EBV may be expressed in the LP cells of nodular lymphocyte predominant Hodgkin lymphoma (NLPHL) in both children and adults

摘要

Nodular lymphocyte predominant Hodgkin lymphoma (NLPHL) and classical Hodgkin lymphoma (CHL) are classified separately because of their distinct clinical and pathological features. While EBV is detected in the neoplastic cells of 25-70% of CHL, NLPHL is generally considered to be EBV-negative. We assessed EBV status in 302 pediatric and adult cases of NLPHL. A total of 145 pediatric (age ≤18) and 157 adult cases of NLPHL were retrieved from 3 North American centers and tested for EBV by in situ hybridization (EBER). Clinical and pathological features were analyzed. Five (3.4%) pediatric and 7 (4.5%) adult NLPHL cases contained EBV-positive LP cells. While all 12 cases met criteria for the diagnosis of NLPHL, atypical features were present, including capsular fibrosis, atrophic germinal centers and pleomorphic or atypical lymphocyte predominant (LP) cells. Both CD20 and OCT-2 expression were strong and diffuse in all except one case. However, PAX5 and CD79a were weak and/or variable in 7/8 and 6/6 cases tested, respectively. EBV-positive cases were more likely to be CD30-positive (75%) than EBV-negative cases (25%) (p=0.0007); CD15 was negative in all cases. Our results show that EBV-positive LP cells may occur in NLPHL. Distinguishing EBV+ NLPHL from CHL can be challenging, since EBV+ NLPHL can have partial expression of CD30 and weak PAX5 staining as well as pleomorphic-appearing LP cells. However, the overall appearance and maintenance of B-cell phenotype, with strong and diffuse CD20 and OCT-2 expression, support the diagnosis of NLPHL in these cases.