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Interphase Fluorescence in situ Hybridization of Bone Marrow Smears of Multiple Myeloma
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Angioimmunoblastic T-cell lymphoma in bone marrow: a morphologic and immunophenotypic study.

Faisal A Khokhar1, William D Payne, Sameer S Talwalkar

  • 1Department of Hematopathology, University of Texas M.D. Anderson Cancer Center, Houston, TX 77030, USA. fvegava@mdanderson.org

Human Pathology
|September 11, 2009
PubMed
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Diagnosing angioimmunoblastic T-cell lymphoma in bone marrow is challenging due to atypical features. Programed death-1 and BCL-6/CD3 staining aid in identifying this lymphoma subtype.

Area of Science:

  • Hematopathology
  • Oncology
  • Immunology

Background:

  • Angioimmunoblastic T-cell lymphoma (AITL) commonly affects bone marrow.
  • Histologic and immunophenotypic features of AITL in bone marrow are not well-characterized.

Purpose of the Study:

  • To define the histologic and immunophenotypic characteristics of AITL in bone marrow.
  • To identify reliable diagnostic markers for AITL in bone marrow.

Main Methods:

  • Analysis of 27 bone marrow specimens from 20 patients with AITL.
  • Histologic examination and immunohistochemistry (PD-1, CD10, CXCL13, BCL-6/CD3).
  • Flow cytometry immunophenotyping.

Main Results:

  • AITL bone marrow involvement was multifocal (74%) and nodular (78%).

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  • Programed death-1 (PD-1) was expressed by atypical lymphocytes in 85% of cases.
  • BCL-6/CD3 dual staining identified BCL-6+ T-cells in all cases; CD10 expression was uncommon (18.5%).
  • Follicular dendritic cells and CXCL13 were rarely identified in bone marrow.

    • Conclusions:

    • AITL diagnosis in bone marrow is complicated by uncommon CD10 expression and lack of CXCL13.
    • The bone marrow microenvironment differs significantly from lymph nodes, impacting marker expression.
    • PD-1 immunohistochemistry and BCL-6/CD3 dual staining are valuable for recognizing the follicular T-helper cell phenotype of AITL in bone marrow.