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Usefulness of Bcl-2 Expression and the Expression of Cytoplasmic Immunoglobulin Light Chains in the Differentiation Between B-Cell Lymphoma and Reactive Lymphocytic Proliferations in FNA. Int J Mol Sci 2019; 20:ijms20112648. [PMID: 31146399 PMCID: PMC6601031 DOI: 10.3390/ijms20112648] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2019] [Revised: 05/24/2019] [Accepted: 05/25/2019] [Indexed: 11/16/2022] Open
Abstract
Flow cytometry is helpful in differentiating between B-cell lymphoma (BCL) and reactive lymphocytic proliferation (RLP) in FNA biopsies. However; the presence of inconclusive surface immunoglobulin light chains (sIg LC) poses a problem. We investigated the usefulness of additional tests; namely Bcl-2 expression and expression of cytoplasmic Ig LC (cIg LC), mainly on samples with inconclusive sIg LC. Both tests were performed on 232 FNA samples from lymph nodes. Bcl-2 alone was determined qualitatively and quantitatively on 315 samples. The quantitative test was correctly positive in 76% of cases and falsely negative in 24%. The correctly positive results of the qualitative test were 11% points lower. cIg LC correctly identified 65% of BCL with dual positive sIg LC; 36% of BCL with difficult to interpret sIg LC and only 7% of BCL with negative sIg LC. The best results in differentiating between BCL and RLP were obtained when all three tests were used together. In samples with inconclusive sIg LC and additional monoclonal or polyclonal populations the κ:λ ratios did not differentiate between RLP and BCL. We propose that in case of inconclusive sIg LC Bcl-2 test is used first. The addition of cIg LC test is sensible only in cases with dual positive and difficult to interpret sIg LC.
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Significance of CD10-positive clonal B cell populations identified by flow cytometry in histologically benign gastric biopsies. J Hematop 2016. [DOI: 10.1007/s12308-016-0271-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
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Brozic A, Pohar Marinsek Z, Novakovic S, Kloboves Prevodnik V. Inconclusive flow cytometric surface light chain results; can cytoplasmic light chains, Bcl-2 expression and PCR clonality analysis improve accuracy of cytological diagnoses in B-cell lymphomas? Diagn Pathol 2015; 10:191. [PMID: 26482649 PMCID: PMC4612408 DOI: 10.1186/s13000-015-0427-5] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2015] [Accepted: 10/12/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Flow cytometric immunophenotyping (FCI), is widely used in cytology for distinguishing between B-cell lymphoma (BCL) and reactive lymphocytic proliferations (RLP), mainly by identifying monotypic B-cell populations. Since this cannot always be determined by ratios of surface immunoglobulin light chains (sIg LCs) we wanted to assess if cytoplasmic immunoglobulin (cIg) LCs, Bcl-2 and polymerase chain reaction (PCR) based clonality analysis can improve accuracy of cytological diagnoses of BCL. METHODS Our study included 98 fine needle aspiration biopsies from lymph nodes suspicious for BCL with inconclusive sIg LCs. In all cases PCR clonality analysis was performed in order to determine immunoglobulin heavy chain (IGH) gene and T-cell receptor (TRC) gene rearrangement. In selected cases expression of Bcl-2 and cIg LC were determined by FC. RESULTS Thirty patients had lymphoma and 68 had reactive lymphocytic proliferations. Three patterns of sIg LCs staining were found: negative, dual positive and difficult to interpret. Percentage of lymphomas was highest in the dual positive group (75 %). Morphology coupled with cIg LCs determination and/or Bcl-2 expression was able to give a correct diagnosis in 83 % of cases. Molecular tests would have been misleading in 15 % of cases because 7/30 BCL were polyclonal and 8/68 RLP were monoclonal. CONCLUSIONS Determination of cIg LCs, Bcl-2 expression and PCR clonality analysis of B cells improved accuracy of cytological diagnoses in BCL with inconclusive sIg LC. However, clonality determined by PCR was misleading in some cases.
