Research ArticlesUtility of Fascin and JunB in Distinguishing Nodular Lymphocyte Predominant From Classical Lymphocyte-rich Hodgkin LymphomaBhargava, Parul MD*; Pantanowitz, Liron MD†; Pinkus, Geraldine S. MD‡; Pinkus, Jack L. PhD‡; Paessler, Michele E. MD§; Roullet, Michele MD∥; Gautam, Shiva PhD¶; Bagg, Adam MD∥; Kadin, Marshall E. MD♯Author Information ¶Department of Biostatistics *Departments of Pathology, Beth Israel Deaconess Medical center ‡Department of Pathology, Brigham and Women's Hospital, Harvard Medical School, Boston †Department of Pathology, Baystate Medical Center, Tufts University, Springfield, MA §Children's Hospital of Pennsylvania ∥University of Pennsylvania, Philadelphia, PA ♯Department of Dermatology, Roger Williams Medical Center, Providence, Rhode Island Adam Bagg is supported by SCOR grant from the Leukemia and Lymphoma Society of America. Marshall E. Kadin is supported by NIH grant P20RR018757. Reprints: Parul Bhargava, MD, Department of Pathology, Beth Israel Deaconess Medical Center, YA309, 330 Brookline Avenue, Boston, MA 02215 (e-mail: [email protected]). Received for publication November 20, 2008 accepted February 27, 2009 Drs Parul Bhargava and Liron Pantanowitz contributed equally to this article. Data from a subset of these cases were presented at the poster session of the American Society of Clinical Pathology meeting held in October 2005 in Seattle, WA. Applied Immunohistochemistry & Molecular Morphology: January 2010 - Volume 18 - Issue 1 - p 16-23 doi: 10.1097/PAI.0b013e3181a307f7 Buy Metrics Abstract Nodular lymphocyte-predominant Hodgkin lymphoma (NLPHL) and lymphocyte-rich classical Hodgkin lymphoma (LRCHL), although clinically and morphologically similar, differ biologically and in prognosis. Immunolabeling of Reed-Sternberg (RS) cells in LRCHL and lymphocytic and/or histiocytic variants (L&H cells) in NLPHL is often required to help distinguish between the 2 variants. Our aim was to evaluate fascin (a distinct 55-kd actin-bundling protein) and JunB (an activator protein-1 family transcription factor) to differentiate NLPHL from LRCHL. A total of 35 archival cases of NLPHL (n=24) and LRCHL (n=11) from adults and children were studied. Slides were reviewed for all cases and clinical, morphologic, and immunohistochemical features were evaluated. Each case was immunostained for fascin and JunB, and immunoreactivity of RS cells, L&H cells, and background lymphocytes were recorded. Whereas occasional L&H cells were weakly positive for fascin in 3 out of 24 (12.5%) cases of NLPHL, RS cells in LRCHL were positive for fascin in 11 out of 11 (100%) cases with a strong cytoplasmic staining pattern. JunB was positive in 10 out of 24 (41.7%) of NLPHL cases, and 11 out of 11 (100%) of LRCHL cases, showing a stippled and/or diffuse nuclear staining pattern. In addition to L & H Cells, JunB also stained small background lymphocytes, particularly in areas of progressively transformed germinal centers of NLPHL. Either stains when tested alone, if negative, or with rare L&H cell weak positivity for fascin, is indicative of NLPHL. The L&H cells of NLPHL cases were negative for concomitant staining in 24 out of 24 (100%) cases. Concomitant positive staining of classic RS cells for fascin and JunB was found in 11 out of 11 (100%) of LRCHL cases. Although fascin positivity alone supports the diagnosis of LRCHL, concomitant positivity offers stronger support and is less likely to lead to a false conclusion if aberrant fascin staining were to be encountered in a case of NLPHL. Staining for fascin and JunB provides a basis for distinguishing NLPHL from LRCHL and offers an alternative to other antibody profiles. © 2010 Lippincott Williams & Wilkins, Inc.