title: Nodular Lymphocyte Predominant Hodgkin Lymphoma versus T-Cell/Histiocyte-Rich Large B-Cell Lymphoma: A Diagnostic Challenge.
abstract: Lymphomas with overlapping histological features of two distinct entities cause difficulty in classification. Their classification is of particular significance when the two alternatives require different treatment modalities. We present a diagnostically challenging case of a nodular lymphocyte predominant Hodgkin lymphoma (NLPHL) with features of T-cell/histiocyte-rich large B-cell lymphoma (THRLBCL). Our patient is a 39-year-old woman who presented with painless subclavicular and axillary lymphadenopathy. The biopsied lymph node showed diffuse architectural effacement and scattered large neoplastic cells with large irregular nuclei and prominent nucleoli. These cells were positive for CD20 and Bcl-6 and negative for CD15, CD30, IgD, and Bcl-2. The background cells were predominantly T lymphocytes, whereas B cells were markedly depleted. The lymph node was interpreted as NLPHL, consistent with THRLBCL-like variant. NLPHL, especially THRLBC-like variant, and de novo THRLBCL are characterized by significant morphologic and immunophenotypic overlap. Our case demonstrates a rare predominance of background T-cells in NLPHL and emphasizes the importance of thorough evaluation of multiple morphologic and immunophenotypic features as an essential approach for arriving at the correct diagnosis.
authors.affiliation: Department of Pathology, State University of New York Downstate Medical Center, 450 Clarkson Avenue, Brooklyn, NY 11203, USA.
authors.forename: Anton V
authors.initials: AV
authors.lastname: Rets
authors.affiliation: Department of Pathology, State University of New York Downstate Medical Center, 450 Clarkson Avenue, Brooklyn, NY 11203, USA.
authors.forename: Susan R S
authors.initials: SR
authors.lastname: Gottesman
references.citation: J Clin Oncol. 1999 Mar;17(3):776-83
references.pmid: 10071266
references.citation: Blood. 2003 Nov 15;102(10):3753-8
references.pmid: 12881319
references.citation: PLoS One. 2013 Nov 11;8(11):e78812
references.pmid: 24244368
references.citation: Blood. 2005 Mar 1;105(5):1851-61
references.pmid: 15550490
references.citation: J Clin Oncol. 2010 Feb 10;28(5):793-9
references.pmid: 20048177
references.citation: J Clin Oncol. 2010 Jan 1;28(1):e8
references.pmid: 19933898
references.citation: Blood. 2013 Dec 19;122(26):4246-52; quiz 4292
references.pmid: 24100447
references.citation: J Clin Oncol. 2010 Jan 1;28(1):136-41
references.pmid: 19933914
references.citation: N Engl J Med. 2005 Mar 24;352(12):1197-205
references.pmid: 15788496
references.citation: J Clin Oncol. 2004 Aug 1;22(15):3032-8
references.pmid: 15210738
references.citation: Mod Pathol. 2013 Jan;26 Suppl 1:S57-70
references.pmid: 23281436
references.citation: Am J Pathol. 2002 Nov;161(5):1861-7
references.pmid: 12414532
references.citation: Hum Pathol. 2010 Dec;41(12):1726-34
references.pmid: 20825974
references.citation: J Clin Oncol. 1989 Nov;7(11):1630-6
references.pmid: 2809679
references.citation: Am J Surg Pathol. 2008 Aug;32(8):1252-7
references.pmid: 18594468
references.citation: J Hematop. 2009 Dec 22;2(4):211-36
references.pmid: 20309430
references.citation: Am J Surg Pathol. 2003 Oct;27(10):1346-56
references.pmid: 14508396
references.citation: J Exp Med. 2008 Sep 29;205(10):2251-68
references.pmid: 18794340