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Affiliation(s)
- Andreja Brozic
- Department of Experimental Oncology, Institute of Oncology, Ljubljana, Slovenia.
| | | | - Srdjan Novakovic
- Department of Molecular Diagnostic, Institute of Oncology, Ljubljana, Slovenia.
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Sharma S, Dorwal P, Sachdev R, Pande A, Tyagi N, Jain D, Raina V. Primary follicular lymphoma of the breast: a rare clinical entity diagnosed using tissue flow cytometry. Indian J Hematol Blood Transfus 2015; 31:300-1. [PMID: 25825578 DOI: 10.1007/s12288-014-0463-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2014] [Accepted: 09/29/2014] [Indexed: 11/26/2022] Open
Affiliation(s)
- Shivani Sharma
- Department of Pathology & Lab Medicine, Medanta The Medicity, Sector 38, Gurgaon, 122001 Delhi NCR India
| | - Pranav Dorwal
- Department of Pathology & Lab Medicine, Medanta The Medicity, Sector 38, Gurgaon, 122001 Delhi NCR India
| | - Ritesh Sachdev
- Department of Pathology & Lab Medicine, Medanta The Medicity, Sector 38, Gurgaon, 122001 Delhi NCR India
| | - Amit Pande
- Department of Pathology & Lab Medicine, Medanta The Medicity, Sector 38, Gurgaon, 122001 Delhi NCR India
| | - Neetu Tyagi
- Department of Pathology & Lab Medicine, Medanta The Medicity, Sector 38, Gurgaon, 122001 Delhi NCR India
| | - Dharmendra Jain
- Department of Pathology & Lab Medicine, Medanta The Medicity, Sector 38, Gurgaon, 122001 Delhi NCR India
| | - Vimarsh Raina
- Department of Pathology & Lab Medicine, Medanta The Medicity, Sector 38, Gurgaon, 122001 Delhi NCR India
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Craig FE, Brinkman RR, Ten Eyck S, Aghaeepour N. Computational analysis optimizes the flow cytometric evaluation for lymphoma. CYTOMETRY PART B-CLINICAL CYTOMETRY 2013; 86:18-24. [PMID: 24002786 DOI: 10.1002/cyto.b.21115] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/02/2013] [Revised: 05/20/2013] [Accepted: 07/01/2013] [Indexed: 11/06/2022]
Abstract
BACKGROUND Although many clinical laboratories are adopting higher color flow cytometric assays, the approach to optimizing panel design and data analysis is often traditional and subjective. In order to address the question "What is the best flow cytometric strategy to reliably distinguish germinal center B-cell lymphoma (GC-L) from germinal center hyperplasia (GC-H)?" we applied a computational tool that identifies target populations correlated with a desired outcome, in this case diagnosis. DESIGN Cases of GC-H and GC-L evaluated by flow cytometric immunophenotyping using CD45, CD20, kappa, lambda, CD19, CD5, CD10, CD38, were analyzed with flowType and RchyOptimyx to construct cellular hierarchies that best distinguished the two diagnostic groups. RESULTS The population CD5-CD19+CD10+CD38- had the highest predictive power. Manual reanalysis confirmed significantly higher CD10+/CD38-B-cells in GC-L (median 12.44%, range 0.74-63.29, n = 52) than GC-H (median 0.24%, 0.03-4.49, n = 48, P = 0.0001), but was not entirely specific. Difficulties encountered using this computational approach included the presence of CD10+ granulocytes, continuously variable B-cell expression of CD38, more variable intensity antigen staining in GC-L and inability to assess the contribution of light chain restriction. CONCLUSION Computational analysis with construction of cellular hierarchies related to diagnosis helped guide manual analysis of high dimensional flow cytometric data. This approach highlighted the diagnostic utility of CD38 expression in the evaluation of B-cells with a CD10+ GC phenotype. In contrast to computational analysis of non-neoplastic cell populations, evaluation of neoplastic cells must be able to take into consideration increased variability in antigen expression.
