NLPHL vs LRCHL
Lymphocyte-rich Classic Hodgkin Lymphoma (LRCHL): Lymphocyte-rich classic Hodgkin lymphoma (LRCHL) can closely mimic nodular lymphocyte-predominant Hodgkin lymphoma (NLPHL). LRCHL tends to occur in older patients as compared to NLPHL. LRCHL shows regressed germinal centers, whereas NLPHL has expanded macrofollicles. In LRCHL, there are classic HRS cells that are CD30+, CD15+, CD45-, CD20+/-, EMA-, and EBV+ (40-50% of cases). Immunostains for fascin and JUNB are highly sensitive and specific for LRCHL. They are negative in NLPHL. This image of NLPHL shows several LP cells with complex, multilobated nuclei (popcorn cells) in a background of small lymphocytes. They have one or more basophilic nucleoli and scant cytoplasm. A few scattered epithelioid histiocytes are also present.