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CD4-positive diffuse large B cell lymphoma identified by flow cytometry: two case reports.

Marisa Arrondini¹, Antonella Barreca, Sabrina Aliberti

¹Laboratory of Pathology, Department of Pathology, Molinette Hospital, via Santena 7, Turin, Italy.

International Journal of Hematology

|June 26, 2010

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Two rare cases of diffuse large B cell lymphoma (DLBCL) in the small bowel coexpressed the CD4 antigen, a marker typically found on T-cells. This unusual finding suggests potential lineage infidelity in malignant B cells.

Area of Science:

Oncology
Immunology
Gastroenterology

Background:

Diffuse large B cell lymphoma (DLBCL) is an aggressive non-Hodgkin lymphoma.
The small bowel is an uncommon site for DLBCL primary origin.
CD4 is a surface glycoprotein typically expressed on helper T-lymphocytes, monocytes, and macrophages, not B-cells.

Observation:

Two patients presented with DLBCL localized to the small bowel.
Immunohistochemistry and flow cytometry revealed coexpression of PAX5, weak or absent CD20, and the CD4 antigen on lymphoma cells.
CD4 expression was initially detected by flow cytometry and confirmed by immunohistochemistry.

Findings:

These are the first reported cases of gastrointestinal DLBCL coexpressing the CD4 antigen.
The coexpression of CD4 on malignant B-cells suggests a phenomenon of lineage infidelity.

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It is hypothesized that dysregulated gene expression, particularly of PAX5, in DLBCL may activate silent T-cell differentiation genes.

Implications:

This finding expands the understanding of aberrant antigen expression in DLBCL.
It highlights the importance of comprehensive immunophenotyping in lymphoma diagnosis.
Further research is warranted to explore the mechanisms behind CD4 coexpression in DLBCL and its potential impact on prognosis and treatment.