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.

 

H&E Stain; Low Power Magnification: Vague nodular pattern with mottled boarders
H&E Stain: Large atypical lymphocyte predominant cells (LP cells), formerly referred to as L&H cells in background of reactive small lymphocytes
H&E Stain: Large atypical lymphocyte predominant cells (LP cells), formerly referred to as L&H cells in background of reactive small lymphocytes. Scattered epithelioid histiocytes are also seen
H&E Stain: Large clusters of epithelioid histiocytes in background of small lymphocytes
H&E Stain; High Power Magnification: LP cells in background of small lymphocytes, characteristic of NLPHL
H&E Stain; High Power Magnification: LP cells, (the neoplastic cells in NLPHL) have multilobated/folded nuclei with smaller basophilic nucleoli giving the cells a "popcorn" appearance
H&E Stain: More LP cells
H&E Stain; Low Power Magnification: The nodules on the left represent Nodular Lymphocyte Predominant Hodgkin Lymphoma (NLPHL) with a rim of follicular hyperplasia on the right
H&E Stain; Low Power Magnification: Single reactive follicle with a prominent germinal center
H&E Stain; Low Power Magnification: NLPHL nodules on the left, and reactive lymphoid follicles on the right
IHC Stain: LP cells are ringed by CD3+ T-cells
IHC Stain; High Power Magnification: CD3+ T-cells surrounding LP cells
IHC Stain: OCT-2+ LP cells
IHC Stain: BCL6+ LP cells
IHC Stain: CD20+ LP cells