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This is an interesting case. This is a 40 y lady from North of Jordan that had shortness of breath and cough for months. She went to one of university hospitals and they did small biopsy from mediastinal mass. Their lab did not reach a final diagnosis. The oncology at that hospital asked her to come to me to do CT guided core biopsy I did for her the following: CT guided fine needle aspiration from the mediastinal mass, core biopsy and aspirated fluid from the left pleural effusion. I diagnosed her (after performing immunohistochemistry) as Acute lymphoplastic lymphoma The oncologist treated her with protocol for ALL. She responded dramatically. (per follow up with her father), both the mass and the pleural fluid disappeared. I did have a follow up only for one year. Then, I lost the connection with her father after that This is a nice case to show how very good biopsy makes a difference in patient diagnosis and health.