Slow-Growing Mediastinal Grey Zone Lymphoma Originating From a Formerly Resected Multilocular Thymic Cyst Rie Tabata, MD, PhD, Chiharu Tabata, MD, PhD,

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Slow-Growing Mediastinal Grey Zone Lymphoma Originating From a Formerly Resected Multilocular Thymic Cyst Rie Tabata, MD, PhD, Chiharu Tabata, MD, PhD, Yoshitane Tsukamoto, MD, PhD, Masaki Hashimoto, MD, PhD, Ryoji Yasumizu, MD, PhD, Masaru Kojima, MD, PhD The Annals of Thoracic Surgery Volume 102, Issue 6, Pages e561-e563 (December 2016) DOI: 10.1016/j.athoracsur.2016.04.101 Copyright © 2016 The Society of Thoracic Surgeons Terms and Conditions

Fig 1 (A) Roentgenogram of the chest and (B) computed tomographic image of the chest, demonstrating multiple swollen lymph nodes in the upper mediastinal regions. The Annals of Thoracic Surgery 2016 102, e561-e563DOI: (10.1016/j.athoracsur.2016.04.101) Copyright © 2016 The Society of Thoracic Surgeons Terms and Conditions

Fig 2 Histologic and immunohistologic examination results of the cervical lymph nodes. (A) Heavy infiltration of germinal centerlike aggregates with moderate fibrosis. (Hematoxylin and eosin, original magnification ×2.) (B) High-power field view showing proliferation of large lymphoid cells; small lymphocytes, neutrophils, and eosinophils are also seen. (Hematoxylin and eosin, ×20.) (C) Large lymphoid cells with clear cytoplasm have large, clear nuclei with prominent nucleoli; some cells are Hodgkin cell (HC)-like, containing Reed-Sternberg–like cells. (Hematoxylin and eosin, ×40.) (D, E, F) Immunohistologic view showing positivity of HC-like cells for CD30 (D, ×40), CD20 (E, ×40), and Oct-2 (F, ×40.) The Annals of Thoracic Surgery 2016 102, e561-e563DOI: (10.1016/j.athoracsur.2016.04.101) Copyright © 2016 The Society of Thoracic Surgeons Terms and Conditions

Fig 3 Histologic and immunohistologic examination results of thymus resected 4 years previously. (A) Several irregularly shaped cysts with diameters <1 cm. Cyst walls are smooth and lined by columnar epithelium. (Hematoxylin and eosin, original magnification ×2.) (B) The lymphoid follicle-like small nodules (hematoxylin and eosin, ×2.) (C) In addition to reactive follicles, cytokeratin AE1/AE3-positive thymic epithelial cells (TECs) are seen to proliferate (×2). (D) CD30+ cells are aggregated and associated with TECs (×2). (E) High-power field view showing proliferation of thymic epithelial cells, with increased levels of small lymphocytes, plasma cells, and eosinophils. Large lymphoid cells are occasionally observed, with clear cytoplasm and large clear nuclei with prominent nucleoli. (Hematoxylin and eosin, ×20.) (F) Hodgkin cell (HC)-like, containing Reed-Sternberg–like cells. (Hematoxylin and eosin, ×40.) (G) HC-like cells appearing to proliferate beneath the sheetlike spread TECs. (Cytokeratin AE1/AE3, ×40.) The Annals of Thoracic Surgery 2016 102, e561-e563DOI: (10.1016/j.athoracsur.2016.04.101) Copyright © 2016 The Society of Thoracic Surgeons Terms and Conditions