Nodular Lymphocyte-Predominante Hodgkin Lymphoma

F. Itatahine, F. Acherar, S. Ouldslimane, N. Nouar, K. Bouzid-Bendissari


Nodular Lymphocyte-Predominant Hodgkin Lymphoma (NLPHL) is an indolent germinal center B-cell neoplasm characterized histologically by a nodular or nodular and diffuse proliferation comprising a minority of large neoplastic centroblasts with multilobated nuclei known as popcorn or lymphocyte predominant (LP) cells (formerly called L&H cells for lymphocytic histiocytic Reed-Sternberg (RS) cell variants) , and a majority of reactive lymphocytes and histiocytes. It represents approximately 5% of all HL and occurs most frequently in the 30-50 year age groups with ranges from children to old adults and male predominance in 70% of cases. The aim of this study is to report the clinico-pathological features and discuss differentials diagnosis with overlapping features.
It’s a study that report four cases presented by enlarged lymph node ( cervical , under chin and two inguinal lymph nodes ). The ages are 21, 22, 24 and 49 with three males and one female. Three patients presented with single enlarged lymph node (stage I), One with superficial and abdominal adenopathies (stage III), all without B symptoms. The usual technics are systematic and immunohistochemistry study as well as CD20 , CD3 , CD30 , CD15 , CD57 , CD68 , CD10 , and EMA.
The histology shows effaced lymph node architecture with features of typical NLPHL in two cases but in the others neoplastic cells had sterbergoid aspect were rare. Immunohistochemistry data revealed the neoplastic cells to be CD20+, EMA+/- , CD30-, CD15- Background cells were Bcl2+, CD3+, CD57+ with some rosettes. One patient (stage III) received chemotherapy( 3 RCHOP), for the others the “watch and wait” approach was applied. All patient are alive without symptoms (1 to 5 years delay)
In spite of histological criteria there are diagnostic difficulties including progressively transformed germinal center (PTGC), classical Hodgkin lymphoma (CHL) especially NLRCHL and non-Hodgkin lymphoma (follicular lymphoma, T-cell/histiocyte rich large B-cell lymphoma). NLPHL is the type of HL with the most favorable prognosis despite relatively frequent late relapses.

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