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Lymphoma - Non B cell neoplasms

Hodgkin lymphoma

Lymphocyte-rich classical Hodgkin lymphoma


Reviewer: Dragos Luca, M.D. (see Reviewers page)
Revised: 28 September 2011, last major update September 2011
Copyright: (c) 2001-2011, PathologyOutlines.com, Inc.

Definition
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● Lymphocyte rich classical Hodgkin lymphoma (LRCHL) is a subtype of classical Hodgkin lymphoma (CHL) with scattered Hodgkin Reed-Sternberg (HRS) cells and a nodular or less commonly a diffuse cellular background consisting of small lymphocytes and with an absence of neutrophils and eosinophils (WHO 2008)

Terminology
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● ~30% of nodular lymphocyte predominant Hodgkin lymphoma (NLPHL) cases diagnosed in the past were found to be LRCHL
● Also known as follicular Hodgkin lymphoma (Am J Clin Pathol 2002;117:29)

Epidemiology
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● 5% of all classical Hodgkin lymphoma
● Median age higher than in other subtypes of classical Hodgkin lymphoma (43 years)
● Male predominance (M:F ~ 2:1)

Sites
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● Peripheral lymph nodes (typically), mediastinal (~15%) and bulky disease uncommon, lungs (4%), bones (3%), bone marrow (2%), liver (2%), Waldeyer's ring

Clinical features
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● Stage I or II at presentation in most cases (~70%)
● B symptoms rare (~10%)

Treatment and prognosis
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● Slightly better prognosis than other types of classical Hodgkin lymphoma (95% complete remission rate, 17% relapse rate)
● Similar prognosis as NLPHL, but relapses less frequently (Blood 2000;96:1889)

Micro description
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● Two growth patterns: nodular (common) and diffuse (rare)
● Attenuated T-zone; nodules composed of small lymphocytes, may have eccentric, small or regressed germinal centers; no eosinophils or neutrophils
● Some of the HRS cells may resemble LP cells or mononuclear lacunar cells; easily confused with NLPHL
● Rarely LRCHL-typical nodules surrounded by fibrous bands; maybe classifying as nodular sclerosing classical Hodgkin lymphoma is more appropriate
● Coexisting LRCHL and mixed cellularity classical Hodgkin lymphoma possible but rare

Micro images
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Various images

Stains / immunophenotype
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● Has classical Hodgkin lymphoma phenotype (CD15+, CD30+, fascin+); IgM+D+ small lymphocytes in nodules (expanded mantle zones); CD21 highlights small eccentric intact germinal centers (infrequent in NLPHL); JunB+, EBV+ (more than nodular sclerosing but less than mixed cellularlity classical Hodgkin lymphoma)

Differential diagnosis
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Nodular lymphocyte predominant Hodgkin lymphoma: fascin-, JunB negative in 58% (Appl Immunohistochem Mol Morphol 2010;18:16)
● Follicular lymphoma, mantle cell lymphoma, reactive lymphonodular hyperplasia

End of Lymphoma - Non B cell neoplasms > Hodgkin lymphoma > Lymphocyte-rich classical Hodgkin lymphoma


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