The ASCO Post is pleased to present Hematology Expert Review, an ongoing feature that quizzes readers on issues in hematology. In this installment, Drs. Abutalib and Medeiros explore the updated World Health Organization (WHO) classification of nodular lymphocyte-predominant Hodgkin lymphoma. For each quiz question that follows, select the one best answer. The correct answers and accompanying discussions appear below.
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Dr. Abutalib is Assistant Director, Hematology and Hematopoietic Cell Transplantation Director, Hematopoietic Cell Transplant Apheresis Service, Cancer Treatment Centers of America, Zion, Illinois, Editor-in-Chief, Advances in Cell & Gene Therapy. Dr. Medeiros is Professor and Chair, Department of Hematopathology, The University of Texas MD Anderson Cancer Center, Houston.Question 1
Which of the following statements about nodular lymphocyte-predominant Hodgkin lymphoma (HL) is correct?
A. Nodular lymphocyte-predominant HL can transform into large B-cell lymphoma.
B. Another name for this neoplasm is nodular variant lymphocyte-rich classical Hodgkin lymphoma.
C. Nodular lymphocyte-predominant Hodgkin lymphoma can transform into classical Hodgkin lymphoma.
D. Most patients present with advanced-stage disease with mediastinal involvement.
Question 2
In nodular lymphocyte-predominant HL, six distinct immunoarchitectural patterns are recognized. Which of the following statements about these patterns is correct?
A. Patterns A and B are nodular and considered to be typical variants.
B. Pattern E is mostly diffuse and resembles T-cell/histiocyte-rich large B-cell lymphoma.
C. Pattern C is nodular, but lymphocyte-predominant cells are located at the periphery and outside of the nodules.
D. All of the above
Syed Ali Abutalib, MD
L. Jeffrey Medeiros, MD
Question 3
Which statement about neoplastic lymphocyte-predominant cells in nodular lymphocyte-predominant HL is correct?
A. Lymphocyte-predominant cells are small T lymphocytes with distinct features.
B. Lymphocyte-predominant cells are small B cells intermingled with large lymphoid cells.
C. Lymphocyte-predominant cells are large and usually have a multilobulated nucleus.
D. Lymphocyte-predominant cells are positive for CD15 and CD30 and are negative for CD45.
Question 4
Which of the following lymphocyte-predominant cell immunophenotypes most likely represents nodular lymphocyte-predominant HL?
A. Strong expression of CD79a with absence of CD20
B. Strong co-expression of CD20, OCT2, and CD79a
C. Strong co-expression of CD10, CD20, and OCT2
D. Weak co-expression of CD20, OCT2, and CD79a
