engleski

Nodular Lymphocyte Predominant Hodgkin Lymphoma (NLPHL) - The Diagnostic Problem

NLPHL represents 5% of all HL. Compared with CHL, NLPHL shows a slightly older median age at presentation (med. 37), male predominance and localized peripheral lymphadenopathy with less mediastinal involvement (<15%). Neoplastic LP (L&H or “popcorn”) cells of GCB origin express B-cell associated antigens, are embedded in background of progressively transformed follicles which contain FDC networks, small B and T lymphocytes many of which are CD4+/CD57+ that surround LP cells. Aim: Because NLPHL shares morphologic and immunophenotypic characteristics with THRLBCL, CHL, DLBCL, ALCL and PTGC we analyze the possibility to diagnose NLPHL in lymph node (LN) aspirates. Patients and methods: In period 2005–2009, 11 patients with NLPHL were diagnosed in LN biopsies samples, using following markers CD20, CD3, CD4, CD8, CD21, CD30, CD15, CD57, CD68, EBV-LMP, TIA-1, PAX5, EMA, ALK. The LN aspiration biopsy was performed in all patients as first morphological approach and following markers CD20, CD3, CD30, CD15, EMA, ALK were used. Results: The cytology diagnoses were: HL (1/11) ; CHL (1/11), LN biopsy diagnosis on previously extirpated, another LN was reactive hyperplasia ; HL, ALCL? (1/11) ; NHL pleomorphic type, ALCL? (1/11) ; NHL (3/11) ; NHL MALT (1/11) ; granulomatous lesion, NHL? (1/11) ; bad preserved neoplastic cells, origin? (1/11) ; lymph node reactive hyperplasia with some atypical, reticular cells (1/11). Conclusion: The diversity of differential diagnoses indicates the NLPHL as a diagnostic problem. The immunophenotype of small lymphocytes in lymph node smears was not determinate. Also the clonal IgH rearrangements are usually not detectable in whole tissue DNA with flow cytometry and PCR, although NLPHL is a monoclonal B-cell neoplasm. To confirm NLPHL diagnosis the clonal IgH rearrangements are detectable only in the DNA of isolated single LP cells by microdissection.

NLPHL; CHL

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