Lymphoma & related disorders

Hodgkin lymphoma

CHL lymphocyte rich

Last author update: 1 September 2011
Last staff update: 10 February 2023 (update in progress)

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PubMed Search: "Lymphocyte rich" classic Hodgkin lymphoma

Dragos C. Luca, M.D.
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Cite this page: Luca DC. CHL lymphocyte rich. website. 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)
  • ~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)
  • 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)
  • 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%)
  • 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

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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
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