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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

CD20-positive cells (CD20 immunostain, 40x; inlet, 40x). Highlighted B-cells are depleted and form loose clusters. Neoplastic cells strongly express CD20.
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fig4: CD20-positive cells (CD20 immunostain, 40x; inlet, 40x). Highlighted B-cells are depleted and form loose clusters. Neoplastic cells strongly express CD20.

Mentions: The neoplastic cells were positive for CD20 and Bcl-6 and negative for CD3, CD15, CD30, IgD, and Bcl-2. The background cells were predominantly T lymphocytes with CD20 : CD3 ratio of 1 : 10 (Figure 3). CD4+ population greatly outnumbered CD8+ cells (CD4 : CD8 ratio of 8 : 1). B-cells were markedly depleted and formed loose clusters (Figure 4). Besides a Bcl-6-positive B-cell population, these clusters contained a disrupted CD21-positive framework of follicular dendritic cells along with CD57 and PD1-positive T-cells, qualifying them as remnants of germinal centers. Occasional rosettes formed by PD1+ lymphocytes around the neoplastic cells were seen. The lymph node was interpreted as NLPHL, consistent with T-cell/histiocyte-rich large B-cell lymphoma-like variant (NLPHL THRLBCL-like variant). The clinical presentation corresponded with Stage IV disease by Ann Arbor system with Cotswolds modifications [3]. The patient was treated with 6 cycles of ABVD therapy and showed an appropriate initial response. The long-term therapeutic effect cannot be yet assessed.


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)

CD20-positive cells (CD20 immunostain, 40x; inlet, 40x). Highlighted B-cells are depleted and form loose clusters. Neoplastic cells strongly express CD20.
© Copyright Policy - open-access
Related In: Results  -  Collection

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

fig4: CD20-positive cells (CD20 immunostain, 40x; inlet, 40x). Highlighted B-cells are depleted and form loose clusters. Neoplastic cells strongly express CD20.
Mentions: The neoplastic cells were positive for CD20 and Bcl-6 and negative for CD3, CD15, CD30, IgD, and Bcl-2. The background cells were predominantly T lymphocytes with CD20 : CD3 ratio of 1 : 10 (Figure 3). CD4+ population greatly outnumbered CD8+ cells (CD4 : CD8 ratio of 8 : 1). B-cells were markedly depleted and formed loose clusters (Figure 4). Besides a Bcl-6-positive B-cell population, these clusters contained a disrupted CD21-positive framework of follicular dendritic cells along with CD57 and PD1-positive T-cells, qualifying them as remnants of germinal centers. Occasional rosettes formed by PD1+ lymphocytes around the neoplastic cells were seen. The lymph node was interpreted as NLPHL, consistent with T-cell/histiocyte-rich large B-cell lymphoma-like variant (NLPHL THRLBCL-like variant). The clinical presentation corresponded with Stage IV disease by Ann Arbor system with Cotswolds modifications [3]. The patient was treated with 6 cycles of ABVD therapy and showed an appropriate initial response. The long-term therapeutic effect cannot be yet assessed.

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