Histopathological growth patterns in patients with advanced nodular lymphocyte‐predominant Hodgkin lymphoma treated within the randomized HD18 study: a report from the German Hodgkin Study Group

Eichenauer, Dennis A.; Bühnen, Ina; Kreissl, Stefanie; Goergen, Helen; Fuchs, Michael; Tresckow, Bastian von; Rosenwald, Andreas; Klapper, Wolfram; Hansmann, Martin‐Leo; Möller, Peter; Bernd, Heinz‐Wolfram; Feller, Alfred C.; Engert, Andreas; Borchmann, Peter; Hartmann, Sven

doi:10.1111/bjh.17770

Cited by 4 publications

(7 citation statements)

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“…In addition, we confirmed the previous observation that variant growth patterns are more prevalent in patients with advanced-stage disease. [3][4][5]15 In more detail, a gradual increase in clinical stage was observed from patterns A/B through pattern C to patterns D/E. Due to the lack of patients with pure pattern F, no information on this pattern could be obtained in the present analysis.…”

Section: Discussionmentioning

confidence: 77%

Tumour cell characteristics and microenvironment composition correspond to clinical presentation in newly diagnosed nodular lymphocyte‐predominant Hodgkin lymphoma

et al. 2022

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Summary Different studies have characterized the microenvironment and its prognostic impact in classic Hodgkin lymphoma whereas such analyses are pending for nodular lymphocyte‐predominant Hodgkin lymphoma (NLPHL). We thus investigated characteristics of tumour cells and microenvironment in NLPHL and evaluated possible correlations with the clinical presentation. Lymph node samples from 152 NLPHL patients who had first‐line treatment within the randomized German Hodgkin Study Group HD16–HD18 trials were available and analysed with regard to IgD status and nuclear size of the tumour cells as well as presence of PD1‐positive follicular T helper cells and CD163‐positive macrophages in the microenvironment. While large tumour cell nuclei and high numbers of PD1‐positive follicular T helper cells in the microenvironment were more common in patients presenting with early/intermediate stages than in patients with advanced‐stage disease (p < 0.0001, unpaired t‐test; p = 0.0022, Mann–Whitney test), no differences between risk groups were observed in terms of the IgD status of the tumour cells and the content of CD163‐positive macrophages in the microenvironment. PD1‐positive follicular T helper cells were present in both cases with typical and variant growth patterns and rosetting around the tumour cells was observed in 96% of patients, indicating an important role of PD1‐positive follicular T helper cells in NLPHL.

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Section: Discussionmentioning

confidence: 77%

Tumour cell characteristics and microenvironment composition correspond to clinical presentation in newly diagnosed nodular lymphocyte‐predominant Hodgkin lymphoma

et al. 2022

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“…It should also be noted that the differences in outcomes between patients with typical histological pattern and variant histological pattern can be overcome by treatment with more intense regimens. The recent study from the GHSG on patients treated using positron emission tomography after two cycles of chemotherapy-guided escalated BEACOPP regimen (bleomycin, etoposide, doxorubicin, cyclophosphamide, vincristine, procarbazine, prednisone; HD18 study) showed that the differences in disease biology between typical and variant patterns can be overcome by intensified treatment regimens 20…”

Section: Discussionmentioning

confidence: 99%

Variant histology in nodular lymphocyte predominant Hodgkin lymphoma in an adult population: disease investigations and characteristics from a retrospective cohort

2022

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A subset of variant histological patterns of nodular lymphocyte-predominant Hodgkin lymphoma (NLPHL) has been associated with advanced disease stage and increased recurrence risk. Histopathology reports on core needle (CNB) and/or surgical excision biopsies (SEB) for 33 adult patients with NLPHL were examined for variant histology prevalence and association with disease stage and clinical outcome. Variant histological pattern was present in 13/33 patients (39%). Obtained tissue was inadequate for diagnosis in 1/23 (4.3%) cases of CNB. Variant histology was associated with stage IV disease at presentation (p<0.001). While SEB should be the procedure of choice in workup of patients for a diagnosis of NLPHL, CNB is an alternate option when SEB is contraindicated or difficult to undertake. Diagnostic reports should specifically note presence of variant histological patterns. Although late-stage disease was associated with progression or recurrence, overall prognosis is excellent for patients with NLPHL.

