{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,27]],"date-time":"2026-08-27T22:46:52Z","timestamp":1787870812759,"version":"build-2784847793"},"reference-count":25,"publisher":"Wiley","issue":"9","license":[{"start":{"date-parts":[[2023,5,30]],"date-time":"2023-05-30T00:00:00Z","timestamp":1685404800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Pediatric Blood &amp; Cancer"],"published-print":{"date-parts":[[2023,9]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>The 2022 World Health Organization (WHO) classification redefines the concept of gray zone lymphoma (GZL), restricting it in practice to cases of mediastinal\/thymic origin (mediastinal gray zone lymphoma, MGZL) with overlapping features between primary mediastinal B\u2010cell lymphoma (PMBCL) and classical Hodgkin lymphoma (CHL). Cases with histological characteristics of GZL but occurring without mediastinal involvement are better classified as diffuse large B\u2010cell lymphoma, not otherwise specified (DLBCL NOS), with few exceptions.<\/jats:p><\/jats:sec><jats:sec><jats:title>Procedure<\/jats:title><jats:p>We collected clinical and pathological data about all Italian pediatric patients diagnosed with GZL over a 20\u2010year period.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>We identified only four cases of bona fide MGZL. All patients were adolescent and presented with a mediastinal disease, always associated with other nodal involvement. B symptoms and increased levels of both erythrocyte sedimentation rate (ESR) and lactate dehydrogenase (LDH) were observed. Only two patients achieved a first complete remission, suggesting a more aggressive clinical behavior than either PMBCL or CHL.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Prospective studies evaluating prognostic factors and establishing the most effective first\u2010line therapy for MGZL are highly needed.<\/jats:p><\/jats:sec>","DOI":"10.1002\/pbc.30481","type":"journal-article","created":{"date-parts":[[2023,5,31]],"date-time":"2023-05-31T05:33:41Z","timestamp":1685511221000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Pediatric gray zone lymphoma according to the 2022 WHO classification: An Italian cohort study"],"prefix":"10.1002","volume":"70","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-7778-0525","authenticated-orcid":false,"given":"Giulia Angela","family":"Restivo","sequence":"first","affiliation":[{"name":"Pediatric Hematology and Oncology Unit ARNAS Ospedali Civico, G. Di Cristina e Benfratelli  Palermo Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Piero","family":"Farruggia","sequence":"additional","affiliation":[{"name":"Pediatric Hematology and Oncology Unit ARNAS Ospedali Civico, G. Di Cristina e Benfratelli  Palermo Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1190-3198","authenticated-orcid":false,"given":"Marta","family":"Pillon","sequence":"additional","affiliation":[{"name":"Clinic of Pediatric Hemato\u2010Oncology, Department of Women's and Children's Health University of Padova  Padua Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maurizio","family":"Mascarin","sequence":"additional","affiliation":[{"name":"AYA Oncology and Pediatric Radiotherapy Unit Centro di Riferimento Oncologico di Aviano, IRCSS  Aviano Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Caterina","family":"Elia","sequence":"additional","affiliation":[{"name":"AYA Oncology and Pediatric Radiotherapy Unit Centro di Riferimento Oncologico di Aviano, IRCSS  Aviano Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Santina","family":"Recupero","sequence":"additional","affiliation":[{"name":"Pediatric Onco\u2010Hematology Fondazione IRCCS Policlinico San Matteo  Pavia Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Paola","family":"Muggeo","sequence":"additional","affiliation":[{"name":"Pediatric Hematology\u2010Oncology University Hospital of Bari  Bari Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Celeste","family":"Cagnazzo","sequence":"additional","affiliation":[{"name":"Pediatric Onco\u2010Hematology Azienda Ospedaliero\u2010Universitaria Citt\u00e0 Della Salute e della Scienza Regina Margherita Children's Hospital  Turin Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daniela","family":"Onofrillo","sequence":"additional","affiliation":[{"name":"Department of Hematology Spirito Santo Hospital, Pediatric Hematology and Oncology Unit  Pescara Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rosamaria","family":"Mura","sequence":"additional","affiliation":[{"name":"Department of Pediatric Onco\u2010Hematology Microcitemico Hospital  