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 Prepublished online as a Blood First Edition Paper on July 24, 2003; DOI 10.1182/blood-2003-02-0626.

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Submitted February 26, 2003
Accepted July 5, 2003

Nodular lymphocyte predominant Hodgkin lymphoma with nodules resembling T-cell/histiocyte rich B-cell lymphoma: differential diagnosis between nodular lymphocyte predominant Hodgkin lymphoma and T-cell/histiocyte rich B-cell lymphoma

Ludmila Boudova, Emina Torlakovic, Jan Delabie, Peter Reimer, Beate Pfistner, Sabine Wiedenmann, Volker Diehl, Hans-Konrad Muller-Hermelink, and Thomas Rudiger*

Department of Pathology, Charles University, Pilsen, Czech Republic
Department of Pathology, The Norwegian Radium Hospital, Oslo, Norway
Medizinische Poliklinik, University of Wuerzburg, Wuerzburg, Germany
German Hodgkin Lymphoma Study Group, University of Cologne, Cologne, Germany
Department of Pathology, University of Wuerzburg, Wuerzburg, Germany

* Corresponding author; email: thomas.ruediger{at}mail.uni-wuerzburg.de.

Nodular lymphocyte predominant Hodgkin lymphoma (NLPHL) and T-cell/histiocyte rich B-cell lymphoma (T/HRBCL) are distinct tumors treated differently. They are linked by a morphological and probably a biological continuum, which renders the differential diagnosis difficult. To develop criteria to distinguish the entities along the morphological continuum we correlated the lymph node architecture and immunophenotype of both tumor cells and reactive components of 235 neoplasms in the spectrum of NLPHL and T/HRBCL to clinical data. Two hundred and eighteen cases fitted the WHO criteria of NLPHL (139) or T/HRBCL (79). While tumor cells in both entities were immunophenotypically similar, background composition differed: in NLPHL small B-cells and CD3+CD4+CD57+ T-cells were common, while in T/HRBCL CD8+ cytotoxic T-cells and histiocytes dominated. Follicular dendritic cells (FDC) formed expanded meshworks in NLPHL while absent in T/HRBCL. Seventeen cases represented a "grey zone": within FDC meshworks neoplastic B-cells resided in a background depleted of small B-cells but rich in T-cells and histiocytes. Tumor cells were either loosely scattered or formed clusters, thus resembling areas of either T/HRBCL or inflammatory DLBCL within the nodules. Patients with these NLPHL with T-cell/histiocyte rich nodules presented at a high stage and with B-symptoms, like T/HRBCL, but had an excellent survival, like NLPHL. This morphological pattern suggests a biological continuum between NLPHL and T/HRBCL.


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