Back to Homepage

Case 218 - Discussion

Uploaded: 2011-10-08, Updated: 2011-10-08

 

CD45

CD15

CD30

CD20

BOB1

OCT2

CD3

CD3

CD3

CD57

CD57

CD57

 

The Key Features

  • Nodular infiltrate with scattered neoplastic LH cells (CD19+, CD79a+, BCL6+, EMA+, OCT2+, CD15-, CD30-);

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

  • CD57+ T cells surround LH cells and form the rosette-like pattern;

CASE STUDY

 

Case 1: Lymph node, supraclavicular

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

CD30

CD15

CD45

CD20

CD79a

BSAP

EMA

BCL6

ALK

CD43

J Chain

Ig

CD2

CD3

OCT2

BOB1

Perforin

Granzyme B

+

+

+

+

+/-

+

+/−

+/−

+bright

+/−

+

+

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