title: Morphologic, immunphenotypic and clinical discriminators between T-cell/histiocyte-rich large B-cell lymphoma and lymphocyte-predominant Hodgkin lymphoma.
abstract: BACKGROUND
  Features of T-cell/histiocyte rich large B-cell lymphoma (THRLBCL) overlap with those of lymphocyte predominant Hodgkin lymphoma (LPHL). The two lymphomas may represent a spectrum of the same disease, and differentiation between the two can sometimes be difficult. We looked at histomorphologic, immunophenotypic and clinical information that may help differentiate the two entities.
  
  
  METHODS
  Cases of THRLBCL and LPHL were blindly reviewed and studied for histological pattern (nodular vs. diffuse), nuclear features and pattern of expression of CD20, CD30, CD57, epithelial membrane antigen (EMA) and Epstein-Barr virus (EBV). A score encompassing diffuse histology, high nuclear grade, CD20 single-cell pattern, CD30+, CD57-, EMA-, and EBV+ was estimated for the diagnosis of TCHRLBCL.
  
  
  RESULTS
  There were 58 cases, including 30 cases of TCHRLBL and 28 cases of LPHL. The median age was 36 years for TCHRLBCL and 21 years for LPHL (P = 0.0001). Three types of nuclei were identified (lymphocytic/histocytic, Reed-Sternberg and centroblast-like). The latter two high-grade nuclei were suggestive of TCHRLBCL. TCHRLBCL and LPHL, respectively, showed diffuse histology, 90% vs. 4% (P = 0.001), single CD20+ cells, 93% vs. 3.5% (P = 0.00004), CD30+ cells, 30% vs. 0% (P = 0.01), CD57+ cells, 41% vs. 93% (P = 0.008), EMA+ cells, 27% vs. 60% (P = 0.113), EBV+ cells, 24% vs. 0% (P = 0.117), high nuclear grade, 70% vs. 0% (P = 0.001), total score 2-7 (mean 4.68) vs. 0-2 (mean 0.72) (P = 0.001), high stage, 86% vs. 7% (P = 0.0001).
  
  
  CONCLUSIONS
  Our findings indicate that a combination of multiple parameters can help differentiate between the two diseases. Two cases originally diagnosed as LPHL were re-assigned the diagnosis of THRLBCL.
authors.affiliation: University of Kentucky, Department of Pathology and Laboratory Medicine, 800 Rose St., MS 117, Lexington, KY 40536-0298, USA. wmourad@hotmail.com
authors.forename: Walid A
authors.initials: WA
authors.lastname: Mourad
authors.forename: Sheikha
authors.initials: S
authors.lastname: Al Thani
authors.forename: Abdelghani
authors.initials: A
authors.lastname: Tbakhi
authors.forename: Mohamed
authors.initials: M
authors.lastname: Al Omari
authors.forename: Yasser
authors.initials: Y
authors.lastname: Khafaga
authors.forename: Mohamed
authors.initials: M
authors.lastname: Shoukri
authors.forename: Amr
authors.initials: A
authors.lastname: El Weshi
authors.forename: Mohamed
authors.initials: M
authors.lastname: Al Shabana
authors.forename: Adnan
authors.initials: A
authors.lastname: Ezzat
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015703:Antigens, CD / Q000096:biosynthesis; D000951:Antigens, Neoplasm / Q000096:biosynthesis; D014408:Biomarkers, Tumor / Q000032:analysis*; D002648:Child; D002675:Child, Preschool; D003937:Diagnosis, Differential; D006689:Hodgkin Disease / Q000276:immunology / Q000378:metabolism* / Q000473:pathology*; D006801:Humans; D007150:Immunohistochemistry; D016130:Immunophenotyping; D016403:Lymphoma, Large B-Cell, Diffuse / Q000276:immunology / Q000378:metabolism* / Q000473:pathology*; D008875:Middle Aged; D055815:Young Adult
chemical_list: D015703:Antigens, CD; D000951:Antigens, Neoplasm; D014408:Biomarkers, Tumor