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

Abstract

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.

Proposal of ‘reactive‐lymphocyte/histiocyte rich large B‐cell lymphoma’ as an alternate term for ‘nodular lymphocyte predominant Hodgkin lymphoma’ that would also address its overlap with T‐cell/histiocyte rich large B‐cell lymphoma

“…NLPHL can present with six growth patterns (Fan patterns, A-F) [4]. Typical NLPHL has a prominent nodular pattern and a predominant background of reactive small B-cells (patterns A and B; 60%-75% of cases) [4,5]. Rest has either a predominantly diffuse pattern and/or marked depletion of small reactive B-cells along with predominance of small reactive T-cells (variant patterns C-F).…”