Surgical Management of Pediatric Nodular Lymphocyte‐Predominant Hodgkin's Lymphoma: A Systematic Review of Surgical Outcomes and Case Report
Bhavik Singh, Eileen M. RaynorABSTRACT
Introduction
Nodular lymphocyte‐predominant Hodgkin lymphoma (NLPHL) is a rare subtype, representing 5% of Hodgkin lymphoma cases. It is distinguished by lymphocyte‐predominant cells expressing CD20 and CD79a but not CD15 and CD30. Pediatric NLPHL affects primarily males aged 4–17, often presenting with localized lymphadenopathy and favorable outcomes. NLPHL's distinct pathology makes treatment optimization critical. Long‐term risks of chemotherapy and radiotherapy have led to interest in surgical resection for low‐risk, early‐stage disease. The objective of this study is to systematically review the available literature describing surgical management of pediatric NLPHL and summarize reported outcomes following surgical resection.
Methods
We conducted a systematic review of studies on pediatric NLPHL with a focus on surgical resection. PubMed and Scopus searches identified 37 studies, of which four met the inclusion criteria. Data regarding surgical outcomes, recurrence rates, and survival were extracted. Additionally, we analyzed our own case study of an 11‐year‐old male who underwent modified neck dissection followed by chemotherapy due to residual disease found on subsequent PET.
Discussion
Surgical resection was associated with event‐free survival rates of 57%–77% and 100% overall survival in low‐risk patients across the limited available studies. Complete resection reduced recurrence risk, while incomplete resections required adjuvant therapies. Our case study demonstrated that adjunctive chemotherapy could achieve remission when residual disease is present after surgical resection as well as in cases of disease recurrence.
Conclusion
Surgical resection may represent a potential treatment option for carefully selected pediatric patients with localized NLPHL when complete resection is achievable. However, the current evidence base remains limited and further prospective research is needed to optimize patient selection.