Lymphoma and plasma cell neoplasms
Hodgkin lymphoma
Nodular lymphocyte predominant

Author: Lauren B. Smith, M.D. (see Authors page)

Revised: 16 March 2017, last major update July 2010

Copyright: (c) 2002-2017, PathologyOutlines.com, Inc.

PubMed Search: Nodular lymphocyte predominant [tite] Hodgkin Lymphoma

Cite this page: Nodular lymphocyte predominant. PathologyOutlines.com website. http://pathologyoutlines.com/topic/lymphomanonBNLPHL.html. Accessed July 24th, 2017.
Definition / general
  • Uncommon variant of Hodgkin lymphoma (HL) with indolent behavior, characterized by total replacement of nodal architecture by expansive vague nodules of small lymphocytes with sparse, relatively large LP tumor cells; may have follicular B cell origin
  • References: Oncologist 2009;14:739
Epidemiology
  • More common in young men; 5% of all Hodgkin lymphoma cases
Sites
  • Peripheral lymph nodes generally
Etiology
  • A distinct entity from classic Hodgkin lymphoma (Clin Lymphoma Myeloma 2009;9:206)
  • L&H cells may have follicular B cell origin, as they have identical IgH gene rearrangements and have Vh segments with somatic hypermutation, seen in follicular B cells (J Exp Med 2008;205:2251)
Clinical features
  • Indolent behavior but higher recurrence rate than classical Hodgkin lymphoma
  • Usually nodular; existence of diffuse subtype is controversial
  • Usually young men with cervical or axillary adenopathy; rarely mediastinal or bone marrow involvement (Am J Surg Pathol 2004;28:489); often long history of localized disease
  • Usually stage I / II, excellent prognosis (10 year survival of 80 - 90%)
  • Frequently recurs (Cancer 2010;116:631)
  • May be associated with progressive transformation of germinal centers (large germinal centers with infiltration by small lymphocytes, Am J Surg Pathol 1984;8:253)
  • 3 - 5% transform to diffuse large B cell lymphoma and tumor cells in each may be clonally related (Am J Clin Pathol 2001;116:506)
  • IgD+ cases (27% frequency) compared to IgD- cases are associated with a younger median age (21 vs. 44 years), male predominance (M/F of 23:1 vs. 1.5:1) and frequent cervical lymph node involvement (56% vs. 18%, Am J Surg Pathol 2006;30:585)
Prognostic factors
Case reports
Treatment
  • Recent approaches have included more conservative therapy such as localized radiation therapy, excision or observation
  • Treatment related morbidity and mortality are common with aggressive therapy
  • Rituximab may be useful for relapses / refractory cases (Blood 2008;111:109)
Microscopic (histologic) description
  • Usually total replacement of nodal architecture by expansive vague nodules of small lymphocytes with sparse, relatively large tumor cells with multilobulated or round nucleus, thin nuclear membrane, finely granular chromatin and variable small nucleoli
  • The large cells are called LP cells (previously known as popcorn cells or L&H (lymphocytic & histiocytic) cells
  • LP cells are admixed with numerous small B lymphocytes, epithelioid histiocytes and CD21+ dendritic reticulum cells
  • Postcapillary venules may be prominent
  • Often T cell rosettes surrounding LP cells (Am J Surg Pathol 2008;32:1252)
  • May have rim of normal lymph node
  • Scant eosinophils, plasma cells or fibrosis
  • Prominent sclerosis is unusual but may occur in older lesions
  • Small germinal centers are rare between the nodules and usually present only at the compressed edge of normal lymph node tissue
  • No / rare classic Reed-Sternberg (RS) cells, although LP cells may occasionally resemble R-S cells / variants
  • No well formed granulomas, although epithelioid histiocytes may be prominent
  • Diffuse cases have background of reactive T cells
  • Syncytial variant is rare (Am J Surg Pathol 2009;33:1725)

Patterns (usually mixed):
  • Classic B cell rich nodular, serpiginous / interconnected nodular, nodular with prominent LP cells, T cell rich nodular, diffuse with T cell rich background and diffuse (moth eaten) B cell rich (Am J Surg Pathol 2003;27:1346)

Bone marrow involvement:
  • 3% of cases; involvement by large B cells (< 10% of all cases) in background of T cells and histiocytes
  • Microscopic (histologic) images

    Scroll to see all images:


    Images hosted on PathOut server:

    LP cells

    Large numbers of LP cells

    LP cells resemble RS cell

    Background has
    small lymphocytes
    and epithelioid
    histiocytes

    Wreath of
    epithelioid histiocytes
    surrounds
    the nodule

    3 LP cells with
    highly irregular nuclear;
    contours in a background
    of small lymphocytes

    Nodules are larger than in follicular lymphoma

    Diffuse scattering of LP cellswith vague nodular pattern

    Only rare Hodgkin
    cells are identified;
    most of infiltrate is
    small round lymphocytes

    Transition to diffuse
    large cell lymphoma, with
    sheets of LP cells in
    internodular areas

    Nodular LP HL and large cell lymphoma

    Nodular LP HL and classic interfollicular HL

    Submandibular mass


    CD20+

    CD30


    CD45RB+; #2-CD45 / LCA

    CD57+ cells form a wreath around the LP cells

    CD3 (low and high power)

    CD21



    Images contributed by Dr. Lauren B. Smith, University of Michigan (USA):

    Low power

    LP cell

    CD20



    Images hosted on other servers:

    Axillary lymph node

    LP cells

    Various immunostains

    Low power


    RS vs. LP cells

    Nodular pattern and LP cells

    Various images


    T cell / histiocyte rich nodules

    CD20+

    Positive stains
    LP cells:
    Background cells:
    Negative stains
    Molecular / cytogenetics description
    Differential diagnosis