Nodular Lymphocyte Predominant Hodgkin Lymphoma versus T-Cell/Histiocyte-Rich Large B-Cell Lymphoma: A Diagnostic Challenge

Table 1

Diagnostic features of NLPHL, THRLBCL, and our case.

Criterion	NLPHL	TCHRLBCL	Our case
Clinical features
Age	Any, most commonly between 30 and 50 years old	Middle age	39 years old
Gender predilection	Strong male predominance	Male predominance	Female
Presentation	Solitary peripheral lymphadenopathy	Advanced disease with lymphadenopathy, liver, spleen, and bone marrow involvement	Widespread peripheral lymphadenopathy with possible splenic, hepatic, and bone marrow involvement
Neoplastic cells
Distribution	Nodular or diffuse and nodular	Diffuse; vague nodularity is rare	Diffuse and vaguely nodular
Bcl-6 expression	Present	Less common	Present
IRF4/MUM1 expression	Absent	May be present	Not performed
IgD expression	Present in approximately 1/3 cases	Absent	Absent
Average number of genomic imbalances	10.8	4.7	Not performed
Background cells
Predominant lymphocyte population	B-cells	T-cells	T-cells
B lymphocytes distribution	Nodules	Nodules are absent	Vague nodules
CD4+ T lymphocytes	More prominent	Less prominent	Prominent
CD4+ versus CD8+ T lymphocytes	Mostly CD4+	Mostly CD8+	Mostly CD4+
Follicular center T lymphocytes (CD4+/CD57+/PD1+)	Present	Rare	Present
Follicular dendritic cell meshwork	Present	Absent	Present
PD1+ T lymphocyte rosettes around neoplastic cells	Present, may be absent in THRLBC-like variant	Absent	Occasional rosettes are present