Department of Laboratory Medicine, Robert J. Tomsich Pathology and Laboratory Medicine Institute, Cleveland Clinic, Cleveland, OH.
Am J Surg Pathol. 2022 Aug 1;46(8):1078-1083. doi: 10.1097/PAS.0000000000001881. Epub 2022 Feb 24.
Establishing a diagnosis of nodular lymphocyte-predominant Hodgkin lymphoma (nLPHL) is often challenging as the differential diagnosis is broad, including classic Hodgkin lymphoma (cHL), progressive transformation of germinal centers (PTGC), and other lymphoproliferative disorders. In this study, we investigate the utility of a recently described ultrasensitive in situ hybridization assay for kappa and lambda immunoglobulin light chains in distinguishing nLPHL, cHL, and PTGC. A total of 72 cases were examined (21 nLPHL, 33 cHL, and 18 PTGC). In nLPHL, the large neoplastic cells were light chain restricted in 21/21 (100%) cases (16 kappa, 5 lambda). In contrast, Reed-Sternberg cells of cHL were negative for kappa and lambda in all cases (0/33, 0%; P <0.001). In PTGC, polytypic B cells were noted in mantle zones and germinal centers in all cases, with 1 case (5%) also showing focal collections of light chain restricted large B cells. Background monotypic small B cells were identified in 3 cases, including 1 nLPHL and 2 cHL (1 of which arose in chronic lymphocytic leukemia). Ultrasensitive in situ hybridization for kappa and lambda is a useful addition to a standard immunophenotyping panel for the evaluation of suspected nLPHL.
诊断结节性淋巴细胞为主型霍奇金淋巴瘤 (nLPHL) 常常具有挑战性，因为其鉴别诊断范围广泛，包括经典霍奇金淋巴瘤 (cHL)、生发中心进展性转化 (PTGC) 和其他淋巴增生性疾病。在这项研究中，我们研究了最近描述的用于区分 nLPHL、cHL 和 PTGC 的 κ 和 λ 免疫球蛋白轻链超灵敏原位杂交检测的效用。共检查了 72 例病例（21 例 nLPHL、33 例 cHL 和 18 例 PTGC）。在 nLPHL 中，21/21（100%）例的大型肿瘤细胞呈轻链限制（16 例 κ，5 例 λ）。相比之下，cHL 的 Reed-Sternberg 细胞在所有病例中均为 κ 和 λ 阴性（0/33，0%；P <0.001）。在 PTGC 中，所有病例均在套区和生发中心可见多克隆 B 细胞，1 例（5%）也显示出局灶性聚集的轻链限制的大 B 细胞。3 例（包括 1 例 nLPHL 和 2 例 cHL）中发现了背景单克隆小 B 细胞，其中 1 例源于慢性淋巴细胞白血病。κ 和 λ 的超灵敏原位杂交是评估疑似 nLPHL 的标准免疫表型分析的有用补充。
