Nodular lymphocyte predominant


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  • Names

    • NLPHL
    • nodular lymphocyte predominant Hodgkin lymphoma

  • Clinical

    • 5% of Hodgkins
    • male, 30-50
    • site: nodes

  • Histology

    • nodular (one is sufficient) +/- diffuse component
    • small lymphocytes
    • scattered popcorn cells
    • T cells forming rosettes around popcorn cells

  • Stains

    • popcorn cells
      • positive: CD20, CD79a, CD75, BCL6, CD45
      • frequent: J chain, EMA (50%)
      • coexpression of OCT2, BOB1 and AID (in contrast to Reed Sternberg)
    • PD1/CD57+ T cell rosettes around popcorn cells
    • nodules: CD21 stains follicular dendritic meshwork

  • Molecular

    • clonal IG rearrangement

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    • Most consistent with nodular lymphocyte predominant Hodgkin lymphoma
    • Lymph node with architecture effaced by a nodular proliferation of lymphoid cells consisting of numerous small lymphocytes and scattered large, atypical neoplastic cells.
    • The neoplastic cells are frequently multinucleated, have vesicular chromatin, and variably prominent nucleoli.
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