Nodular lymphocyte–predominant Hodgkin lymphoma (NLPHL) with unusual features, including some that can overlap morphologically with classic Hodgkin lymphoma (CHL), have been described. Herein, we describe 12 cases of NLPHL with fibrous bands and capsular fibrosis resembling, in part, nodular sclerosis (NS) CHL. Seven of 12 cases harbored Reed-Sternberg–like cells, further suggestive of CHL, but all cases lacked associated eosinophils and/or plasma cells in the background. In this cohort, all cases had areas of so-called pattern D (nodular T-cell rich) as a sole component in 7 (58%) cases or as a hybrid pattern along with pattern E (diffuse T-cell/histiocyte-rich) in 5 (42%) cases. The immunophenotype of the large neoplastic cells in these cases supported their being lymphocyte predominant cells of NLPHL, positive for CD20, CD79a, and OCT2, and negative for CD15 and CD30. However, PAX5 was weak in 9 of 11 cases similar to Hodgkin/Reed-Sternberg cells in CHL. We conclude that some cases of NLPHL are associated with fibrous bands and capsular fibrosis and resemble, in part, NS CHL. In our experience, NLPHL with NS-like features occurs in 10% to 15% of cases of NLPHL and is associated with a variant pattern (D and/or E). In addition, all patients in this cohort were not treated before biopsy, suggesting that the prominent sclerosis in these cases is inherent to disease biology. Recognition of NLPHL with NS-like features further expands the morphologic spectrum of NLPHL and helps avoid potential misdiagnosis as CHL.

已经描述了具有不寻常特征的结节性淋巴细胞为主的霍奇金淋巴瘤（NLPHL），包括一些在形态上可以与经典霍奇金淋巴瘤（CHL）重叠的部分。在这里，我们描述了 12 例 NLPHL 病例，其纤维带和包膜纤维化部分类似于结节性硬化症 (NS) CHL。12 例中有 7 例含有 Reed-Sternberg 样细胞，进一步提示 CHL，但所有病例背景中均缺乏相关的嗜酸性粒细胞和/或浆细胞。在这个队列中，所有病例都具有所谓的 D 型区域（富含结节性 T 细胞）作为 7 例（58%）病例的唯一成分，或者与 E 型（弥漫性 T 细胞/组织细胞丰富）的混合模式) 在 5 (42%) 例中。免疫表型这些病例中的大肿瘤细胞支持它们是 NLPHL 的淋巴细胞优势细胞，CD20、CD79a 和 OCT2 阳性，CD15 和 CD30 阴性。然而，PAX5 在 11 例中有 9 例弱于 CHL 中的 Hodgkin/Reed-Sternberg 细胞。我们得出结论，一些 NLPHL 病例与纤维带和包膜纤维化有关，部分类似于 NS CHL。根据我们的经验，具有 NS 样特征的 NLPHL 发生在 10% 至 15% 的 NLPHL 病例中，并且与变异模式（D 和/或 E）相关。此外，该队列中的所有患者在活检前均未接受治疗，这表明这些病例中突出的硬化是疾病生物学所固有的。识别具有 NS 样特征的 NLPHL 进一步扩大了 NLPHL 的形态学谱，并有助于避免潜在的误诊为 CHL。