Grey Zone Lymphoma, Diagnostic and Therapeutic Challenges: A Rare Case Report

Eman EL-Sawalhy^1, , Wehbi Hnayni¹, Sarah Lonardo² and Shahina Patel³

¹Department of Internal medicine, Beaumont Hospital, Dearborn, MI

²2Department of Hematopathology, Wayne State University School of Medicine, MI

³Division of Hematology & Oncology, Internal Medicine Department, Beaumont Hospital, Dearborn, MI

Cite this paper:
Eman EL-Sawalhy, Wehbi Hnayni, Sarah Lonardo and Shahina Patel. Grey Zone Lymphoma, Diagnostic and Therapeutic Challenges: A Rare Case Report. American Journal of Medical Case Reports. 2021; 9(5):298-300. doi: 10.12691/ajmcr-9-5-10

Abstract

Grey zone lymphoma (GZL) remains a challenging diagnosis because it has mixed features of diffuse large B cell lymphoma (DLBCL) and classic Hodgkin lymphoma (cHL). In this case report, we present a 69-year-old man who was diagnosed with GZL after an incidental finding of right axillary lymphadenopathy on Computed tomography (CT) scan during a recent hospitalization for an ischemic stroke. Excisional biopsy of the axillary node pathology was consistent with classic Hodgkin lymphoma (Nodular Sclerosing type). Subsequent Positron Emission Tomography (PET)/CT scan showed adenopathy above and below the diaphragm, as well as possible liver, bone, and colon disease. Liver biopsy revealed pathology consistent with DLBCL contrary to the Hodgkin disease seen on axillary biopsy resulting in an eventual diagnosis of GZL on further pathology review.

Keywords:
Grey zone lymphoma B cell Lymphoma classic Hodgkin Lymphoma

This work is licensed under a Creative Commons Attribution 4.0 International License. To view a copy of this license, visit http://creativecommons.org/licenses/by/4.0/

References:

[1]	Egan, Caoimhe, and Stefania Pittaluga. “Into the Gray-Zone: Update on the Diagnosis and Classification of a Rare Lymphoma.” Expert Review of Hematology, 30 Nov. 2019, vol. 13, no. 1, pp. 1-3, 10.
[2]	Pilichowska, Monika, et al. “Clinicopathologic Consensus Study of Gray Zone Lymphoma with Features Intermediate between DLBCL and Classical HL.” Blood Advances, 12 Dec. 2017, vol. 1, no. 26, pp. 2600-2609.
[3]	Pak, Stella. “A Case Report: Remission of Gray Zone Lymphoma on R-CHOP and Adjuvant Radiation Treatment.” Journal of Cancer Science and Clinical Therapeutics, 4 Dec. 2017, vol. 1, no. 1, pp. 19-21.
[4]	Mallipudi, Rajiv M., et al. “A Rare Case of Grey Zone Lymphoma Successfully Treated with Brentuximab Vedotin and R-CHP Chemotherapy.” Case Reports in Oncological Medicine, 11 Apr. 2019.