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Clinical Trial
. 2018 Jan;65(1):10.1002/pbc.26753.
doi: 10.1002/pbc.26753. Epub 2017 Aug 12.

Variant histology, IgD and CD30 expression in low-risk pediatric nodular lymphocyte predominant Hodgkin lymphoma: A report from the Children's Oncology Group

Ramona Vesna Untanu  1 , Jason Back  1   2 , Burton Appel  3 , Qinglin Pei  4 , Lu Chen  5 , Allen Buxton  6 , David C Hodgson  7 , Peter F Ehrlich  8 , Louis S Constine  9 , Cindy L Schwartz  10 , Robert E Hutchison  1
Affiliations
Clinical Trial

Variant histology, IgD and CD30 expression in low-risk pediatric nodular lymphocyte predominant Hodgkin lymphoma: A report from the Children's Oncology Group

Ramona Vesna Untanu et al. Pediatr Blood Cancer. 2018 Jan.

Abstract

Background: Histologic prognostic factors have been described for nodular lymphocyte predominant Hodgkin lymphoma (NLPHL). This study examines histologic and immunophenotypic variants in a clinical trial for pediatric NLPHL.

Procedure: One hundred sixty-eight cases of localized NLPHL were examined for histologic variants, CD30 and immunoglobulin D (IgD) expression, and outcome. Histologic types were scored categorically as 0 = 0, 1 ≤ 25%, and 2 > 25% of the sample.

Results: Fifty-eight (35.1%) cases showed only typical nodular with or without serpiginous histology (types A and B). The remainder showed mixtures of histologies. The numbers of patients with score 2 are 85 (50.6%) type A, 21 (12.5%) type B, 46 (27.4%) with extranodular large B cells (type C), 3 with T-cell-rich nodular pattern (type D), 55 (32.7%) with diffuse T-cell-rich (type E) pattern, and 2 (1.2%) with diffuse B-cell pattern (type F). Higher level of types C (P = 0.048) and D (P = 0.033) resulted in lower event-free survival (EFS). Cytoplasmic IgD was found in 65 of 130 tested (50%), did not significantly associate with EFS but positively correlated with types C and E histology (P < 0.0001) and negatively correlated with types A (P = 0.0003) and B (P = 0.006). Seventeen (10%) expressed CD30, with no adverse effect.

Conclusions: Variant histology is common in pediatric NLPHL, especially types C and E, which are associated with IgD expression. Type C variant histology and possibly type D are associated with decreased EFS, but neither IgD nor CD30 are adverse features. Variant histology may warrant increased surveillance, but did not affect overall survival.

Keywords: Hodgkin; children; histology; lymphoma; pathology.

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Conflict of interest statement

CONFLICT OF INTEREST

The authors declare that there is no conflict of interest.

Figures

FIGURE 1
FIGURE 1
Histology and immunophenotype of typical nodular lymphocyte predominant Hodgkin lymphoma. (A) Scattered large LP cells are present, along with a few histiocytes, in a nodule of small B cells in typical NLPHL. The inset shows B-cell marker CD20 antibody labeling both small and large cells. (B) Small T cells labeled with anti-CD3 (illustrated here) and often CD57 form rosettes around the LP cells. (C) Nodules of small lymphocytes with admixed LP cells and histiocytes in typical type A histology. (D) CD20 shows the B-cell nature of nodules. (E) Some cases show a serpiginous growth pattern in type B NLPHL. (F) CD20 labels both small B cells and LP cells in serpiginous areas of type B NLPHL
FIGURE 2
FIGURE 2
Examples of variant histology. (A) Fan type C histology shows large cells labeling with anti-CD20 in extranodular areas. (B) Small lymphocytes in nodules of this case label with anti-CD3, identifying type D NLPHL. (C) CD20 highlights LP cells in the CD20-negative T-cell background of nodules in type D. (D) This hematoxylin and eosin (H&E) stain shows an apparently diffuse infiltrate in a case with type E morphology. (E) This case has >25% with diffuse small lymphocytes labeling with anti-CD20 as diffuse B-cell type D. This case is not as “moth-eaten” as usually described. (F) This case labeled with anti-CD20 shows type C with increased extranodular large B cells, merging into a diffuse type E pattern
FIGURE 3
FIGURE 3
Survival curves. Kaplan–Meier survival curves for each histologic variant A–F show categorical scores of 0, 1, and 2, with significant differences seen in type C with extranodular LP cells and type D, nodular T-cell-rich type, each showing decreased EFS with category 2
FIGURE 4
FIGURE 4
(A) Extranodular LP cells show cytoplasmic IgD staining in a background of small T cells in this case that includes score 2 types C and E, along with score 1 type A; (B) LP cells labels with anti-CD30
FIGURE 5
FIGURE 5
Categorical scores for each histologic type and for CD30 are compared for IgD expression. Note. Cytoplasmic IgD is negatively correlated with histologic types A (P = 0.0003) and B (P = 0.0059), and is positively correlated with types C and E (P < 0.0001).
FIGURE 6
FIGURE 6
Each combination of histologic type seen in the study is represented, with those containing A, B, C, and E being most common; other combinations are seen one to three times
See this image and copyright information in PMC

References

    1. Appel BE, Chen L, Buxton AB, et al. Minimal treatment of low-risk pediatric lymphocyte predominant Hodgkin lymphoma: a report from the Children’s Oncology Group. J Clin Oncol. 2016;34:2372–2379. - PMC - PubMed
    1. Swerdlow SH, Campo E, Harris NL, et al., editors. WHO Classification of Tumours of Haematopoietic and Lymphoid Tissues. IARC; Lyon: 2008.
    1. Anagnostopoulos I, Hansmann ML, Franssila K, et al. European Task Force on Lymphoma project on lymphocyte predominance Hodgkin disease: histologic and immunohistologic analysis of submitted cases reveals 2 types of Hodgkin disease with a nodular growth pattern and abundant lymphocytes. Blood. 2000;96(5):1889–1899. - PubMed
    1. Nicholas DS, Harris S, Wright DH. Lymphocyte predominance Hodgkin’s disease—an immunohistochemical study. Histopathology. 1990;16(2):157–165. - PubMed
    1. Poppema S, Delsol G, Pileri SA, et al. Nodular lymphocyte predominant Hodgkin lymphoma. In: Swerdlow SH, Campo E, Harris NL, et al., editors. WHO Classification of Tumours of Haematopoietic and Lymphoid Tissues. IARC; Lyon: 2008. pp. 323–325.

MeSH terms