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Updated: Feb 15, 2026

Optimization, Design and Avoiding Pitfalls in Manual Multiplex Fluorescent Immunohistochemistry

Optimization, Design and Avoiding Pitfalls in Manual Multiplex Fluorescent Immunohistochemistry

Published on: July 26, 2019

CD3-positive plasmablastic B-cell neoplasms: a diagnostic pitfall.

Zenggang Pan¹, Mingyi Chen², Qianyun Zhang³

¹Department of Pathology, University of Colorado Denver, Aurora, CO, USA.

Modern Pathology : an Official Journal of the United States and Canadian Academy of Pathology, Inc

|January 13, 2018

Summary

CD3-positive plasmablastic neoplasms are rare B-cell tumors that can be misdiagnosed. Accurate diagnosis requires comprehensive B-cell and T-cell marker analysis, including CD138, and molecular studies.

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Area of Science:

Hematopathology
Oncology
Immunohistochemistry

Background:

Rare B-cell neoplasms can exhibit plasmablastic differentiation.
Aberrant CD3 expression in these neoplasms poses diagnostic challenges, potentially leading to misclassification as T-cell lymphomas or neuroendocrine carcinomas.

Purpose of the Study:

To investigate the immunophenotypic and molecular characteristics of CD3-positive plasmablastic B-cell neoplasms.
To highlight diagnostic pitfalls and emphasize accurate classification strategies.

Main Methods:

Retrospective analysis of 17 cases of CD3+ plasmablastic B-cell neoplasms (12 lymphomas, 5 myelomas).
Immunohistochemical staining for B-cell (CD138, CD79a, CD20, PAX5), T-cell (CD3, CD2, CD4, CD5, CD7, CD8), and other markers (CD56).
Detection of Epstein-Barr virus (EBV), Human herpesvirus 8 (HHV8), and assessment of immunoglobulin heavy chain (IGH) and T-cell receptor gamma (TRG) gene rearrangements.

Main Results:

All 17 cases occurred in extranodal sites with male predominance.
Four cases were initially misdiagnosed.
CD3 was diffusely expressed cytoplasmically in most cases, while other T-cell markers were largely negative.
CD138 was universally positive; CD79a was variably positive; CD20 and PAX5 were rarely positive.
IGH rearrangements were detected in 6/9 cases, with no TRG rearrangements.

Conclusions:

CD3+ plasmablastic neoplasms are a distinct entity requiring careful diagnostic evaluation.
Accurate classification relies on integrating morphology, a broad panel of B-cell and T-cell markers (especially CD138), and molecular studies.
Distinguishing these from peripheral T-cell lymphomas is critical.