Abstract
Objectives: We recently examined the utility of flow cytometric analysis in the diagnosis of nodular lymphocyte predominant Hodgkin lymphoma (NLPHL) by examining reactive T-cell features. This study aims to compare these features in sequential biopsies of persistent or recurrent lymphadenopathy in patients with NLPHL. Methods: We reanalysed the histopathology and flow cytometry findings of 9 patients with multiple biopsies for persistent or recurrent lymphadenopathy and either initial or recurrent NLPHL. A flow cytometry signature was considered suggestive of NLPHL if ≥12% of T-cells expressed CD57 or ≥3% of T-cells co-expressed CD4 and CD8. Results: A flow cytometry signature considered suggestive of NLPHL was seen in 18 of 20 specimens. Based on histopathology, 11 were diagnosed as NLPHL, 3 were initially underdiagnosed as atypical lymphoid proliferation, and 4 were initially incorrectly diagnosed as negative or progressive transformation of germinal centers. Flow cytometry showed similar expression patterns of CD57 and CD4/CD8 in T-cells between initial and subsequent biopsies. The remaining 2 specimens lacked the flow cytometry signature suggestive of NLPHL and were histopathologically diagnosed as reactive hyperplasia. Conclusion: Flow cytometry analysis based on our criteria is highly sensitive in detecting NLPHL. Correlation with the cytospin cytology may increase the diagnostic specificity. A negative flow essentially ruled out the possibility of NHLPHL.
Highlights
Nodular lymphocyte-predominant Hodgkin lymphoma (NLPHL) is a rare, indolent B-cell lymphoma
We recently examined the utility of flow cytometric analysis in the diagnosis of nodular lymphocyte predominant Hodgkin lymphoma (NLPHL) by examining reactive T-cell features
The diagnosis of NLPHL can be difficult when based solely on the histopathologic evaluation of an excisional biopsy. It is even more difficult when material is obtained by needle aspiration or core biopsy. This case series confirms the utility of flow cytometry in the initial diagnostic work up and post-therapeutic monitoring of NLPHL
Summary
Nodular lymphocyte-predominant Hodgkin lymphoma (NLPHL) is a rare, indolent B-cell lymphoma. It accounts for approximately 5% of all Hodgkin lymphomas and predominantly affects men ages 30-50 years. LP cells are typically positive for CD20, CD45, CD79a, Bcl-6, Pax-5, OCT2, and BOB1 and negative for CD15 [2,3,4]. This immunophenotypic profile based on immunohistochemistry is neither sensitive nor specific. It can be difficult to distinguish NLPHL from other lymphoid neoplasms with similar architectural characteristics, such as lymphocyte-rich classic Hodgkin Lymphoma (LRCHL), T-cell/histiocyte rich large B-cell lymphoma (TCRLBCL), follicular lymphoma, and follicular hyperplasia with progressive transformation of germinal centers (PTGC) [1, 4, 5]. Morphologic examination of these disease entities may
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