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Lymphocyte predominant Hodgkin lymphoma, antigen‐driven after all?
Author(s) -
Poppema Sibrandes
Publication year - 2021
Publication title -
the journal of pathology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.964
H-Index - 184
eISSN - 1096-9896
pISSN - 0022-3417
DOI - 10.1002/path.5567
Subject(s) - lymphoma , germinal center , antigen , lymph node , biology , follicular lymphoma , immunology , immune system , marginal zone , b cell , pathology , medicine , antibody
Nodular lymphocyte predominant Hodgkin lymphoma (NLPHL) was suggested as an entity separate from other types of Hodgkin lymphoma 40 years ago and recognized in the WHO classification in 2001. Based on its relatively benign course with late distant relapses, relation with lymph node hyperplasia with progressively transformed germinal centers, presence of clonal immunoglobulin gene rearrangements with somatic hypermutations and ongoing mutations, and relation with a number of inherited defects affecting the immune system, it has been suspected that NLPHL might be antigen‐driven. Recent evidence has shown that cases of IgD‐positive NLPHL are associated with infection by Moraxella catarrhalis , a common bacterium in the upper respiratory tract and in lymph nodes. This review summarizes the evidence for NLPHL as a B‐cell lymphoma involving follicular T‐lymphocytes normally found in germinal centers, its molecular features and relation to inherited immune defects, and its relation and differential diagnosis from similar entities. Finally, it discusses the evidence that in many cases a watch and wait policy might be a viable initial management strategy. © 2020 The Pathological Society of Great Britain and Ireland. Published by John Wiley & Sons, Ltd.