Lymphocyte-rich Hodgkin Lymphoma
Lymphocyte-rich classic Hodgkin lymphoma (cHL) makes up about 5% of all cHL cases. It presents with stage I or II disease in 70% of cases. There is usually no bulky mediastinal disease or B symptoms. It is associated with EBV in about 40% of cases and has an excellent prognosis. Morphologically, lymphocyte rich cHL resembles nodular lymphocyte predominant Hodgkin lymphoma due to abundant lymphocytes and nodular architecture. The histologic hallmark is small number of Hodgkin and Reed-Sternberg (HRS) cells with classic immunophenotype in mantle and marginal zones of residual lymphoid follicles. The background small lymphocytes are mostly B cells in contrast to other classic Hodgkin lymphoma subtypes that show T cells. At low magnification, the involved lymph nodes show nodular pattern (most frequent; shown here) or a diffuse growth pattern (uncommon).