Cellular Classification and Biologic Correlates
Nodular Lymphocyte-Predominant Hodgkin Lymphoma
This pathologic class of Hodgkin lymphoma is characterized by large cells with multilobed nuclei, referred to as popcorn cells. These cells express B-cell antigens such as CD19, CD20, CD22, and CD79A, and are negative for CD15. These cells may or may not express CD30. The OCT-2 and BOB.1 oncogenes are both expressed in NLPHL; they are not expressed in the cells of patients with classical Hodgkin lymphoma. While diffuse subtypes may exist with lymphocytic and histiocytic cells set against a diffuse background consisting of reactive T-cells, reliable discrimination from non-Hodgkin lymphoma is problematic. In addition, a purely diffuse subtype would be classified as diffuse large B-cell lymphoma or T-cell-rich B-cell lymphoma. Even NLPHL can be difficult to distinguish from progressive transformation of germinal centers and/or T-cell-rich B-cell lymphoma. NLPHL is most common in males younger than 18 years. In the CCG-5942 study, NLPHL accounted for approximately 18% of cases in children younger than 10 years and 8% of cases in children 10 years or older. Approximately 80% of these patients were male. Patients with NLPHL generally present with localized, nonbulky disease that infrequently involves the mediastinum. Almost all patients are asymptomatic.
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