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Here we present the case of a 59-year-old woman with mediastinal grey zone lymphoma (MGZL), who, shortly after achieving complete remission, developed a subsequent cutaneous neoplasm. Comparative molecular studies were performed using high-throughput sequencing (HTS), which demonstrated that both neoplasms shared high-allele-frequency\n                    <jats:italic>E<\/jats:italic>\n                    <jats:italic>P300<\/jats:italic>\n                    :p.P2333L and\n                    <jats:italic>P<\/jats:italic>\n                    <jats:italic>TPRK<\/jats:italic>\n                    :p.R532K\u00a0variants. In addition, each neoplasm harboured private, mutually exclusive variants\u2014\n                    <jats:italic>NFK<\/jats:italic>\n                    <jats:italic>BIA<\/jats:italic>\n                    :p.R245Sfs*39 and\n                    <jats:italic>B<\/jats:italic>\n                    <jats:italic>TG2<\/jats:italic>\n                    :c.142+5G&gt;C in the MGZL and\n                    <jats:italic>JA<\/jats:italic>\n                    <jats:italic>K1<\/jats:italic>\n                    :p.Q562*\u00a0and\n                    <jats:italic>J<\/jats:italic>\n                    <jats:italic>A<\/jats:italic>\n                    <jats:italic>K1<\/jats:italic>\n                    :p.G1097D in the skin. Integrating the clinical course with HTS, we diagnosed lymphomatoid papulosis and excluded relapse of the MGZL. Interestingly, the shared variants were likely germline rather than clonal, suggesting they created a permissive background predisposing to two independent transforming events along the B- and T-cell lineages. Molecular studies may help to reveal the genetic basis of composite lymphomas and to resolve diagnostically discordant, complex presentations.\n                  <\/jats:p>","DOI":"10.1007\/s00428-026-04733-6","type":"journal-article","created":{"date-parts":[[2026,9,29]],"date-time":"2026-09-29T06:46:13Z","timestamp":1790664373000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Sequential lymphoid neoplasms mimicking relapse of mediastinal grey zone lymphoma in a patient with germline variants in EP300 and PTPRK"],"prefix":"10.1007","author":[{"given":"Maria J","family":"Tapken","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Darius","family":"Juskevicius","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ilaria","family":"Balestri","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Claudia Ruth","family":"Bollinger","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ilaria","family":"Alborelli","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sebastian","family":"Kurscheid","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lucian","family":"Cajacob","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Niels","family":"Willi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Peter","family":"H\u00e4usermann","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stefan","family":"Dirnhofer","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1100-3819","authenticated-orcid":false,"given":"Alexandar","family":"Tzankov","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,9,29]]},"reference":[{"issue":"16","key":"4733_CR1","doi-asserted-by":"publisher","first-page":"1239","DOI":"10.1056\/NEJM199904223401604","volume":"340","author":"A Br\u00e4uninger","year":"1999","unstructured":"Br\u00e4uninger A, Hansmann ML, Strickler JG, Dummer R, Burg G, Rajewsky K et al (1999) Identification of common germinal-center B-cell precursors in two patients with both Hodgkin\u2019s disease and non-Hodgkin\u2019s lymphoma. 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Informed written consent including display of photographs was obtained from the patient shown in the study.","order":1,"name":"Ethics","label":"Compliance with ethical standards","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"Authors performed this research in their free time without financial support and thus have no conflict of interest.","order":2,"name":"Ethics","label":"Conflict of interest","group":{"name":"EthicsHeading","label":"Declarations"}}]}}