NODULAR LYMPHOCYTE PREDOMINANT HODGKIN LYMPHOMA IN BACKGROUND OF PROGRESSIVE TRANSFORMATION OF GERMINAL CENTERS
Case provided by Jila Khorsand, MD
Case History
A 41 year old woman has been followed for a right axillary adenopathy since 2006. Ultrasound guided biopsies x2 were reported as follicular hyperplasia with progressively transformed gernminal centers. The patient’s latest ultrasound revealed a 2-3cm right axillary mass, which was biopsied.
Microscopic Findings
Microscopic sections showed a predominant nodular pattern. The nodules were composed of small lymphcytes interspersed by histiocytes and LP cells (Lymphocytic predominant cells). The LP cells showed immunostaining with CD45, CD20, bcl 6, BOB-1, and OCT-2. CD3 and PD1 stains highlighted the T-cells surrounding the LP cells forming rosette-like structures. Some sections revealed progressive transformation of germinal centers.
Diagnosis
NODULAR LYMPHOCYTE PREDOMINENT HODGKIN LYMPHOMA IN BACKGROUND OF PROGRESSIVE TRANSFORMATION OF GERMINAL CENTERS.
Discussion
Nodular lymphocyte predominant Hodgkin lymphoma is an indolent B-cell malignancy which accounts for 3-8% of Hodgkin lymphoma cases in western countries. NLPHL occurs at any age with a peak incidence in the fourth decade. Cervical and axillary lymph nodes are most frequently involved. NLPHL typically presents as an early stage disease with slow progression and has an excellent outcome with standard therapy. Recurrence is common and occurs in 21% of cases. Unlike classical Hodgkin Lymphoma, the LP cells show immunoreactivity with CD45 and CD20 and no staining with CD30 or CD15. There is consistent staining with CD20, CD22, and CD79a. Progressive transformation of germinal centers, PTGC which shows some histomorphologic similarities to NLPHL and may precede, coexist or follow NLPHL.
References
1. Jaffe, E, Hematopathology. Philadelphia: Elsevier Saunders, 2011
2. Weiss, L, Lymph Nodes. New York: Cambridge University Press, 2008: 115-121.