Lymphoma and plasma cell neoplasms
Hodgkin lymphoma
Lymphocyte rich classical Hodgkin lymphoma

Author: Dragos Luca, M.D. (see Authors page)

Revised: 21 March 2017, last major update September 2011

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PubMed Search: "Lymphocyte rich" classical Hodgkin lymphoma

Cite this page: Lymphocyte rich classical Hodgkin lymphoma. PathologyOutlines.com website. http://pathologyoutlines.com/topic/lymphomanonBLRHL.html. Accessed July 24th, 2017.
Definition / general
  • Lymphocyte rich classical Hodgkin lymphoma (LRCHL) is a subtype of classical Hodgkin lymphoma (CHL) with scattered Hodgkin Reed-Sternberg (HRS) cells and a nodular or less commonly a diffuse cellular background consisting of small lymphocytes and with an absence of neutrophils and eosinophils (WHO 2008)
Terminology
  • ~30% of nodular lymphocyte predominant Hodgkin lymphoma (NLPHL) cases diagnosed in the past were found to be LRCHL
  • Also known as follicular Hodgkin lymphoma (Am J Clin Pathol 2002;117:29)
Epidemiology
  • 5% of all classical Hodgkin lymphoma
  • Median age higher than in other subtypes of classical Hodgkin lymphoma (43 years)
  • Male predominance (M:F ~ 2:1)
Sites
  • Peripheral lymph nodes (typically), mediastinal (~15%) and bulky disease uncommon, lungs (4%), bones (3%), bone marrow (2%), liver (2%), Waldeyer's ring
Clinical features
  • Stage I or II at presentation in most cases (~70%)
  • B symptoms rare (~10%)
Treatment
  • Slightly better prognosis than other types of classical Hodgkin lymphoma (95% complete remission rate, 17% relapse rate)
  • Similar prognosis as NLPHL but relapses less frequently (Blood 2000;96:1889)
Microscopic (histologic) description
  • Two growth patterns: nodular (common) and diffuse (rare)
  • Attenuated T-zone; nodules composed of small lymphocytes, may have eccentric, small or regressed germinal centers; no eosinophils or neutrophils
  • Some of the HRS cells may resemble LP cells or mononuclear lacunar cells; easily confused with NLPHL
  • Rarely LRCHL typical nodules surrounded by fibrous bands; maybe classifying as nodular sclerosing classical Hodgkin lymphoma is more appropriate
  • Coexisting LRCHL and mixed cellularity classical Hodgkin lymphoma possible but rare
Microscopic (histologic) images

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Various images

Immunohistochemistry
  • Has classical Hodgkin lymphoma phenotype (CD15+, CD30+, fascin+); IgM+ D+ small lymphocytes in nodules (expanded mantle zones); CD21 highlights small eccentric intact germinal centers (infrequent in NLPHL); JunB+, EBV+ (more than nodular sclerosing but less than mixed cellularlity classical Hodgkin lymphoma)
Differential diagnosis