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As immunophenotypic studies became part of the standard practice of hematopathology, however, it became clear that many of the cases diagnosed as lymphocyte predominance HD displayed biologic and clinical features that separated these cases from all of the other forms of HD. In addition, with improvements in standard therapy, the earlier prognostic differences between the other subtypes of HD essentially vanished. To reflect these advances, the classification of HD was modified in the revised European-American lymphoma (REAL) classification of 1994 into two large categories: lymphocyte predominance HD and classical HD.18 The remaining histologic subtypes of the Rye classification were retained under the heading of classical HD. In addition, the term "lymphocyte-rich classical HD" was introduced to identify cases containing a lymphoid rich background, but an immunophenotype that was identical to the other forms of classical HD and to separate such cases from lymphocyte predominance HD (Table 71.1). The WHO classification of 2001 retained the overall organization of the REAL classification. However, the term "Hodgkin's disease" was replaced by "Hodgkin's lymphoma" to represent the now-definitive lymphoid histogenesis of this malignancy, and the characteristic nodular growth pattern of cases of lymphocyte predominant HL was explicitly acknowledged. 19

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