Beyond the lymphocyte predominant cell: CD4⁺CD8⁺T-cells in nodular lymphocyte predominant Hodgkin lymphoma

Abstract

Hodgkin lymphomas are characterised by the presence of rare malignant cells in a background of non-neoplastic inflammatory cells. Flow cytometric analysis of involved tissues is generally not thought to be useful in establishing the diagnosis, because of the small number of neoplastic cells present. However, two recent studies describing a CD4+CD8+ (double-positive) T-cell population in nodular lymphocyte predominant Hodgkin lymphoma (NLPHL) suggest that flow cytometry could play a role in the diagnosis of this Hodgkin lymphoma subtype. In addition, awareness of this unusual T-cell population is important in avoiding a misdiagnosis of a T-cell neoplasm. Although the function of CD4+CD8+ T-cells in NLPHL is not known, studies of phenotypically similar cells in other settings point to a reactive or regulatory role. CD4+CD8+ T-cells have also been identified in the benign entity progressive transformation of germinal centres (PTGC), suggesting a possible relationship between NLPHL and PTGC.

Tissue flow cytometry immunophenotyping in the diagnosis and classification of non‐Hodgkin's lymphomas: A retrospective evaluation of 1,792 cases

“…We experienced moreover that results of FC analysis may help the pathologist in the differential diagnosis of certain HL subtypes, particularly in those cases in which a diffuse growth pattern makes the recognition of an NLPHL from a TCRBCL difficult. The high amount of CD4 þ CD8 dimþ T-cells detected by FC and previously described in NLPHL (63,64) oriented the histologic diagnosis toward NLPHL, in three HL cases recently observed at our institution (personal observation).…”

Lymph Node Fine-Needle Cytology of Non-Hodgkin Lymphoma: Diagnosis and Classification by Flow Cytometry

“…Recent studies [32,33] have also described CD4+CD8+ T cells in nodular lymphocyte-predominant HL, suggesting that FC could play a significant role in the diagnosis of this HL subtype. Although the function of CD4+CD8+ T cells in nodular lymphocyte-predominant HL is unknown, some studies on phenotypically similar cells, in other clinical settings, seem to indicate a reactive or regulatory role [32,33,34]. Finally, CD4+CD8+ T cells have also been identified in the progressive transformation of germinal centers, suggesting a possible relationship between nodular lymphocyte-predominant HL and the progressive transformation of germinal centers [33].…”

“…Awareness of a possible occurrence of such unusual T-cell populations may be helpful to avoid a misdiagnosis of T-cell NHL, especially in cases of ectopic thymoma [3]. Recent studies [32,33] have also described CD4+CD8+ T cells in nodular lymphocyte-predominant HL, suggesting that FC could play a significant role in the diagnosis of this HL subtype. Although the function of CD4+CD8+ T cells in nodular lymphocyte-predominant HL is unknown, some studies on phenotypically similar cells, in other clinical settings, seem to indicate a reactive or regulatory role [32,33,34].…”

“…Although the function of CD4+CD8+ T cells in nodular lymphocyte-predominant HL is unknown, some studies on phenotypically similar cells, in other clinical settings, seem to indicate a reactive or regulatory role [32,33,34]. Finally, CD4+CD8+ T cells have also been identified in the progressive transformation of germinal centers, suggesting a possible relationship between nodular lymphocyte-predominant HL and the progressive transformation of germinal centers [33]. Therefore, awareness of these aberrant T-cell phenotypes is mandatory in FC-FNC diagnosis of T-cell proliferations [3,32,33,34].…”

Nodular Lymphocyte Predominant Hodgkin Lymphoma

“…ϩ CD8 ϩ T cells and even T cell-rich infiltrates can be seen [55,56]. Surrounding the LP cells are CD4 ϩ T-cell rosettes [19]; these are typically CD57…”