Nodular lymphocyte predominant Hodgkin lymphoma with T-cell/histiocyte - rich large B-cell lymphoma pathohistological characteristics and extranodal presentation: Case report and literature review

Nodular lymphocyte predominant Hodgkin lymphoma appears in 5% of Hodgkin lymphoma. Because of major biological and clinical differences with classical Hodgkin lymphoma and close relationship to T-cell/histiocyte-rich large B-cell lymphoma, lately the term nodular lymphocyte predominant B-cell lymphoma is accepted. The presence of lymphocyte predominant cells with preserved B-cell phenotype and a lack of CD30 is the prerequisite for the diagnosis of nodular lymphocyte predominant Hodgkin lymphoma. Lymphocyte predominant cells are typically embedded in large nodules of B lymphocytes (growth patterns A and B), but variants that are characterized by lymphocyte predominant cells located outside the nodules, a Tcell- rich nodular growth pattern and T-cell-rich or B-cell-rich diffuse growth patterns, respectively, have also been described (growth patterns C, D, E, and F). Variant growth patterns are associated with the recurrence and progression of disease and should be recognized and specified in pathology reports. Broad B-cell immunohistochemical panel, including PAX5, CD79a, Bob.1, and Oct-2 is indicated in these cases to distinguish between nodular lymphocyte predominant Hodgkin lymphoma, classical Hodgkin lymphoma and T-cell/histiocyte-rich large B-cell lymphoma, which have significant differences in clinical behavior and treatment. There are different treatment approaches in patients with nodular lymphocyte predominant Hodgkin lymphoma depending on pathohistological type, clinical presentation and stage of the disease. Treatment may include active surveillance, radiation therapy, immunotherapy or chemotherapy. A multidisciplinary approach is beneficial to optimize the diagnosis and management of patients with nodular lymphocyte predominant Hodgkin lymphoma.