Synopsis

 minority of large atypical cells, lymphocytic and/or histiocytic (L&H) cells or popcorn cells
 scattered in nodular infiltrates of small lymphoid and epithelioid cells
 network of follicular dendritic cells (CD21+)

 IHC and molecular evidence for a germinal center B-cell origin

Immunohistochemistry

 L&H cells : CD45+, CD20+, CD79a+/-, CD30-, CD15-, EMA +/-, BCL6+, BOB1+, Oct2+, PU1+, BSAP+, IRF4-

Morphological variants (#14508396#)

 "classic" (B-cell-rich) nodular
 serpiginous/interconnected nodular (#14508396#)
 nodular with prominent extranodular popcorn cells (L&H cells) (#14508396#)
 T-cell-rich nodular (#14508396#)
 diffuse with a T-cell-rich background (T-cell-rich B-cell lymphoma [TCRBCL]-like) (#14508396#)
 (diffuse) B-cell-rich pattern (#14508396#)
 focal changes of sinus histiocytosis with massive lymphadenopathy (#8522313#)

Localization

 lymph node
 bone marrow (#15087668#)

Cytogenetics

 monoclonal B cell population with clonal rearrangement of Ig genes and somatic mutations of the variable region of the Ig heavy chain genes cluster
 frequent BCL6 rearrangement [different types; example : t(3;22)(q27;q11)](#15339680#)

Differential diagnosis

 progressive transformation of germinal centers (#9888701#)
 T-cell/histiocyte-rich B-cell lymphoma (#12881319#)

See also

 Hodgkin lymphomas

References

 Pijuan L, Vicioso L, Bellosillo B, Ferrer MD, Baro T, Pedro C, Lloreta-Trull J, Munne A, Serrano S. CD20-Negative T-Cell-Rich B-Cell Lymphoma as a Progression of a Nodular Lymphocyte-Predominant Hodgkin's Lymphoma Treated With Rituximab: A Molecular Analysis Using Laser Capture Microdissection. Am J Surg Pathol. 2005 Oct;29(10):1399-1403. PMID: #16160485#

 Khoury JD, Jones D, Yared MA, Manning JT Jr, Abruzzo LV, Hagemeister FB, Medeiros LJ. Bone marrow involvement in patients with nodular lymphocyte predominant Hodgkin lymphoma. Am J Surg Pathol. 2004 Apr;28(4):489-95. PMID: #15087668#

 Boudova L, Torlakovic E, Delabie J, Reimer P, Pfistner B, Wiedenmann S, Diehl V, Muller-Hermelink HK, Rudiger T. Nodular lymphocyte-predominant Hodgkin lymphoma with nodules resembling T-cell/histiocyte-rich B-cell lymphoma: differential diagnosis between nodular lymphocyte-predominant Hodgkin lymphoma and T-cell/histiocyte-rich B-cell lymphoma. Blood. 2003 Nov 15;102(10):3753-8. PMID: #12881319#

 Fan Z, Natkunam Y, Bair E, Tibshirani R, Warnke RA. Characterization of variant patterns of nodular lymphocyte predominant hodgkin lymphoma with immunohistologic and clinical correlation. Am J Surg Pathol. 2003 Oct;27(10):1346-56. PMID: #14508396#

 Nguyen PL, Ferry JA, Harris NL. Progressive transformation of germinal centers and nodular lymphocyte predominance Hodgkin's disease: a comparative immunohistochemical study. Am J Surg Pathol. 1999 Jan;23(1):27-33. PMID: #9888701#

 Chang KL, Kamel OW, Arber DA, Horyd ID, Weiss LM. Pathologic features of nodular lymphocyte predominance Hodgkin's disease in extranodal sites. Am J Surg Pathol. 1995 Nov;19(11):1313-24. PMID: #7573694#

 Ferry JA, Zukerberg LR, Harris NL. Florid progressive transformation of germinal centers. A syndrome affecting young men, without early progression to nodular lymphocyte predominance Hodgkin's disease. Am J Surg Pathol. 1992 Mar;16(3):252-8. PMID: #1599017#

 Grossman DM, Hanson CA, Schnitzer B. Simultaneous lymphocyte predominant Hodgkin's disease and large-cell lymphoma. Am J Surg Pathol. 1991 Jul;15(7):668-76. PMID: #2058762#

 Chittal SM, Alard C, Rossi JF, al Saati T, Le Tourneau A, Diebold J, Delsol G. Further phenotypic evidence that nodular, lymphocyte-predominant Hodgkin's disease is a large B-cell lymphoma in evolution. Am J Surg Pathol. 1990 Nov;14(11):1024-35. PMID: #2240355#

 Sundeen JT, Cossman J, Jaffe ES. Lymphocyte predominant Hodgkin's disease nodular subtype with coexistent "large cell lymphoma". Histological progression or composite malignancy? Am J Surg Pathol. 1988 Aug;12(8):599-606. PMID: #3041849#

 Wlodarska I, Stul M, De Wolf-Peeters C, Hagemeijer A. Heterogeneity of BCL6 rearrangements in nodular lymphocyte predominant Hodgkin's lymphoma. Haematologica. 2004 Aug;89(8):965-72. PMID: #15339680#