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Affiliation(s)
- Fiona E Craig
- Division of Hematopathology, Department of Pathology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
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ZHENG JIE. Oncogenic chromosomal translocations and human cancer (Review). Oncol Rep 2013; 30:2011-9. [DOI: 10.3892/or.2013.2677] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2013] [Accepted: 08/02/2013] [Indexed: 11/06/2022] Open
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Sun T. Comparison of Immunohistochemistry and Flow Cytometry in Immunophenotyping of Hematologic Neoplasms. J Histotechnol 2013. [DOI: 10.1179/his.2004.27.2.101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
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Demurtas A, Stacchini A, Aliberti S, Chiusa L, Chiarle R, Novero D. Tissue flow cytometry immunophenotyping in the diagnosis and classification of non-Hodgkin's lymphomas: a retrospective evaluation of 1,792 cases. CYTOMETRY PART B-CLINICAL CYTOMETRY 2013; 84:82-95. [PMID: 23325563 DOI: 10.1002/cyto.b.21065] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/29/2012] [Revised: 10/23/2012] [Accepted: 11/21/2012] [Indexed: 12/17/2022]
Abstract
A retrospective analysis of 1,792 solid tissues suggestive of lymphoma, submitted over a 12-year period, was carried out and flow cytometry (FC) results were compared with histologic findings. The final histologic diagnosis of cases documented in this report is as follows: 1,270 non-Hodgkin's lymphomas (NHL); 17 composite lymphomas; four NHL plus carcinomas; five post-transplant lymphoproliferative disorders; 105 Hodgkin's lymphomas (HL); eight acute leukemias; 42 tissue cancers; and 341 non-neoplastic diseases. A strong correlation between morphology and FC data was observed among hematological malignancies (1,268/1,304, 97.2%) with the exception of HL. Among B-NHL, FC detection of clonally restricted B-cell allowed the identification of lymphomas that were not histologically clear and the differential diagnosis between follicular lymphoma and reactive hyperplasia. A high correlation level (r = 0.83; P < 0.0001) was obtained in comparing proliferation results obtained by FC and immunohistochemistry. Among T-NHL, FC detection of an aberrant phenotype direct histologic diagnosis in cases having less than 20% of neoplastic cells. In nine cases, FC suggested the need to evaluate a neoplastic population, not morphologically evident. Results show that FC routinely performed on tissue samples suspected of lymphomas is a fundamental adjunct to morphology in the diagnosis of NHL and may enhance the performance of the histologic evaluation so as to achieve the final diagnosis. To the best of our knowledge, this is the first report in the literature of a wide series of tissues also studied by FC.
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Affiliation(s)
- Anna Demurtas
- Flow Cytometry Unit, Anatomical Pathology Laboratory 2, Molinette Hospital, University of Turin, Italy
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Bezerra AMPS, Pasqualin DDC, Guerra JCDC, Colombini MP, Velloso EDRP, Silveira PAA, Mangueira CLP, Kanayama RH, Nozawa ST, Correia R, Apelle AC, Pereira WDO, Garcia RG, Bacal NS. Correlation between flow cytometry and histologic findings: ten year experience in the investigation of lymphoproliferative diseases. EINSTEIN-SAO PAULO 2011; 9:151-9. [DOI: 10.1590/s1679-45082011ao2027] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Objective: To demonstrate the advantages of correlating flow cytometry immunophenotyping with the pathology/ immunohistochemistry of lymph nodes or nodules in the diagnosis of lymphoproliferative diseases. Methods: A retrospective study was carried out of 157 biopsy or fine-needle aspiration lymph nodes/ nodule specimens taken from 142 