Peripheral T-cell lymphomas of follicular helper T-cell type frequently display an aberrant CD3-/dim CD4+ population by flow cytometry: An important clue to the diagnosis of a Hodgkin lymphoma mimic

Mir Alikhan, Joo Y. Song, Aliyah R. Sohani, Julien Moroch, Anne Plonquet, Amy S. Duffield, Michael J. Borowitz, Liuyan Jiang, Carlos Bueso-Ramos, Kedar Inamdar, Madhu P. Menon, Sandeep Gurbuxani, Ernest Chan, Sonali M. Smith, Alina Nicolae, Elaine S. Jaffe, Philippe Gaulard, Girish Venkataraman

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12 Scopus citations

Abstract

Nodal follicular helper T-cell-derived lymphoproliferations (specifically the less common peripheral T-cell lymphomas of follicular type) exhibit a spectrum of histologic features that may mimic reactive hyperplasia or Hodgkin lymphoma. Even though angioimmunoblastic T-cell lymphoma and peripheral T-cell lymphoma of follicular type share a common biologic origin from follicular helper T-cells and their morphology has been well characterized, flow cytometry of peripheral T-cell lymphomas of follicular type has not been widely discussed as a tool for identifying this reactive hyperplasia/Hodgkin lymphoma mimic. We identified 10 peripheral T-cell lymphomas of follicular type with available flow cytometry data from five different institutions, including two cases with peripheral blood evaluation. For comparison, we examined flow cytometry data for 8 classical Hodgkin lymphomas (including 1 lymphocyte-rich classical Hodgkin lymphoma), 15 nodular lymphocyte predominant Hodgkin lymphomas, 15 angioimmunoblastic T-cell lymphomas, and 26 reactive nodes. Lymph node histology and flow cytometry data were reviewed, specifically for the presence of a CD3 -/dim CD4 + aberrant T-cell population (described in angioimmunoblastic T-cell lymphomas), besides other T-cell aberrancies. Nine of 10 (90%) peripheral T-cell lymphomas of follicular type showed a CD3 -/dim CD4 + T-cell population constituting 29.3% (range 7.9-62%) of all lymphocytes. Five of 10 (50%) had nodular lymphocyte predominant Hodgkin lymphoma or lymphocyte-rich classical Hodgkin lymphoma-like morphology with scattered Hodgkin-like cells that expressed CD20, CD30, CD15, and MUM1. Three cases had a nodular growth pattern and three others exhibited a perifollicular growth pattern without Hodgkin-like cells. Epstein-Barr virus was positive in 1 of 10 cases (10%). PCR analysis showed clonal T-cell receptor gamma gene rearrangement in all 10 peripheral T-cell lymphomas of follicular type. By flow cytometry, 11 of 15 (73.3%) angioimmunoblastic T-cell lymphomas showed the CD3 -/dim CD4 + population (mean: 19.5%, range: 3-71.8%). Using a threshold of 3% for CD3 -/dim CD4 + T cells, all 15 nodular lymphocyte predominant Hodgkin lymphoma controls and 8 classical Hodgkin lymphomas were negative (Mann-Whitney P=0.01, F-PTCL vs Hodgkin lymphomas), as were 25 of 26 reactive lymph nodes. The high frequency of CD3 -/dim CD4 + aberrant T cells is similar in angioimmunoblastic T-cell lymphomas and peripheral T-cell lymphomas of follicular type, and is a useful feature in distinguishing peripheral T-cell lymphomas of follicular type from morphologic mimics such as reactive hyperplasia or Hodgkin lymphoma.

Original languageEnglish (US)
Pages (from-to)1173-1182
Number of pages10
JournalModern Pathology
Volume29
Issue number10
DOIs
StatePublished - Oct 1 2016
Externally publishedYes

ASJC Scopus subject areas

  • Pathology and Forensic Medicine

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    Alikhan, M., Song, J. Y., Sohani, A. R., Moroch, J., Plonquet, A., Duffield, A. S., Borowitz, M. J., Jiang, L., Bueso-Ramos, C., Inamdar, K., Menon, M. P., Gurbuxani, S., Chan, E., Smith, S. M., Nicolae, A., Jaffe, E. S., Gaulard, P., & Venkataraman, G. (2016). Peripheral T-cell lymphomas of follicular helper T-cell type frequently display an aberrant CD3-/dim CD4+ population by flow cytometry: An important clue to the diagnosis of a Hodgkin lymphoma mimic. Modern Pathology, 29(10), 1173-1182. https://doi.org/10.1038/modpathol.2016.113