Nguyen P L, Ferry J A, Harris N L
Department of Pathology, Massachusetts General Hospital and Harvard Medical School, Boston, USA.
Am J Surg Pathol. 1999 Jan;23(1):27-33. doi: 10.1097/00000478-199901000-00003.
To determine whether there might be immunophenotypic differences between nodular lymphocyte predominance Hodgkin's disease (NLPHD) and progressive transformation of germinal centers (PTGC) to aid in the differential diagnosis, we compared 16 cases of NLPHD with 13 cases of florid PTGC and 2 cases of focal PTGC. Paraffin-section immunohistochemistry was performed for CD20, CD45RA, CD45RO, CD3, CD43, CD57, EMA, CD30, and CD21. All PTGC cases showed well-circumscribed nodules of confluent sheets of CD20+ CD45RA+ small cells. T cells were scattered singly or in small groups. In 5 patients with florid PTGC, the T cells in some of the nodules formed rings around a few large transformed lymphocytes. In contrast, the nodules in all NLPHD cases showed an irregular, "broken-up" pattern with CD20 and CD45RA, and there were prominent T cell rosettes around the CD20+ large cells in all nodules. Rosettes of CD57+ cells and staining of large cells for EMA were seen in 3 and 2 cases of NLPHD, respectively, but not in PTGC. There were no differences between NLPHD and PTGC with respect to staining for CD30 or CD21. Three of the eight patients with florid PTGC and a few T cell rosettes had had persistent or recurrent lymphadenopathy; NLPHD developed in 1 of these patients 13 years later. We conclude that a combination of pan-B and pan-T antigens can be a useful adjunct to morphology in distinguishing NLPHD from PTGC. In approximately one-third of florid PTGC cases, T cell rosettes may be present, but they are notably fewer than those in NLPHD. Close follow-up of such patients may be appropriate.
为了确定结节性淋巴细胞为主型霍奇金淋巴瘤（NLPHD）与生发中心进行性转化（PTGC）之间是否存在免疫表型差异以辅助鉴别诊断，我们将16例NLPHD与13例典型PTGC及2例局灶性PTGC进行了比较。对石蜡切片进行CD20、CD45RA、CD45RO、CD3、CD43、CD57、EMA、CD30和CD21的免疫组织化学检测。所有PTGC病例均显示CD20+CD45RA+小细胞融合成片的边界清晰的结节。T细胞单个或成小群散在分布。在5例典型PTGC患者中，部分结节中的T细胞围绕少数大的转化淋巴细胞形成环状。相比之下，所有NLPHD病例的结节在CD20和CD45RA方面呈现不规则的“破碎”模式，并且所有结节中CD20+大细胞周围均有明显的T细胞花环。分别在3例和2例NLPHD病例中观察到CD57+细胞花环和大细胞EMA染色，但PTGC中未观察到。NLPHD和PTGC在CD30或CD21染色方面无差异。8例典型PTGC且有一些T细胞花环的患者中有3例曾有持续性或复发性淋巴结病；其中1例患者在13年后发生了NLPHD。我们得出结论，全B和全T抗原联合检测在区分NLPHD与PTGC时可作为形态学的有用辅助手段。在大约三分之一的典型PTGC病例中可能存在T细胞花环，但明显少于NLPHD中的T细胞花环。对此类患者进行密切随访可能是合适的。