patients, from 1999 and 2009. The specimens were simultaneously studied with fow cytometry and pathology at Hospital Israelita Albert Einstein. The specimens were prepared in hematoxylin/eosin, Giemsa, or monoclonal antibody stained slides for detecting specific antibodies for the purposes of pathology/immunohistochemical analysis. The samples were hemolyzed and marked with different monoclonal antibody panels for different antigens in fow cytometry immunophenotyping. Results: The diagnostic results of pathology/immunohistochemical studies and flow cytometry immunophenotyping agreed in 115 patients (81%), corresponding to 127 specimens, as follows according to the pathologic diagnosis: 63 patients with non-Hodgkin's B-cell lymphoma; 26 patients with reactive lymphoid hyperplasia; 5 patients with non-Hodgkin's T-cell lymphoma; 4 patients with atypical lymphoid proliferation; 5 patients with a chronic granulomatous inflammatory process; 5 patients with a non-hematologic diagnosis; 2 patients with granulocytic sarcoma; 2 patients with thymoma; 1 patient with byphenotypic leukemia; 1 patient with kappa plasmocytoma; 1 patient with Hodgkin's lymphoma. Subtypes of lymphomas could be classified by associating the two techniques: 19 patients with follicular lymphoma; 15 patients with diffuse large B-cell lymphoma; 7 patients with small lymphocytic B-cell lymphoma/chronic lymphocytic leukemia; 3 patients with mantle cell lymphoma; 1 patient with Burkitt's lymphoma; 1 patient with MALT type lymphoma; 1 patient with post-transplant lymphoproliferative disease; 2 patients with high grade non-Hodgkin's B-cell lymphoma; 1 patient with low grade non-Hodgkin's B-cell lymphoma not otherwise specified; 1 patient with Hodgkin's lymphoma; and 12 patients with B-cell non-Hodgkin's lymphoma not otherwise specified. Conclusion: Flow cytometry adds to the results of morphologic and immunohistochemical studies, facilitating a rapid and accurate diagnosis of lymphoproliferative diseases.
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Socolovsky M, Spaho N, Cueto DG, Doglietto F, Fernandez E. Reactive lymphoid follicular hyperplasia mimicking a peripheral nerve tumor. ACTA ACUST UNITED AC 2008; 70:514-7. [PMID: 18261777 DOI: 10.1016/j.surneu.2007.05.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2007] [Accepted: 05/09/2007] [Indexed: 11/29/2022]
Abstract
BACKGROUND Reactive lymphoid follicular hyperplasia is a benign proliferation of lymphoid follicles, which can develop wherever lymphoid tissue is present. We present the unique case of an RLFH that involved the radial nerve and presented as a peripheral nerve tumor. CASE DESCRIPTION A 62-year-old woman came to our attention because of the evidence of a mass in her right arm, associated with numbness in the lateral aspect of her right arm and forearm. Magnetic resonance findings revealed a contrast-enhancing, spindle-shaped tumor, suggestive of a schwannoma or neurofibroma, along the course of the radial nerve. The intraoperative appearance was that of an infiltrating tissue around a lateral branch of the nerve, which could be resected en bloc. Pathologic examination documented hyperplastic lymphoid tissue surrounding the nerve, and immunostaining confirmed the diagnosis of benign reactive follicular hyperplasia. Systemic infections and autoimmune disorders were excluded by screening examinations. The patient remains free of recurrence 24 months postoperatively. CONCLUSION To our knowledge this is the first description of RLFH affecting a peripheral nerve and mimicking a neoplasm. This rare and benign condition should be considered in the differential diagnosis of peripheral nerve tumors.
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Affiliation(s)
- Mariano Socolovsky
- Department of Neurosurgery, University of Buenos Aires School of Medicine, Buenos Aires, Argentina.
