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Nodular Lymphocyte Predominant Hodgkin Lymphoma versus T-Cell/Histiocyte-Rich Large B-Cell Lymphoma: A Diagnostic Challenge.

Rets AV, Gottesman SR - Case Rep Pathol (2014)

Bottom Line: The biopsied lymph node showed diffuse architectural effacement and scattered large neoplastic cells with large irregular nuclei and prominent nucleoli.These cells were positive for CD20 and Bcl-6 and negative for CD15, CD30, IgD, and Bcl-2.The background cells were predominantly T lymphocytes, whereas B cells were markedly depleted.

View Article: PubMed Central - PubMed

Affiliation: Department of Pathology, State University of New York Downstate Medical Center, 450 Clarkson Avenue, Brooklyn, NY 11203, USA.

ABSTRACT
Lymphomas with overlapping histological features of two distinct entities cause difficulty in classification. Their classification is of particular significance when the two alternatives require different treatment modalities. We present a diagnostically challenging case of a nodular lymphocyte predominant Hodgkin lymphoma (NLPHL) with features of T-cell/histiocyte-rich large B-cell lymphoma (THRLBCL). Our patient is a 39-year-old woman who presented with painless subclavicular and axillary lymphadenopathy. The biopsied lymph node showed diffuse architectural effacement and scattered large neoplastic cells with large irregular nuclei and prominent nucleoli. These cells were positive for CD20 and Bcl-6 and negative for CD15, CD30, IgD, and Bcl-2. The background cells were predominantly T lymphocytes, whereas B cells were markedly depleted. The lymph node was interpreted as NLPHL, consistent with THRLBCL-like variant. NLPHL, especially THRLBC-like variant, and de novo THRLBCL are characterized by significant morphologic and immunophenotypic overlap. Our case demonstrates a rare predominance of background T-cells in NLPHL and emphasizes the importance of thorough evaluation of multiple morphologic and immunophenotypic features as an essential approach for arriving at the correct diagnosis.

No MeSH data available.


Related in: MedlinePlus

Biopsied lymph node architecture (hematoxylin and eosin stain, 40x). Vague nodules are present in the background of diffuse architectural effacement.
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fig1: Biopsied lymph node architecture (hematoxylin and eosin stain, 40x). Vague nodules are present in the background of diffuse architectural effacement.

Mentions: The architecture of the biopsied supraclavicular lymph node was effaced and demonstrated moderate fibrosis, hyalinosis, and capsular thickening. The overall histologic appearance was predominantly diffuse, although small vague nodules could be appreciated (Figure 1). The neoplastic cells were large and scattered throughout the lymph node; they also formed loose clusters admixed with macrophages and small mature lymphocytes. These neoplastic cells had one or multiple, large, irregular, multilobulated nuclei with vesicular chromatin and prominent eosinophilic or amphophilic nucleoli (Figure 2). Numerous mitotic figures, including atypical ones, were present.


Nodular Lymphocyte Predominant Hodgkin Lymphoma versus T-Cell/Histiocyte-Rich Large B-Cell Lymphoma: A Diagnostic Challenge.

Rets AV, Gottesman SR - Case Rep Pathol (2014)

Biopsied lymph node architecture (hematoxylin and eosin stain, 40x). Vague nodules are present in the background of diffuse architectural effacement.
© Copyright Policy - open-access
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC4109592&req=5

fig1: Biopsied lymph node architecture (hematoxylin and eosin stain, 40x). Vague nodules are present in the background of diffuse architectural effacement.
Mentions: The architecture of the biopsied supraclavicular lymph node was effaced and demonstrated moderate fibrosis, hyalinosis, and capsular thickening. The overall histologic appearance was predominantly diffuse, although small vague nodules could be appreciated (Figure 1). The neoplastic cells were large and scattered throughout the lymph node; they also formed loose clusters admixed with macrophages and small mature lymphocytes. These neoplastic cells had one or multiple, large, irregular, multilobulated nuclei with vesicular chromatin and prominent eosinophilic or amphophilic nucleoli (Figure 2). Numerous mitotic figures, including atypical ones, were present.

Bottom Line: The biopsied lymph node showed diffuse architectural effacement and scattered large neoplastic cells with large irregular nuclei and prominent nucleoli.These cells were positive for CD20 and Bcl-6 and negative for CD15, CD30, IgD, and Bcl-2.The background cells were predominantly T lymphocytes, whereas B cells were markedly depleted.

View Article: PubMed Central - PubMed

Affiliation: Department of Pathology, State University of New York Downstate Medical Center, 450 Clarkson Avenue, Brooklyn, NY 11203, USA.

ABSTRACT
Lymphomas with overlapping histological features of two distinct entities cause difficulty in classification. Their classification is of particular significance when the two alternatives require different treatment modalities. We present a diagnostically challenging case of a nodular lymphocyte predominant Hodgkin lymphoma (NLPHL) with features of T-cell/histiocyte-rich large B-cell lymphoma (THRLBCL). Our patient is a 39-year-old woman who presented with painless subclavicular and axillary lymphadenopathy. The biopsied lymph node showed diffuse architectural effacement and scattered large neoplastic cells with large irregular nuclei and prominent nucleoli. These cells were positive for CD20 and Bcl-6 and negative for CD15, CD30, IgD, and Bcl-2. The background cells were predominantly T lymphocytes, whereas B cells were markedly depleted. The lymph node was interpreted as NLPHL, consistent with THRLBCL-like variant. NLPHL, especially THRLBC-like variant, and de novo THRLBCL are characterized by significant morphologic and immunophenotypic overlap. Our case demonstrates a rare predominance of background T-cells in NLPHL and emphasizes the importance of thorough evaluation of multiple morphologic and immunophenotypic features as an essential approach for arriving at the correct diagnosis.

No MeSH data available.


Related in: MedlinePlus