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- Title
T-Cell--Rich Hodgkin Lymphoma With Features of Classic Hodgkin Lymphoma and Nodular Lymphocyte-Predominant Hodgkin Lymphoma: A Borderline Category With Overlapping Morphologic and Immunophenotypic Features.
- Authors
El Hussein, Siba; Hong Fang; Jelloul, Fatima Zahra; Wei Wang; Loghavi, Sanam; Miranda, Roberto N.; Friedberg, Jonathan W.; Burack, W. Richard; Evans, Andrew G.; Jie Xu; Medeiros, L. Jeffrey
- Abstract
Context.--: It is known that a subset of cases of classic Hodgkin lymphoma (CHL) with B-cell-rich nodules (lymphocyte-rich CHL) exhibits morphologic and immunophenotypic features that overlap with nodular lymphocyte-predominant Hodgkin lymphoma (NLPHL), raising diagnostic difficulties that can be resolved in most cases by performing an adequate battery of immunohistochemical studies. Objective.--: To fully characterize cases of T-cell-rich Hodgkin lymphoma where a specific diagnosis of NLPHL (ie, pattern D) or CHL could not be made even after complete immunophenotypic investigation. Design.--: The clinical, immunomorphologic, and molecular (when applicable) presentation of 3 cases of T-cell-rich Hodgkin lymphoma was thoroughly investigated. Results.--: These 3 cases harbored lymphocyte-predominant-like and Hodgkin and Reed-Sternberg-like cells that partially expressed B-cell and CHL markers and were negative for Tiftein-Barr virus-encoded small RNA, in a T-cell-rich background with residual follicular dendritic cell meshworks; 1 case had frequent and the other 2 cases scant/absent eosinophils and plasma cells. Two patients with advanced-stage (III or IV) disease presented with axillary and supraclavicular lymphadenopathy, respectively, and without B symptoms. These patients underwent NLPHL-like therapeutic management with 6 cycles of R-CHOP (rituximab, cyclophosphamide, doxorubicin hydrochloride [hydroxydaunorubicin], vincristine sulfate [Oncovin], and prednisone) chemotherapy; both are in complete remission 7 years posttherapy. One patient presented with stage I disease involving an internal mammary lymph node without B-symptoms and was treated with surgical excision alone; this patient is also in complete remission 1 year later. Conclusions.--: These cases illustrate overlapping features of T-cell-rich NLPHL and CHL with neoplastic cells expressing both B-cell program and CHL markers. This underrecognized overlap has not been fully illustrated in the literature, although it portrays a therapeutic challenge. These neoplasms may deserve in-depth investigation in the future that may bring up diagnostic or theragnostic implications.
- Subjects
HODGKIN'S disease treatment; IMMUNOPHENOTYPING; T cells; CANCER patients; TUMOR markers; DISEASE remission; GENE expression; IMMUNOHISTOCHEMISTRY; EPSTEIN-Barr virus; RNA probes; ONCOGENES; GENE expression profiling; TUMOR classification; HODGKIN'S disease; PHENOTYPES; DENDRITIC cells; EOSINOPHILS; B cells; SYMPTOMS
- Publication
Archives of Pathology & Laboratory Medicine, 2024, Vol 148, Issue 8, p914
- ISSN
0003-9985
- Publication type
Article
- DOI
10.5858/arpa.2023-0133-OA