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NLPHL : Diffuse Pattern

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Nodular lymphocyte-predominant Hodgkin lymphoma (NLPHL): This image shows Pattern E - a rare pattern described by Fan et al (See Reference). By definition, there is lack of nodules (morphologically and with CD21 immunostain). It consists of a completely diffuse growth pattern, a background rich in reactive T-cells (CD4+, CD57+, forming T-cell rosettes around LP cells), few small reactive B-cells, and scattered LP cells.

It resembles T-cell/histiocyte-rich Large B-cell Lymphoma (THRLBCL). If CD57+ cells cannot be demonstrated, the diagnosis of THRLBCL should be considered.

Reference:
Fan Z, Natkunam Y, Bair E, et al. Characterization of variant patterns of nodular lymphocyte predominant Hodgkin lymphoma with immunohistologic and clinical correlation. Am J Surg Pathol 2003; 27:1346-56.

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