Lymphoma & related disorders
Hodgkin lymphoma
CHL lymphocyte rich
Author: Dragos C. Luca, M.D.
Last author update: 1 September 2011
Last staff update: 10 February 2023 (update in progress)
Copyright: 2002-2023, PathologyOutlines.com, Inc.
PubMed Search: "Lymphocyte rich" classic Hodgkin lymphoma
Table of Contents
Definition / general | Terminology | Epidemiology | Sites | Clinical features | Treatment | Microscopic (histologic) description | Microscopic (histologic) images | Immunohistochemistry & special stains | Differential diagnosisCite this page: Luca DC. CHL lymphocyte rich. PathologyOutlines.com website. https://www.pathologyoutlines.com/topic/lymphomanonBLRHL.html. Accessed May 30th, 2023.
Definition / general
- Lymphocyte rich classic Hodgkin lymphoma (LRCHL) is a subtype of classic 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
- ~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
- 5% of all classic Hodgkin lymphoma
- Median age higher than in other subtypes of classic Hodgkin lymphoma (43 years)
- Male predominance (M:F ~ 2:1)
Sites
- Peripheral lymph nodes (typically), mediastinal (~15%) and bulky disease uncommon, lungs (4%), bones (3%), bone marrow (2%), liver (2%), Waldeyer's ring
Clinical features
- Stage I or II at presentation in most cases (~70%)
- B symptoms rare (~10%)
Treatment
- Slightly better prognosis than other types of classic Hodgkin lymphoma (95% complete remission rate, 17% relapse rate)
- Similar prognosis as NLPHL but relapses less frequently (Blood 2000;96:1889)
Microscopic (histologic) description
- 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 classic Hodgkin lymphoma is more appropriate
- Coexisting LRCHL and mixed cellularity classic Hodgkin lymphoma possible but rare
Microscopic (histologic) images
Images hosted on other servers:
Various images
Immunohistochemistry & special stains
- Has classic 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 cellularity classic Hodgkin lymphoma)
Differential diagnosis
- Follicular lymphoma, mantle cell lymphoma, reactive lymphonodular hyperplasia
- Nodular lymphocyte predominant Hodgkin lymphoma: fascin-, JunB negative in 58% (Appl Immunohistochem Mol Morphol 2010;18:16)
