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Image Description

Immunophenotype: The nodules in nodular lymphocyte predominant Hodgkin lymphoma (NLPHL) are mostly composed of CD21+ follicular dendritic cell meshworks and small B lymphocytes that express CD20, CD22, CD23, and CD45RA (but not CD45RB). The proportion of B cells decreases over time.

The number of T lymphocytes is variable (scant to abundant) and increases as the lesions get older. T-cells can be especially numerous in recurrent/relapsed cases. The T-cells have the following immunophenotype: CD2+, CD3+, CD4+, PD1+, and CD57+. The T-cells surround LP cells forming rosettes or collarettes (see image). The background T-cells may occasionally show considerable atypia and mimic peripheral T-cell lymphoma.

This CD20 immunostain highlights the nodularity (Pattern A) in NLPHL. This architectural pattern is seen in about 75% of cases. Besides B cells and follicular dendritic cell meshwork, the nodules also contain reactive T cells, few epithelioid histiocytes, and scattered lymphocyte-predominant (LP) cells.

Image courtesy of Dr. Jean-Christophe Fournet, Paris, France; humpath.com; Used with permission

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