Cagliari Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ilaria","family":"Furfari","sequence":"additional","affiliation":[{"name":"Pediatric Hematology and Oncology Unit ARNAS Ospedali Civico, G. Di Cristina e Benfratelli  Palermo Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Angela","family":"Trizzino","sequence":"additional","affiliation":[{"name":"Pediatric Hematology and Oncology Unit ARNAS Ospedali Civico, G. Di Cristina e Benfratelli  Palermo Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Patrizia","family":"Bertolini","sequence":"additional","affiliation":[{"name":"UO Pediatria e Oncoematologia\u2010AOU  Parma Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alessandra","family":"Sala","sequence":"additional","affiliation":[{"name":"Department Pediatric Hematology Oncology Fondazione IRCCS San Gerardo dei Tintori, Centro Maria Letizia Verga University of Milano\u2010Bicocca  Monza Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Raffaela","family":"De Santis","sequence":"additional","affiliation":[{"name":"IRCCS Casa Sollievo della Sofferenza, San Giovanni Rotondo  Foggia Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daniela","family":"Galimberti","sequence":"additional","affiliation":[{"name":"Clinica Pediatrica Azienda Ospedaliero Universitaria Senese Policlinico \u201cLe Scotte,\u201d  Siena Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elisabetta","family":"Schiavello","sequence":"additional","affiliation":[{"name":"Pediatric Oncology Unit Fondazione IRCCS Istituto Nazionale Dei Tumori  Milan Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elisa","family":"Carraro","sequence":"additional","affiliation":[{"name":"Clinic of Pediatric Hemato\u2010Oncology, Department of Women's and Children's Health University of Padova  Padua Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"name":"Emanuele Stefano Giovanni D'Amore","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2023,5,30]]},"reference":[{"key":"e_1_2_9_2_1","doi-asserted-by":"publisher","DOI":"10.3324\/haematol.2010.030809"},{"key":"e_1_2_9_3_1","doi-asserted-by":"publisher","DOI":"10.1093\/annonc\/9.suppl_5.S31"},{"key":"e_1_2_9_4_1","doi-asserted-by":"publisher","DOI":"10.1182\/blood-2011-01-293050"},{"key":"e_1_2_9_5_1","doi-asserted-by":"publisher","DOI":"10.1182\/blood-2016-01-643569"},{"key":"e_1_2_9_6_1","doi-asserted-by":"publisher","DOI":"10.1182\/bloodadvances.2020001923"},{"key":"e_1_2_9_7_1","doi-asserted-by":"publisher","DOI":"10.1182\/blood.2020007507"},{"key":"e_1_2_9_8_1","doi-asserted-by":"publisher","DOI":"10.1038\/s41375-022-01620-2"},{"key":"e_1_2_9_9_1","doi-asserted-by":"publisher","DOI":"10.1097\/PAS.0000000000001198"},{"key":"e_1_2_9_10_1","doi-asserted-by":"publisher","DOI":"10.1111\/bjh.16331"},{"key":"e_1_2_9_11_1","doi-asserted-by":"publisher","DOI":"10.1182\/blood-2015-02-630632"},{"key":"e_1_2_9_12_1","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2013.281053"},{"issue":"3","key":"e_1_2_9_13_1","first-page":"332","article-title":"Classification, staging and end results of treatment of childhood non\u2010Hodgkin's lymphomas: dissimilarities from lymphomas in adults","volume":"7","author":"Murphy SB","year":"1980","journal-title":"Semin Oncol"},{"key":"e_1_2_9_14_1","doi-asserted-by":"publisher","DOI":"10.1200\/JCO.2014.59.7203"},{"issue":"11","key":"e_1_2_9_15_1","first-page":"1860","article-title":"Report of the committee on Hodgkin's disease staging classification","volume":"31","author":"Carbone PP","year":"1971","journal-title":"Cancer Res"},{"key":"e_1_2_9_16_1","doi-asserted-by":"publisher","DOI":"10.1200\/JCO.2006.09.2403"},{"key":"e_1_2_9_17_1","doi-asserted-by":"publisher","DOI":"10.1200\/JCO.2013.54.8800"},{"key":"e_1_2_9_18_1","doi-asserted-by":"publisher","DOI":"10.1002\/ajh.24082"},{"key":"e_1_2_9_19_1","doi-asserted-by":"publisher","DOI":"10.1182\/blood-2014-03-564906"},{"key":"e_1_2_9_20_1","doi-asserted-by":"publisher","DOI":"10.3324\/haematol.2016.152256"},{"key":"e_1_2_9_21_1","doi-asserted-by":"publisher","DOI":"10.1002\/pbc.28206"},{"key":"e_1_2_9_22_1","doi-asserted-by":"publisher","DOI":"10.1182\/bloodadvances.2017009472"},{"key":"e_1_2_9_23_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.bbmt.2017.11.033"},{"key":"e_1_2_9_24_1","doi-asserted-by":"publisher","DOI":"10.1182\/blood-2014-09-598763"},{"key":"e_1_2_9_25_1","doi-asserted-by":"publisher","DOI":"10.3324\/haematol.2019.238675"},{"key":"e_1_2_9_26_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMc1704767"}],"container-title":["Pediatric Blood &amp; 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