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“…In the setting of advanced-stage presentation, evidence show that these patients may be adequately treated with R-CHOP18 regimens rather than ABVD, as some patients treated with ABVD or ABVD-like regimens may display high lymphoma recurrence rate 19. Nevertheless, recent studies showed that advanced-stage presentation of NLPHL may be mitigated by escalated BEACOPP (bleomycin, etoposide, doxorubicin, cyclophosphamide, vincristine, procarbazine, prednisone), guided by interim positron emission tomography after 2 cycles of chemotherapy 3…”

Section: Discussionmentioning

confidence: 99%

“…Four patterns, designated C-F, have been associated with a poorer prognosis in some studies, 2 although this difference in survival can be obliterated by using highly effective chemotherapy. 3 Immunohistochemical studies demonstrate that LP cells have a well-developed B-cell immunophenotype, positive for CD20, CD45, CD79a, and OCT2, and usually negative for typical CHL markers such as CD15 and CD30. 1 It is recognized that a subset of NLPHL cases and CHL can closely resemble each other morphologically, requiring immunophenotypic analysis to distinguish between these 2 entities.…”

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confidence: 99%

“…Two patterns, designated A and B, are considered typical patterns. Four patterns, designated C–F, have been associated with a poorer prognosis in some studies,2 although this difference in survival can be obliterated by using highly effective chemotherapy 3. Immunohistochemical studies demonstrate that LP cells have a well-developed B-cell immunophenotype, positive for CD20, CD45, CD79a, and OCT2, and usually negative for typical CHL markers such as CD15 and CD30 1…”

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Nodular Lymphocyte–predominant Hodgkin Lymphoma With Nodular Sclerosis

Hussein

Wang

Fang

et al. 2022

American Journal of Surgical Pathology

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Nodular lymphocyte–predominant Hodgkin lymphoma (NLPHL) with unusual features, including some that can overlap morphologically with classic Hodgkin lymphoma (CHL), have been described. Herein, we describe 12 cases of NLPHL with fibrous bands and capsular fibrosis resembling, in part, nodular sclerosis (NS) CHL. Seven of 12 cases harbored Reed-Sternberg–like cells, further suggestive of CHL, but all cases lacked associated eosinophils and/or plasma cells in the background. In this cohort, all cases had areas of so-called pattern D (nodular T-cell rich) as a sole component in 7 (58%) cases or as a hybrid pattern along with pattern E (diffuse T-cell/histiocyte-rich) in 5 (42%) cases. The immunophenotype of the large neoplastic cells in these cases supported their being lymphocyte predominant cells of NLPHL, positive for CD20, CD79a, and OCT2, and negative for CD15 and CD30. However, PAX5 was weak in 9 of 11 cases similar to Hodgkin/Reed-Sternberg cells in CHL. We conclude that some cases of NLPHL are associated with fibrous bands and capsular fibrosis and resemble, in part, NS CHL. In our experience, NLPHL with NS-like features occurs in 10% to 15% of cases of NLPHL and is associated with a variant pattern (D and/or E). In addition, all patients in this cohort were not treated before biopsy, suggesting that the prominent sclerosis in these cases is inherent to disease biology. Recognition of NLPHL with NS-like features further expands the morphologic spectrum of NLPHL and helps avoid potential misdiagnosis as CHL.

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Histopathological growth patterns in patients with advanced nodular lymphocyte‐predominant Hodgkin lymphoma treated within the randomized HD18 study: a report from the German Hodgkin Study Group

Cited by 4 publications

References 14 publications

Tumour cell characteristics and microenvironment composition correspond to clinical presentation in newly diagnosed nodular lymphocyte‐predominant Hodgkin lymphoma

Tumour cell characteristics and microenvironment composition correspond to clinical presentation in newly diagnosed nodular lymphocyte‐predominant Hodgkin lymphoma

Variant histology in nodular lymphocyte predominant Hodgkin lymphoma in an adult population: disease investigations and characteristics from a retrospective cohort

Nodular Lymphocyte–predominant Hodgkin Lymphoma With Nodular Sclerosis

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