CASE STUDY

Case 1: Lymph node, supraclavicular

Case 2: Lymph node, submandibular

CLINICAL FEATURES

• Monoclonal B-cell tumor, nodular or nodular/diffuse pattern, scattered large popcorn or LH cells;

• 5% of all HD cases;

• M>F, 30-50 YO.

MICROSCOPIC FINDINGS

• Lymph node is totally or partially replaced by a nodular or nodular and diffuse infiltrate;

• The nodules are predominantly consist of small lymphocytes, histocytes, and scattered LH cells;

• The LH cells are large with scant clear cytoplasm and one nucleus;

• The nuclei are often large, irregular, folded or multilobated or popcorn-like;

• The chromatin is mostly vesicular with a thin nuclear membrane;

• The nucleoli are often multiple, basophilic and smaller than those in classic RS cells (large eosinophilic);

• Many non-neoplastic CD57+ T cells may surround LH cells and form the rosette-like pattern;

• The architecture of the nodules is compose of a large spherical meshwork of follicular dendritic cells;

• Neutrophils and eosinophils are absent;

• One typical nodule is sufficient to exclude the diagnosis of T-cell rich large B-cell lymphoma.

DIFFERENTIAL DIAGNOSES

• T-cell rich large B-cell lymphoma: similar IPX profile, but no typical NLPHL nodules;

• DLBCL: less expression of EMA, no typical NLPHL nodules;

• ALCL: CD30+, CD2+, perforin/granzyme+, ALK+/-, CD43+/-, B-cell markers-.

• Reactive lymphoid hyperplasia: especially when tumor cells are scant. Need to spend some time in higher power.

IMMUNOHISTOCHEMISTRY AND SPECIAL STAINS

CYTOGENETIC STUDIES

• Ig clonal rearrangement;

• Tumor cells are EBV negative.

TREATMENT AND PROGNOSIS

• Stage I and II: 10-year overall survival > 80%.

REFERENCES

• WHO Pathology & Genetics. Tumours of Haematopoietic and Lymphoid Tissues. IARC Press, Lyon 2001