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Swart GJ, Wright C, Brundyn K, Mansvelt E, Plessis MD, Oever DT, Jacobs P. Fine needle aspiration biopsy and flow cytometry in the diagnosis of lymphoma. Transfus Apher Sci 2007; 37:71-9. [DOI: 10.1016/j.transci.2007.06.001] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2007] [Accepted: 06/25/2007] [Indexed: 10/22/2022]
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Walsh KJ, Al-Quran SZ, Li Y, Braylan RC, Lynch JW. Discordant Expression of CD20 by Flow Cytometry and Immunohistochemistry in a Patient Responding to Rituximab: An Unusual Mechanism. ACTA ACUST UNITED AC 2007; 7:319-22. [PMID: 17324342 DOI: 10.3816/clm.2007.n.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Immunohistochemistry using the L26 antibody recognizes an intracellular domain of CD20, whereas the L27 antibody used for surface CD20 staining by flow cytometry (FC) recognizes an extracellular domain and would be expected to be a better predictor of response to rituximab. We present a 75-year-old man who was initially treated for CD20- diffuse large B-cell lymphoma based on FC and, at relapse, still had CD20- disease by FC but CD20+ disease by immunohistochemistry. The patient responded to rituximab alone. On further study, it was shown that the malignant B cells, but not normal B cells, expressed the L27 surface binding site only within the intracellular domain. Therefore, it appears that the rituximab binding site is distinct from the surface binding site, and when there is a disparity between the methods to detect CD20 expression, consideration should be given to include rituximab in the treatment plan.
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MESH Headings
- Aged
- Antibodies, Monoclonal/immunology
- Antibodies, Monoclonal/therapeutic use
- Antibodies, Monoclonal, Murine-Derived
- Antigens, CD20/biosynthesis
- Antigens, CD20/immunology
- Antigens, CD20/therapeutic use
- Antineoplastic Combined Chemotherapy Protocols/therapeutic use
- Binding Sites
- Cyclophosphamide/therapeutic use
- Doxorubicin/therapeutic use
- Fatal Outcome
- Flow Cytometry/methods
- Humans
- Immunohistochemistry
- Immunophenotyping
- Lymphoma, B-Cell/drug therapy
- Lymphoma, Large B-Cell, Diffuse/drug therapy
- Male
- Predictive Value of Tests
- Prednisone/therapeutic use
- Recurrence
- Rituximab
- Sensitivity and Specificity
- Tomography, Emission-Computed/methods
- Treatment Outcome
- Vincristine/therapeutic use
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Affiliation(s)
- Katherine J Walsh
- Division of Hematology/Oncology, Department of Medicine, University of Florida Shands Cancer Center, University of Florida College of Medicine, Gainesville, FL 32610, USA
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Jorgensen JL. State of the Art Symposium: flow cytometry in the diagnosis of lymphoproliferative disorders by fine-needle aspiration. Cancer 2006; 105:443-51. [PMID: 16155944 DOI: 10.1002/cncr.21455] [Citation(s) in RCA: 57] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Jeffrey L Jorgensen
- Department of Hematopathology, The University of Texas M. D. Anderson Cancer Center, Houston, Texas 77030, USA.
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Laane E, Tani E, Björklund E, Elmberger G, Everaus H, Skoog L, Porwit-MacDonald A. Flow cytometric immunophenotyping including Bcl-2 detection on fine needle aspirates in the diagnosis of reactive lymphadenopathy and non-Hodgkin's lymphoma. CYTOMETRY PART B-CLINICAL CYTOMETRY 2005; 64:34-42. [PMID: 15669024 DOI: 10.1002/cyto.b.20043] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Fine-needle aspiration (FNA) with immunophenotyping by immunocytochemistry (IC) on cytospins has recently received increased consideration in the diagnosis of lymphoma. The aim of our study was to establish the diagnostic value of a four-color flow cytometric (FCM) panel, including cytoplasmic Bcl-2, in cytologic diagnosis of malignant non-Hodgkin's lymphoma (NHL) and reactive lymphoid hyperplasia (RH). METHODS We investigated 424 FNAs from 396 patients. FCM panel included lambda/kappa/CD19/CD5, CD23/CD10/CD20/CD19, CD4/CD7/CD8/CD3 and Bcl-2/CD10/CD19/CD3 in fluorescein isothiocyanate, phycoerythrin, and peridinin chlorophyll protein or a tandem conjugate of R-phycoerythrin and indodicarbocyanine and allophycocyanin. Bcl-2 expression was evaluated separately for gated B and T cells. RESULTS In 97% of 172 RH samples, FCM was concordant with the diagnosis. FCM gave correct immunologic diagnosis in 95% of low-grade B-cell NHLs, 78% of high-grade B-cell NHLs, and 53% of T-cell lymphomas. Malignant B cells had higher Bcl-2 expression than did reactive B and T cells. This helped to establish a correct diagnosis especially in cases where no clear-cut monoclonality could be shown by kappa/lambda staining or where there was no expression of surface light chain. The highest Bcl-2 expression was found in follicular lymphomas. CONCLUSION Our FCM panel allowed precise classification of NHL in FNA material in 89.5% of all samples. Bcl-2 staining can be recommended for primary differentiation between reactive hyperplasia and NHL.
