T-CELL-RICH B-LARGE-CELL LYMPHOMA SIMULATING LYMPHOCYTE-RICH HODGKINS-DISEASE

Immunophenotypic analysis of 50 cases fulfilling the histologic criter ia for mixed cellularity Hodgkin's disease disclosed nine cases with a B-cell, non-Hodgkin's phenotype (CD20+, CD15-, CD30-, EMA-). The case s were characterized by a diffuse small lymphocytic milieu, interspers ed atypical large cells including classic Reed-Sternberg cells, and in frequent plasma cells, eosinophils, and L&H cells. The male:female rat io was 7:2 (aged 22-65 years, median 39 years). Three patients were An n Arbor stage II, two stage III, and four stage IV. The patients prese nted with generalized lymphadenopathy (four), mesenteric lymph node in volvement (two), splenomegaly (four), and bone marrow involvement (thr ee). Four patients were treated with standard Hodgkin's disease protoc ols. Two attained a complete response and two a partial response; all relapsed and died. Four of five patients treated for large-cell lympho ma achieved a complete response and are currently alive without eviden ce of disease. The one patient with an initial partial response relaps ed and died. We conclude that immunophenotypic analysis is essential i n cases of histologic mixed cellularity Hodgkin's disease, especially in those with lymphocyte-rich morphology. Cases with a B-cell phenotyp e should be diagnosed and treated as T-cell-rich B large-cell lymphoma .