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CD4-positive diffuse large B-cell lymphoma: A variant with aggressive clinical potential.

Mohammad O Hussaini1, Friederike H Kreisel1, Anjum Hassan1

  • 1Mohammad O Hussaini, Division of Molecular Pathology, Department of Pathology and Immunology, Washington University in St. Louis School of Medicine, St. Louis, MO 63110, United States.

World Journal of Methodology
|September 29, 2016
PubMed
Summary

CD4-positive diffuse large B-cell lymphoma (DLBCL) is a rare condition. This study reports on six cases, highlighting their characteristics and aggressive potential, emphasizing careful diagnosis to distinguish from T-cell lymphomas.

Keywords:
CD4+Diffuse large B-cell lymphomaLineage infidelityT-cell lymphoma

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Area of Science:

  • Hematology
  • Oncology
  • Immunology

Background:

  • CD4 expression is exceptionally rare in diffuse large B-cell lymphoma (DLBCL), with only four cases previously documented.
  • The clinical significance and diagnostic implications of CD4 expression in DLBCL remain uncertain.

Purpose of the Study:

  • To report and characterize a series of CD4-positive DLBCL cases.
  • To investigate the immunophenotypic features and clinical behavior of CD4(+) DLBCL.

Main Methods:

  • Retrospective review of six patients with CD4(+) DLBCL or CD4(+) primary mediastinal large B-cell lymphoma identified from an electronic database.
  • Immunohistochemical analysis for B-cell and T-cell antigens (CD20, BCL2, BCL6, CD2, CD5, CD7, CD3).

Main Results:

  • Five patients had CD4(+) DLBCL and one had CD4(+) primary mediastinal large B-cell lymphoma; average age was 56.
  • Neoplastic cells expressed CD20, BCL2, and BCL6, suggesting a germinal center origin.
  • Expression of T-cell antigens (CD2, CD5, CD7) was noted in some cases, but CD3 was negative; lymph node involvement was common (67%).

Conclusions:

  • CD4 expression in DLBCL raises questions regarding B-cell lineage commitment.
  • CD4(+) DLBCL is rare and requires careful diagnosis to differentiate from T-cell lymphomas.
  • A subset of CD4(+) DLBCL may exhibit aggressive clinical behavior.