Hematopathology

Cas 068134

Liens et agrandissements sur : images et texte en bleu. Links - Zoom: pictures and highlighted text.
 

Sujet de 54 ans se présentant en sub-occlusion, Opéré de colectomie: Adénocarcinome de type intestinal, infiltrant la sous-séreuse. Pas de ganglion métastatique.

 

54 yo male complaining of a colonic obstruction; Surgery: right colon: Adenocarcinoma intestinal type, invading the sub-serosa. No lymphnode metastasis.

 
  Biopsie d'un adénopathie aortique.   Biopsy of an enlarged aortic lymphnode.  
     
     
     
  PAS   PAS  
     
     
  CD20   CD20  
     
  EMA   EMA  
     
  CD5   CD5  
 

Diagnostic proposé:

 

 

 

 

 

 

 

 

 

Lymphome de Hodgkin, prédominance lymphocytaire.

 

Proposed diagnosis:

 

 

 

 

 

 

 

 

 

Lymphocyte predominant Hodgkin's lymphoma.

 
  Arguments      
  dans le texte de réference ci-dessous, en gras   Highlighted in the text of the reference below  
  Hodgkin's Disease in Ackermann's Surgical Pathology (8 Ed.)  
  In lymphocyte predominance Hodgkin's disease, the predominant cell is a small B lymphocyte, with or without an accompanying population of benign-appearing histiocytes. Postcapillary venules with high endothelium may be prominent. The lymph node architecture is patially or totally effaced, and the infiltrate may have a diffuse or nodular pattern of growth. The latter may be so pronounced as to simulate on low power the appearance of follicular lymphoma; however, the nodules of Hodgkin's disease are more irregular in size and staining quality, and the admixture of lymphocytes and epithelioid cells gives them a mottled appearance. A rim of uninvolved or hyperplastic lymphoid tissue may be present. Progressively transformed germinal centers may be seen adjacent to the lesion. Eosinophils, plasma cells, and foci of fibrosis are scanty or absent. Classic Reed-Sternberg cells are difficult to find or altogether absent. One sees instead a variable but usually large number of a type of Reed-Sternberg cell (the L&H cell or "popcorn" cell) characterized by a folded, multilobed nucleus with smaller nucleoli. If numerous diagnostic Reed-Sternberg cells are found in a node with a lymphocyte predominance background, the case should probably be classified as one of mixed cellularity. Occasionally, the L&H cells predominate at the margins of the nodules, creating a "wreath" around them. In others, they cluster in large confluent sheets resembling diffuse large cell lymphoma  
  Poppema et al. first proposed that cases of lymphocyte predominance Hodgkin's disease having a nodular pattern of growth (the L&H nodular type of the classification of Lukes et al.) arise from B-cell regions of the node and specifically from progressively transformed germinal centers. They supported their theory by showing that the L&H cell that is characteristic of this condition is of B-cell lineage, and this has been confirmed by many others. L&H cells express the pan­B-cell markers CD19, CD20, CD22, CD74, CDw75, and CD45 RA. They are also positive for CD45 RB (LCA) but consistently negative for T-cell markers. They may express CD30 or EMA, and they generally lack CD15 expression. J chain, a protein associated with immunoglobulin synthesis, has been demonstrated in these cells, but expression of immunoglobulin heavy or light chains has been generally lacking. However, evidence that lymphocyte predominance Hodgkin's disease is a k light chain­restricted monotypic B-cell neoplasm has been recently presented. No Epstein-Barr virus or bcl-2 protein overexpression has been encountered.  
  Prognosis: Traditionally, lymphocyte predominance and nodular sclerosis have been the most favorable forms, mixed cellularity has been intermediate, and the lymphocyte depletion form has had the worst prognosis. The long-term prognosis of lymphocyte predominance Hodgkin's disease is so good that some authors have referred to it as "the benign form" of Hodgkin's disease, and have even doubted that it represents a neoplastic process  

  Path Consult reference (click here)  

 

Current Diagnostic Pathology Volume 10, Issue 5, Pages 385-393 (October 2004)

Nodular lymphocyte-predominant Hodgkin's lymphoma and T-cell/histiocyte-rich large B-cell lymphoma: near neighbours or distant cousins?

Abstract 

The clinicopathological distinctiveness of nodular lymphocyte-predominant Hodgkin's lymphoma (NLPHL) is now unanimously recognized. Occasionally, NLPHL lesions are difficult to distinguish from T-cell/histiocyte-rich large B-cell lymphoma (THR-BCL), a morphological variant of diffuse large B-cell lymphoma. It has been suggested that THR-BCL represents a phenotypically peculiar expression or an evolutionary stage of NLPHL. Here, we present a review of both disorders, integrating our own experience with recent evidence from the literature. Overall, currently available data indicate that both diseases constitute intrinsically different entities that may, however, originate from a comparable transformed germinal centre ancestor.