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MESH Headings
- Adolescent
- Adult
- Aged
- Aged, 80 and over
- Antigens, CD/analysis
- B-Lymphocytes/chemistry
- B-Lymphocytes/pathology
- Biopsy, Fine-Needle
- CD4-CD8 Ratio
- Cell Proliferation
- Child
- Child, Preschool
- Female
- Flow Cytometry/methods
- Humans
- Immunoglobulin kappa-Chains/analysis
- Immunoglobulin lambda-Chains/analysis
- Immunophenotyping/methods
- Lymphocyte Count
- Lymphoma, Non-Hodgkin/blood
- Lymphoma, Non-Hodgkin/diagnosis
- Lymphoma, Non-Hodgkin/pathology
- Lymphoma, T-Cell/blood
- Lymphoma, T-Cell/diagnosis
- Lymphoma, T-Cell/pathology
- Male
- Middle Aged
- Proto-Oncogene Proteins c-bcl-2/metabolism
- Pseudolymphoma/blood
- Pseudolymphoma/diagnosis
- Pseudolymphoma/pathology
- Sensitivity and Specificity
- T-Lymphocytes/chemistry
- T-Lymphocytes/pathology
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Affiliation(s)
- Edward Laane
- Department of Pathology and Cytology, Karolinska University Hospital, Stockholm, Sweden
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Hartung L, Bahler DW. Flow cytometric analysis of BCL-2 can distinguish small numbers of acute lymphoblastic leukaemia cells from B-cell precursors. Br J Haematol 2004; 127:50-8. [PMID: 15384977 DOI: 10.1111/j.1365-2141.2004.05155.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Flow cytometric identification of small numbers of precursor B-cell acute lymphoblastic leukaemia (B-ALL) cells in post-treatment marrow specimens could benefit from the identification of additional, easily detectable markers that could be used in most cases. In this study, we evaluate whether bcl-2 expression quantified by four-colour flow cytometry can be effectively used to discriminate precursor B-ALL blasts from normal B-cell precursors (haematogones) and function as a leukaemia-specific marker. Levels of bcl-2 in the 22 precursor B-ALL cases studied were found to be significantly higher (over sixfold higher on average) than those present in haematogone populations from 22 control marrow specimens. Higher relative levels of bcl-2 expression in the B-ALL cases were maintained with respect to both immature CD34+ and more mature CD34- haematogone subsets, and appeared stable. Dilutional studies indicated that multiparameter flow cytometry analysis using bcl-2 could identify precursor B-ALL blasts representing as few as 1% of CD19+ cells or 0.01% of total leucocytes in bone marrow specimens containing substantial numbers of haematogones. This study suggests that bcl-2 may be an important marker for flow cytometric detection and quantification of small numbers of residual precursor B-ALL cells in bone marrow specimens.
