title: Large B-cell lymphoma with T-cell-rich background and nodules lacking follicular dendritic cell meshworks: description of an insufficiently recognized variant.
abstract: Nodular lymphocyte-predominant Hodgkin lymphoma (NLPHL) is characterized by nodular or nodular and diffuse growth of scattered large neoplastic B cells associated with follicular dendritic cell (FDC) meshworks. Variant patterns, which at least focally show a T-cell-rich background, and rare cases lacking FDC meshworks that overlap with T-cell/histiocyte-rich large B-cell lymphoma (THRLBCL) are also recognized. We reviewed 195 cases spanning the diagnostic spectrum of NLPHL and THRLBCL and identified 5 cases with distinctive features that were difficult to classify according to the World Health Organization criteria or previously described variants. Clinically, they involved peripheral and central lymph node sites or the mediastinum, and the majority also had recurrent disease. Four cases showed large T-cell-rich nodules with fibrosis, and 1 showed diffuse THRLBCL-like pattern with a minor component of nodularity. All cases completely lacked FDC meshworks despite a prominent nodular growth pattern. Large atypical cells in all cases were CD20+ CD30- CD15- B cells, although a small subset (<10%) of CD30+ and CD15+ large cells were seen in 1 case. In 4 cases, the background mainly contained CD4+ PD-1+ or CD57+ T cells that ringed large atypical B cells. In 1 case, B-cell predominance and a ringing pattern of CD57+ T cells were noted in nodules, whereas they were lacking in the diffuse areas. Recognition of these variant cases expands the spectrum between NLPHL and THRLBCL and points to the need for further refinement of diagnostic criteria for appropriate classification and clinical management.
authors.affiliation: Department of Pathology, Stanford University School of Medicine, Stanford, CA 94305; Department of Pathology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok 10700, Thailand.
authors.forename: Jitsupa
authors.initials: J
authors.lastname: Treetipsatit
authors.affiliation: Department of Pathology, Stanford University School of Medicine, Stanford, CA 94305.
authors.forename: Ryan A
authors.initials: RA
authors.lastname: Metcalf
authors.affiliation: Department of Pathology, Stanford University School of Medicine, Stanford, CA 94305.
authors.forename: Roger A
authors.initials: RA
authors.lastname: Warnke
authors.affiliation: Department of Pathology, Stanford University School of Medicine, Stanford, CA 94305. Electronic address: yaso@stanford.edu.
authors.forename: Yasodha
authors.initials: Y
authors.lastname: Natkunam
mesh_terms: D000328:Adult; D000368:Aged; D001402:B-Lymphocytes / Q000276:immunology*; D014408:Biomarkers, Tumor / Q000032:analysis; D001706:Biopsy; D020566:Dendritic Cells, Follicular / Q000276:immunology*; D003937:Diagnosis, Differential; D005355:Fibrosis; D006689:Hodgkin Disease / Q000145:classification / Q000175:diagnosis* / Q000276:immunology / Q000473:pathology; D006801:Humans; D007150:Immunohistochemistry; D016130:Immunophenotyping; D008198:Lymph Nodes / Q000276:immunology* / Q000473:pathology; D016403:Lymphoma, Large B-Cell, Diffuse / Q000145:classification / Q000175:diagnosis* / Q000276:immunology / Q000473:pathology; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D013601:T-Lymphocytes / Q000276:immunology*
chemical_list: D014408:Biomarkers, Tumor
keywords: Follicular dendritic cell meshwork; Gray-zone B-cell lymphoma; Hodgkin lymphoma; Nodular lymphocyte–predominant Hodgkin lymphoma; T-cell/histiocyte-rich large B-cell lymphoma