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A high number of IgG4-positive plasma cells rules out nodular lymphocyte predominant Hodgkin lymphoma

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Abstract

Nodular lymphocyte predominant Hodgkin lymphoma (NLPHL) is a subtype of Hodgkin lymphoma that frequently shows a nodal growth pattern with abundant reactive B cells in the microenvironment. Early NLPHL cases can be particularly difficult to differentiate from progressively transformed germinal centers (PTGC). Since PTGC have been described to be IgG4 associated in a relatively high proportion of cases, the aim of the present study was to determine if IgG4 immunostaining can be helpful in the differential diagnosis between NLPHL and PTGC. We furthermore aimed to learn if LP cells can express IgG4. For this purpose, 58 cases of PTGC and 56 cases of NLPHL were assessed using IgG4 immunostaining. We could confirm that a significant number of PTGC cases showed high numbers of IgG4-positive plasma cells (22/58, 38%), whereas hot spot areas of IgG4-positive plasma cells were not found in any of the NLPHL cases. In lymph node areas with the differential diagnosis of NLPHL and PTGC, IgG4 immunostaining can therefore provide a helpful diagnostic tool to rule out NLPHL when a high number of IgG4-positive plasma cells are encountered. We also assessed 13 cases with a combination of NLPHL and PTGC in the same lymph node. Five of these cases presented hot spot areas of IgG4-positive plasma cells in the PTGC regions, while no significant numbers of IgG4-positive plasma cells were observed in the NLPHL part of the lymph node. LP cells were never IgG4 positive. Furthermore, immunoglobulin heavy chain rearrangements of single IgG4-positive plasma cells were analyzed, revealing a polyclonal plasma cell population. In summary, our data suggest that IgG4 immunostaining can provide additional information in the diagnostic workup of cases with the differential diagnosis of NLPHL and PTGC. IgG4’s inefficiency in clearing antigens may explain why lymph nodes with PTGC are usually strongly enlarged and develop a high number of hyperplastic germinal centers. Polyclonal immunoglobulin heavy chain rearrangements in IgG4-positive plasma cells further support the hypothesis that PTGC represent a misled immune reaction.

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Funding

Deutsche Forschungsgemeinschaft grant numbers HA6145/1-2 and HA6145/3-1

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Authors and Affiliations

  1. Senckenberg Institute of Pathology, Goethe University Hospital Frankfurt, Theodor-Stern-Kai 7, D-60590, Frankfurt am Main, Germany

    Kati Kiil, Julia Bein, Bianca Schuhmacher, Markus Schneider, Martin-Leo Hansmann & Sylvia Hartmann

  2. José Carreras Center for Immuno- and Gene Therapy and Internal Medicine I, Saarland University Medical School, Homburg, Saar, Germany

    Lorenz Thurner

  3. Reference and Consultant Center for Lymph Node and Lymphoma Pathology, Goethe University, Frankfurt am Main, Germany

    Martin-Leo Hansmann & Sylvia Hartmann

  4. Frankfurt Institute of Advanced Studies, Frankfurt am Main, Germany

    Martin-Leo Hansmann

Authors
  1. Kati Kiil
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  2. Julia Bein
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  3. Bianca Schuhmacher
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  4. Lorenz Thurner
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  5. Markus Schneider
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  6. Martin-Leo Hansmann
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  7. Sylvia Hartmann
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Contributions

KK: data acquisition and interpretation, drafting the manuscript; JB, BS, LT, MS: data acquisition and interpretation; MLH: contributed essential material, data interpretation; SH: design of the study, data interpretation, writing of the manuscript.

Corresponding author

Correspondence to Sylvia Hartmann.

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The local ethics committee approved the study, and written informed consent from the donors was obtained in accordance with the Declaration of Helsinki.

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The authors declare that they have no conflict of interest.

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Kiil, K., Bein, J., Schuhmacher, B. et al. A high number of IgG4-positive plasma cells rules out nodular lymphocyte predominant Hodgkin lymphoma. Virchows Arch 473, 759–764 (2018). https://doi.org/10.1007/s00428-018-2460-8

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  • DOI: https://doi.org/10.1007/s00428-018-2460-8

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