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We present a case of a 39-year-old female patient in which the knowledge of prior diagnosis of PTGC influenced workup and management when she presented with recurrent parotid mass and ipsilateral lymphadenopathy.
When pathology was obtained from her previous surgery, the report described PTGC. After review of the pathology from the previous procedure, the decision was made to proceed with excisional biopsy of level II cervical lymph node, sparing the previously operated parotid space with inherent risk of facial nerve injury in revision parotidectomy.
While PTGC may be a precursor of NLPHL, many patients with PTGC do not develop NLPHL later in life .
Progressive transformation of germinal centers has an unknown etiology; it is a benign entity but has a known association with nodular lymphocyte-predominant Hodgkin lymphoma (NLPHL) in a minority of cases, either as concomitant disease or as disease occurring before or after the discovery of PTGC. (30,31) The surgical pathologist should keep this association in mind when evaluating a lymph node with PTGC and be sure to exclude additional involvement by lymphoma.
Several features help distinguish NLPHL from PTGC. (32) In NLPHL, neoplastic macronodules replace the entire lymph node, thus effacing normal architecture; background follicular hyperplasia is usually absent.
Distinguishing lymphocyte-rich classical Hodgkin lymphoma from NLPHL and PTGC has important prognostic and therapeutic consequences.
On low-power magnification, it may closely resemble NLPHL or PTGC (Figure 4).
In cases with PTGCs, the analysis concentrated on the progressively transformed germinal centers, and the largest CD20-positive cells present in these areas were counted.
None of the PTGCs or FH cases showed BCL6 abnormalities.
(29) No specific marker to differentiate between PTGCs and NLPHL exists, and hematopathologists rely on combinations of morphologic, immunohistochemical, and clinical findings to render the correct diagnosis.
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