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VOLUME 1 | ISSUE 1 | FIRST QUARTER ISSUE | 2008

Morphologic, immunphenotypic and clinical discriminators between T-cell/histiocyte- rich large B-cell lymphoma and lymphocyte- predominant Hodgkin lymphoma

Walid A. Mourad,a Sheikha Al Thani,a Abdelghani Tbakhi,a Mohamed Al Omari,a Yasser Khafaga,b Mohamed Shoukri,c Amr El Weshi,b Mohamed Al Shabana,b Adnan Ezzatb

 aDepartments of Pathology and Laboratory Medicine, bCancer Center and cBiostatistics, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia

How to cite this article:

Mourad WA, Al Thani S, Tbakhi A, Al Omari M, Khafaga Y, Shoukri M, El Weshi A, Al Shabana M, Ezzat A. Morphologic, immunphenotypic and clinical discriminators between T-cell/histiocyte- rich large B-cell lymphoma and lymphocyte- predominant Hodgkin lymphoma. Hematol Oncol Stem Cell Ther 2008; 1(1): 22-27.

 

Abstract

BACKGROUND: Features of T-cell/histiocyte rich large B-cell lymphoma (THRLBCL) overlap with those of lymphocyte predominant Hodgkin lymphoma (LPHL). The two lymphomas may represent a spectrum of the same disease, and differentiation between the two can sometimes be difficult. We looked at histomorphologic, immunophenotypic and clinical information that may help differentiate the two entities.


METHODS: Cases of THRLBCL and LPHL were blindly reviewed and studied for histological pattern (nodular vs. diffuse), nuclear features and pattern of expression of CD20, CD30, CD57, epithelial membrane antigen (EMA) and Epstein-Barr virus (EBV). A score encompassing diffuse histology, high nuclear grade, CD20 single-cell pattern, CD30+, CD57-, EMA-, and EBV+ was estimated for the diagnosis of TCHRLBCL.


RESULTS: There were 58 cases, including 30 cases of TCHRLBL and 28 cases of LPHL. The median age was 36 years for TCHRLBCL and 21 years for LPHL (P=0.0001). Three types of nuclei were identified (lymphocytic/histocytic, Reed-Sternberg and centroblast-like). The latter two high-grade nuclei were suggestive of TCHRLBCL. TCHRLBCL and LPHL, respectively, showed diffuse histology, 90% vs. 4% (P=0.001), single CD20+ cells, 93% vs. 3.5% (P=0.00004), CD30+ cells, 30% vs. 0% (P=0.01), CD57+ cells, 41% vs. 93% (P=0.008), EMA+ cells, 27% vs. 60% (P=0.113), EBV+ cells, 24% vs. 0% (P=0.117), high nuclear grade, 70% vs. 0% (P=0.001), total score 2-7 (mean 4.68) vs. 0-2 (mean 0.72) (P=0.001), high stage, 86% vs. 7% (P=0.0001).


CONCLUSION: Our findings indicate that a combination of multiple parameters can help differentiate between the two diseases. Two cases originally diagnosed as LPHL were re-assigned the diagnosis of THRLBCL.