title: Large B-cell lymphoma rich in T-cells and simulating Hodgkin's disease.
abstract: Unusual clinicopathological features drew our attention to nine of 208 cases diagnosed as Hodgkin's disease. Lymph node biopsy specimens in these cases were immunostained with monoclonal antibodies against B-cell, T-cell and Reed-Sternberg cell associated antigens and epithelial membrane antigen (EMA). Reed-Sternberg-like and other atypical large cells were dispersed in a diffuse, small lymphocyte-rich background, consistent more often with the initial diagnosis of diffuse, lymphocyte predominance Hodgkin's disease. The clinical stage in these cases was unusually advanced (stages III and IV). Splenomegaly was a common feature (six of nine cases), the male to female ratio was 7:2 and the median age was 55 years (range 25-77). Response to recognized regimes for Hodgkin's disease treatment was poor in most cases, and three patients died early of their disease. Large cells were B-lymphocytes expressing EMA--an immunophenotype similar to nodular, lymphocyte predominance Hodgkin's disease. Reed-Sternberg cell and T-cell associated antigens were absent on large cells. Mature T-cells, with nuclear irregularities in some instances, predominated in the background. A more appropriate diagnostic category is, therefore, T-cell-rich B-cell lymphoma. The cases represent a 4-5% erroneous diagnosis of Hodgkin's disease and further suggest that there is a need for revision of criteria for the diagnosis of the diffuse, lymphocyte predominance variant.
authors.affiliation: Department of Anatomical Pathology, University Paul Sabatier, Toulouse, France.
authors.forename: S M
authors.initials: SM
authors.lastname: Chittal
authors.forename: P
authors.initials: P
authors.lastname: Brousset
authors.forename: J J
authors.initials: JJ
authors.lastname: Voigt
authors.forename: G
authors.initials: G
authors.lastname: Delsol
mesh_terms: D000328:Adult; D000368:Aged; D015703:Antigens, CD / Q000032:analysis; D004279:DNA, Viral / Q000032:analysis; D003937:Diagnosis, Differential; D005260:Female; D004854:Herpesvirus 4, Human / Q000302:isolation & purification; D006689:Hodgkin Disease / Q000175:diagnosis*; D006801:Humans; D007124:Immunoenzyme Techniques; D007147:Immunoglobulin Light Chains / Q000032:analysis; D016130:Immunophenotyping; D016393:Lymphoma, B-Cell / Q000175:diagnosis* / Q000276:immunology / Q000382:microbiology; D016403:Lymphoma, Large B-Cell, Diffuse / Q000175:diagnosis* / Q000276:immunology / Q000382:microbiology; D008297:Male; D008562:Membrane Glycoproteins / Q000032:analysis; D008875:Middle Aged; D018396:Mucin-1; D009693:Nucleic Acid Hybridization; D012333:RNA, Messenger / Q000032:analysis; D013601:T-Lymphocytes / Q000473:pathology
chemical_list: D015703:Antigens, CD; D004279:DNA, Viral; D007147:Immunoglobulin Light Chains; D008562:Membrane Glycoproteins; D018396:Mucin-1; D012333:RNA, Messenger