page_title: Nodular lymphocyte predominant Hodgkin lymphoma
section_title: Diagnosis
hierarchical_section_title: Nodular lymphocyte predominant Hodgkin lymphoma / Diagnosis
caption_attribution_description: English: Hodgkin lymphoma, nodular lymphocyte predominant - high power view - H&amp;E. Author: Gabriel Caponetti, MD
context_page_description: Nodular lymphocyte predominant Hodgkin lymphoma is an indolent CD20 form of lymphoma.
  Some people no longer classified it as a form of classic Hodgkin lymphoma. This is because the Reed-Sternberg cell variants that characterize this form of the disease invariably express B lymphocyte markers such as CD20, and that NLPHL may progress to diffuse large B cell lymphoma.
  There are small but clear differences in prognosis between the various forms. Lymphocyte predominant HL is an uncommon subtype composed of vague nodules of numerous reactive lymphocytes admixed with large popcorn-shaped RSC. Unlike classic RSC, the non-classic popcorn-shaped RS cells of NLPHL are CD15 and CD30 negative while positive for the B cell marker CD20. The anti-CD20 monoclonal antibody Rituximab has been used in lymphocyte predominant Hodgkin lymphoma with encouraging results.
  BCL6 gene rearrangements have been frequently observed.
context_section_description: The characteristics of NLPHL differ from classical Hodgkin lymphoma (cHL). Lymphocyte predominant (LP) ("popcorn") cells are present embedded in nodules consisting of B cells and other reactive cells (mainly reactive T cells). Reed-Sternberg and Hodgkin (RSH) cells are rarely seen, and immunohistochemistry shows a different pattern on the malignant cells; RSH cells typically express CD15 and CD30, whereas LP cells lack expression of these markers, but express B cell markers like CD20, CD22, and CD79a and also express the common leukocyte antigen CD45, which is uncommon on RSH cells.  The LP cells have scant cytoplasm and one folded or multilobated nuclei with prominent, mostly basophilic nucleoli.  Expert pathology review of multiple morphologic and immunophenotypic features including the use of immunohistochemistry is essential.
caption: Hodgkin lymphoma, nodular lymphocyte predominant (high power view). Notice the presence of L&H cells, also known as "popcorn cells". (H&E)
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