16yrs old male presenting with inguinal lymphadenopathy for 2 years. Biopsy is performed. 2x is a my last choice to demonstrate the panoramic view:)  
HISTO: There are some large lymphoid nodules between normal follicles with popcorn and Hodgin like cells (some of it is crushed), clusters of histyocytes and residual GC cells.  
IH: The nodules with CD23+/CD21 network, with admixture CD20+ and CD3+ lympho's (in some- predominant CD20, in one (numbered 1)- CD3). There are activated CD30+/CD15- paracortical cells. EBC LMP1+ cells are absent. There are CD68+ macrophages in follicles and nodules. The single large cells CD30 (+). Some cells EMA (+) in nudules, but not atypical and large ones. Residual GC cells are CD10+ (single). Some sinus histyocytes S100+.  
 
PROPOSAL: Nodular Lympho Predominant Hodgkin's Lymphoma >>> PROGRESSIVE TRANSFORMATION OF GERMINAL CENTERS .  
Thank you for comments.

ugnius 2006-05-26 12:24	Really we have some nodules CD20 >> CD3 and one with CD3>> CD20+. Anyway in most cases we have a mixture.   I will try to make a photos with more detalied illustration of IH of giant cells. But it seems to be CD20+, EMA-, CD30-/CD15-.   Additionally we have not the FUSSION of the nodules, so it moves step by step toward reactive state... ???
anpo 2006-05-26 19:47	It will be good with some photos of the CD20 detailed in the nodules. On the basis of the photos provided it seems that the general structure of the lymph node is still well-preserved and only a few GC are transformed so I would favor the PTGC diagnosis. Can you staing CD57 to see if thre are rosettes?
ugnius 2006-05-27 09:43	Dear dr.Anna. CD57 rosetting is not prominent and it's very difficult to catch these cells in serial slides.   Some irregular cells CD20+.
anpo 2006-05-27 12:29	I think that it is a borderline case - clinically it is probably benign and should not considered as PTGC. However it is good that it was removed because it would progress to HL-LP with time.
dirnhofer 2006-05-29 05:09	fo me also borderline, some of the critical cells would fit l&h cells; if clinically stage 1, probably regular observation of the pt is o.k.;
hurwitz 2006-05-29 15:08	I strongly favour the diagnosis of PTGC as stated in the previoous comments there are only few transformed germinal centres, the majority of the node shows a well preserved structure with some epitheloid cell clusters.On H&E some large immunoblasts are seen, which might represent the CD30+ activated cells. Negative LMP does mot exclude EBV infection.   However, the patient should remain in clinical follow up, since HD many occur many years after PTGC has been diagnosed. I remember a case in which NPHL developed at the same site where a lymphnode with PTGC has been excised 15 years earlier.
ugnius 2006-05-29 15:42	Thank you for comments. With love- um.
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