Histiocyte-rich B-cell lymphoma. A distinct clinicopathologic entity possibly related to lymphocyte predominant Hodgkin's disease, paragranuloma subtype

Am J Surg Pathol. 1992 Jan;16(1):37-48.


This study reports six non-Hodgkin's lymphoma cases that we called histiocyte-rich B-cell lymphoma (BCL) because of the prominent reactive histiocytic infiltrate obscuring the malignant B-cell population. The involved lymph nodes are characterized by a mixed nodular and diffuse infiltrate and occasionally feature prominent sinuses. The infiltrate is composed of reactive lymphocytes and numerous histiocytes obscuring a tumor population composed of variably sized scattered cells with irregular or multilobar vesicular nuclei. Immunostaining of paraffin sections for the B-cell marker recognized by L26 helps in the identification of these neoplastic cells. The clonal nature and further evidence of the B-cell lineage of this condition is shown by immunoglobulin gene rearrangements detected in three cases. The six cases of histiocyte-rich BCL are remarkably similar clinically: all presented with stage IVB disease with splenomegaly and follow an aggressive clinical course. Except for these features, our series show striking similarities to paragranuloma lymphocyte-predominant Hodgkin's disease, including male preponderance (all patients are male), age distribution (mean age, 41 years), propensity to progress to a diffuse, large B-cell lymphoma (two cases), as well as morphology of the neoplastic B-cell population and expression of Hodgkin's cell markers (Leu-M1 positivity after neuraminidase digestion in three cases, Leu-M1 positivity without neuraminidase digestion in one case, and additional epithelial membrane antigen [EMA] positivity in two cases). Both morphologically and clinically, the present series can be differentiated from other types of infiltrate-rich BCL, such as T-cell-rich BCL. Although additional cases will have to be recognized, histiocyte-rich B-cell lymphoma most likely represents a distinct clinicopathological entity. We speculate that it develops from a subset of B cells that also gives rise to the lymphocytic-histiocytic (L/H) cell, the Hodgkin's cell variant of lymphocyte-predominant Hodgkin's disease, paragranuloma subtype.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Biopsy
  • Bone Marrow / pathology
  • DNA, Neoplasm / analysis
  • Gene Rearrangement, B-Lymphocyte, Heavy Chain / genetics
  • Genotype
  • Hodgkin Disease / diagnosis
  • Hodgkin Disease / pathology*
  • Humans
  • Immunoglobulins / genetics
  • Immunohistochemistry
  • Liver / pathology
  • Lymph Nodes / pathology
  • Lymphoma, B-Cell / chemistry
  • Lymphoma, B-Cell / diagnosis
  • Lymphoma, B-Cell / pathology*
  • Lymphoma, Large B-Cell, Diffuse / chemistry
  • Lymphoma, Large B-Cell, Diffuse / diagnosis
  • Lymphoma, Large B-Cell, Diffuse / pathology*
  • Lymphoma, T-Cell / chemistry
  • Lymphoma, T-Cell / diagnosis
  • Lymphoma, T-Cell / pathology
  • Male
  • Membrane Glycoproteins / analysis
  • Middle Aged
  • Mucin-1
  • Spleen / pathology


  • DNA, Neoplasm
  • Immunoglobulins
  • Membrane Glycoproteins
  • Mucin-1