodgkin's as well as Hodgkin's lymphoma. A diagnosis of mediastinal gray zone lymphoma was made. The patient showed a complete metabolic response to six cycles of chemotherapy.
Rudiger T, Jaffe ES, Delsol GE, deWolf -Peters C, Gascoyne RD, Georgii A, et al. Workshop report on Hodgkin's disease and related diseases (gray zone lymphoma). Ann Oncol 1998;9:S31–S38.
Swerdlow SH, Campo E, Harris NL, Jaffe ES, Pilleri SA, Stein H, et al, editors. WHO Classification of Tumors of Haemopoietic and Lymphoid Tissues; 4th edition. IARC: Lyon;2008.
Eberle FC, Salaverria I, Steidl C, Summer Jr. TA, Pittaluga S, Neriah SB, et al. Gray zone lymphoma: chromosomal aberrations with immunophenotypic and clinical correlations. Mod Pathol 2011;24:1586–97.
Hasserjian RP, Ott G, Elenitoba-Johnson KS, Balague-Ponz O, de Jong O, de level L. Commentary on the WHO classification of tumors of lymphoid tissue (2008). Gray zone lymphomas overlapping with Burkitt lymphoma or classical Hodgkin's lymphoma. J Hematopathol 2009;2:89–95.
Qunitanilla-Martinez L, de Jong D, de Mascarel A, Hsi ED, Kluin P, Natkunam Y, et al. Gray zone around diffuse large B cell lymphoma: conclusions based on the workshop of XIV meeting of European Association and Society of Hematopathology in Bordeaux, France. J Hematopathol 2009;2:211-36.
Holler S, Copie-Bergman C. Gray zone lymphomas: lymphomas with intermediate features. Adv Hematol 2012;2012:46080i/doi 10:1155/2012/460801.
Hoeller S, Zihler D, Zlobec I, Oberman EC, Pileri SA, Dirnnofer S, et al. BOB.1, CD 79a and cyclin E are most appropriate markrers to discriminate classical Hodgkin's lymphoma from primary mediastinal large B cell lymphoma. Histopathology 2010;56:217–28.
Eberle FC, Rodriguez-Canales J, Wei L, Hanson JC, Killian JK, Sun HW, et al. Methylation profiling of mediastinal gray zone lymphoma reveals a distinctive signature with elements shared by classical Hodgkin's lymphoma and primary mediastinal large B cell lymphoma. Hematologica 2011;96:558–66.
Grant C, Dunleavy K, Eberle FC, Pittaluga S, Wilson WH, Jaffe ES, et al. Primary mediastinal large B cell lymphoma, classic Hodgkin's lymphoma presenting the mediastinum, and mediastinal grey zone lymphoma: what is the oncologist to do? Curr Hematol Malig Rep 2011;6:157–63.
Dunleavy K, Grant C, Eberle FC, Pittaluga S, Jaffe ES, Wilson WH, et al. Grey zone lymphoma: better treated like Hodgkin's lymphoma or mediastinal large B cell lymphoma? Curr Hematol Malig Rep 2012;7:241–7.
Pelus LM, Forag SS. Increased mobilization and yield of stem cells using plerixa for in combination of granulocyte colony stimulating factor for the treatment of Non Hodgkin's lymphoma and multiple myeloma. Stem Cell Cloning 2011;4:11–22.
Mabed M, Al-Kgodary. Cyclophosphamide, etoposide, carboplatine plus non cytopreserved autologus peripheral blood stem cell transplantation rescue for patients with refractory or relapsed non Hodgkin's lymphoma. Bone Marrow Transplant 2006;37:739–43.