A Case Report of Nodular Lymphocyte Predominant Hodgkin Lymphoma: A Rare Lymphoma in Myanmar

Nodular lymphocyte-predominant Hodgkin lymphoma (NLPHL) is a germinal center–derived B-cell neoplasm. It is made up of scattered large neoplastic B cells with multilobulated nuclei (lymphocyte-predominant [LP] cells) located within nodules that are predominantly occupied by mantle zone B cells and follicular dendritic cells (FDCs). It manifests with lymph node involvement, and approximately 60% of all cases are attributed to early-stage disease. We presented the case of a 23-year-old young man with left axillary lymph node enlargement for two weeks. He has no loss of appetite, no weight loss, and no fever during this period. Two days prior to consultation, he got tender sensation from these nodes along with a fever and consulted a surgeon. He had history of pulmonary tuberculosis infection and got complete anti-TB drugs at the age of 8 years old. The ultrasound examination of the left axilla shows multiple matted lymph node enlargement, and the largest one is 3.2 x 2.1 cm. The surgeon performed an excisional biopsy and sent it for histopathological examination. The histological section shows complete architectural effacement by a nodular proliferation with diffuse areas containing scattered large cells. Immunohistochemistry confirmed the diagnosis of NLPHL, with LP cells positive for CD20, BCL6, and EMA, and negative for CD30, CD15, CD3, CD4, MUM1, TIA1, and CD56. The true incidence of NLPHL in Myanmar is unknown due to a lack of reported cases. This case highlights the importance of early diagnosis and to give proper immediate management for the disease. A definite diagnosis was achieved through careful histopathological evaluation combined with immunohistochemical analysis.