Hodgkin lymphoma Flashcards
What are the background lymphocytes in
CHL NS and Mixed Cellularity vs.
CHL Lymphocyte rich ?
- Nodular sclerosis and mixed cellularity
- CD4+ T cells
- Lymphocyte rich
- small B cells
What are the typical flow cytometric findings
in Classic Hodgkin Lymphoma ?
- flow is usually negative
- increased CD4:CD8 ratio
- the background reactive T cells have a distinct phenotype
- CD3/CD4/CD7(bright)/CD45(bright) +
- this can also be seen in T cell histiocyte rich large B, but not in NLPHL
What is one strategy that can be employed
when evaluating for Hodgkin-RS cells by
flow cytometry?
- side scatter high
- positive for CD30, CD40 and CD95
- negative to dim for CD20
What is the definition of a Hodgkin cell
(mononuclear R-S cell) ?
- large, ovoid to round
- vesicular nucleus
- prominent nucleolus
What is the definition of a Lacunar cells variant ?
- frequently seen in NS HL
- abundant lightly acidophilic or water-clear cytoplasm
- lobulated nucleus
- small nucleolus
- shrinkage of cytoplasm (due to fixation)
What is the definition of a mummified cell variant ?
- degenerated or apoptotic cell with dark cytoplasm and piknotic nucleus
What is the definition of an anaplastic variant ?
- common in lymphocyte depleted CHL
- highly pleomorphic, large, hyperchromatic
- bizarre polyploidy nucleus with prominent nucleolus
Lymphocyte depleted CHL has a predilection
for what sites of involvement ?
- abdominal organs and retroperitoneal lymph nodes
- more frequently occurs in elderly patients
What is an independent risk factor for relapse in
NLPHL ?
- Focally diffuse pattern
- TCHRLBCL-like pattern
- independent risk factor of disease relapse if that is present
How do LP cells differ morphologically
from RS cells ?
- LP cells are smaller in size, have less pronounced lobation, less prominent nucleoli, and scantier cytoplasm
- The background is predominantly small B lymphocytes with scattered T follicular helper cells (TFH)
- (+) for CD3, CD4, CD57, and PD-1
- form characteristic rosettes
- Occasional clusters of epithelioid histiocytes are present
- Neutrophils and eosinophils are rare
When can prominent sclerosis be
seen in NLPHL ?
- it’s often seen during recurrent disease
- 20% of cases
- also occasional cases can have prominent neutrophils and mimic the syncitial variant of CHL NS type
- just be aware and be careful
Extranodal and bone marrow involvement by
NLPHL is thought to represent what ?
- it’s rare to see involvement by just regular NLPHL in extranodal and bone marrow sites
- usually represents progression of the disease to a large B cell lymphoma
- TCHRLBCL likely
What background findings favor a diganosis
of TCHRLBCL vs. NLPHL ?
- absence of small B cells
- presence of CD8+ and TIA-1+ T cells
- all of these features favor TCHRLBCL
What are the typical flow cytometry findings in
NLPHL ?
- flow cytometry is usually negative
- see increased CD4:CD8 ratio
- increased proportion of CD57+ lymphocytes
- increased number of dual CD4/CD8+ T cells
- highest mean percentage of these cells compared to CHL and TCHRLBCL