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Affiliation(s)
- Leah Hartung
- ARUP Institute of Clinical and Experimental Pathology, University of Utah, Salt Lake City, UT 84132, USA
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The Use of Flow Cytometry in the Characterization of Lymphoid Neoplasia. AJSP-REVIEWS AND REPORTS 2004. [DOI: 10.1097/01.pcr.0000139837.65036.6d] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Martínez A, Aymerich M, Castillo M, Colomer D, Bellosillo B, Campo E, Villamor N. Routine use of immunophenotype by flow cytometry in tissues with suspected hematological malignancies. CYTOMETRY PART B-CLINICAL CYTOMETRY 2004; 56:8-15. [PMID: 14582132 DOI: 10.1002/cyto.b.10044] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
BACKGROUND Immunophenotype is an essential parameter in the diagnosis of hematological malignancies. Flow cytometry (FCM) is used in the analysis of bone marrow or peripheral blood samples but is less frequently used in the evaluation of tissue biopsies with suspected hematological malignancies. The aim of this study was to analyze the role of FCM in the diagnosis of biopsies from patients with a suspected hematological disorder. METHODS A total of 422 consecutive biopsies were studied using standard morphology, immunohistochemistry (IHC), and FCM. Results of FCM were obtained in less than 3 h and were interpreted independently from morphology and IHC. RESULTS A strong correlation between malignant disease and abnormal pattern of FCM was observed (218 of 250) with the exception of Hodgkin disease (P < 0.001). Overall, negative predictive value was 0.52 and positive predictive value was 1. Light chain restriction was observed in 182 of 201 B-cell lymphoma and in 0 of 142 non-B-cell disorders by FCM. In contrast, light chain pattern could only be evaluated in 38 of 91 cases by IHC. FCM allowed a rapid diagnosis of infrequent or high-grade malignancies such as histiocytic sarcoma or T-lymphoblastic lymphoma. The addition of FCM in the routine study of tissue biopsies facilitates the diagnosis of double pathology in five (1%) patients. CONCLUSIONS FCM is a fast and reliable methodology for phenotyping tissue samples, which easily detects infrequent hematological malignancies, disease-specific phenotypes and clonality in B-cell lymphomas. Moreover, the simultaneous recognition of different cell populations allows the diagnosis of composite cell lymphomas, or double pathologies.
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Affiliation(s)
- Antoni Martínez
- Hematopathology Unit, Department of Pathology, Hospital Clinic, University of Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
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Cook JR, Craig FE, Swerdlow SH. bcl-2 Expression by Multicolor Flow Cytometric Analysis Assists in the Diagnosis of Follicular Lymphoma in Lymph Node and Bone Marrow. Am J Clin Pathol 2003. [DOI: 10.1309/820r476ky9g03l9a] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
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Li S, Eshleman JR, Borowitz MJ. Lack of surface immunoglobulin light chain expression by flow cytometric immunophenotyping can help diagnose peripheral B-cell lymphoma. Am J Clin Pathol 2002; 118:229-34. [PMID: 12162683 DOI: 10.1309/57g0-1bnf-kb9r-l4hn] [Citation(s) in RCA: 70] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
Abstract
We determined the prevalence and significance of finding B cells without surface immunoglobulin (SIg) light chain expression. The flow cytometry database at Johns Hopkins Medical Institutions was searched for cases in which immunoglobulin light chain staining was performed to rule out a B-cell malignant neoplasm between January 1994 and February 2000. We excluded plasma cell dyscrasias, precursor B-cell acute lymphoblastic leukemia/lymphomas, and hematogones. Cases with more than 25% of B cells lacking SIg light chain expression were retrieved. Polymerase chain reaction assays for immunoglobulin heavy chain gene rearrangements were performed in SIg-negative cases with available tissue blocks. We identified 36 cases; all represented lymphoma. Their diagnoses included diffuse large B-cell lymphoma (20), HIV-related lymphoma (5), follicular lymphoma (5), Burkitt lymphoma (2), monomorphic posttransplant lymphoproliferative disorder (1), chronic lymphocytic leukemia/small lymphocytic lymphoma (1), marginal zone B-cell lymphoma (1), and low grade B-cell lymphoma (1). Of the 17 SIg-negative cases with amplifiable DNAs, 12 (71%) showed a clonal immunoglobulin heavy chain gene rearrangement. SIg-negative B-cell lymphomas are rare. Complete absence of SIg light chain expression in a mature B cell proliferation can be used as a surrogate marker to help diagnose peripheral B-cell lymphoma.
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Affiliation(s)
- Shiyong Li
- Department of Pathology, Johns Hopkins Medical Institutions, Baltimore, MD, USA
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