title: Does functional imaging distinguish nodular lymphocyte-predominant hodgkin lymphoma from T-cell/histiocyte-rich large B-cell lymphoma?
abstract: BACKGROUND
  Nodular lymphocyte predominant Hodgkin lymphoma (NLPHL) is often associated with concurrent or subsequent development of T-cell/histiocyte-rich large B-cell lymphoma (THR-LBCL). Distinguishing the two is important because their therapies are different. Functional imaging with PET/CT is used to stage both Hodgkin and non-Hodgkin lymphomas. Aggressive lymphomas are usually more PET avid than the indolent subtypes. Therefore, it is possible that PET/CT may help distinguish NLPHL from THR-LBCL.
  
  
  METHODS
  Herein, we retrospectively describe the clinical and PET/CT findings of 12 patients with NLPHL or THR-LBCL seen from 2004-2010.
  
  
  CONCLUSIONS
  Six patients each were identified and the average SUVmax was 6.9 (range, 5.7-7.3) in NLPHL and 16.6 (range, 4-29) in THR-LBCL (p = 0.055). Bone and extranodal involvement was found in one patient with NLPHL compared to four patients with THR-LBCL. This patient failed to respond to ABVD and was subsequently found to have THR-LBCL. We suggest that patients with NLPHL and THR-LBCL have different clinical and PET/CT characteristics. NLPHL patients had lower SUVmax on PET/CT compared to those with THR-LBCL. The presence of bone or extranodal involvement is more common in patients with THR-LBCL. Patients with NLPHL and an uncharacteristically higher SUVmax on PET/CT, or those with bone or extranodal involvement, should alert the clinician to consider the presence of THR-LBCL.
authors.affiliation: Department of Internal Medicine, Division of Hematology/Oncology, University of Nebraska Medical Center, Omaha, Nebraska, USA. nick.barber@unmc.edu
authors.forename: Nicholas A
authors.initials: NA
authors.lastname: Barber
authors.forename: Fausto R
authors.initials: FR
authors.lastname: Loberiza
authors.forename: Anamarija M
authors.initials: AM
authors.lastname: Perry
authors.forename: Martin
authors.initials: M
authors.lastname: Bast
authors.forename: Karen P
authors.initials: KP
authors.lastname: Holdeman
authors.forename: Aliriza B
authors.initials: AB
authors.lastname: Esfahane
authors.forename: Dennis D
authors.initials: DD
authors.lastname: Weisenburger
authors.forename: Julie
authors.initials: J
authors.lastname: Vose
authors.forename: Philip
authors.initials: P
authors.lastname: Bierman
authors.forename: James O
authors.initials: JO
authors.lastname: Armitage
authors.forename: R Gregory
authors.initials: RG
authors.lastname: Bociek
mesh_terms: D000328:Adult; D000368:Aged; D003937:Diagnosis, Differential; D005260:Female; D006689:Hodgkin Disease / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000473:pathology; D006801:Humans; D016130:Immunophenotyping; D008198:Lymph Nodes / Q000473:pathology; D008214:Lymphocytes / Q000473:pathology; D016403:Lymphoma, Large B-Cell, Diffuse / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000473:pathology; D008297:Male; D008875:Middle Aged; D011859:Radiography; D012189:Retrospective Studies
keywords: Nodular lymphocyte-predominant Hodgkin lymphoma; PET/CT; T-cell/histiocyte-rich large B-cell lymphoma