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Diffuse large B-cell lymphoma with partial low Ki67 proliferation index.

Karen Nalbandyan1, Markus Tiemann2

  • 1Institute for Hematopathology Hamburg, Hamburg, Germany. nalbandyan@hp-hamburg.de.

Journal of Hematopathology
|March 26, 2025
PubMed
Summary

This case study highlights a rare instance of false-negative Ki67 staining in diffuse large B-cell lymphoma. Awareness of this potential pitfall is crucial for accurate diagnosis and avoiding misclassification as indolent lymphomas.

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Area of Science:

  • Hematopathology
  • Immunohistochemistry
  • Oncology

Background:

  • Ki67 is a widely used marker for assessing tumor cell proliferation.
  • Immunohistochemical staining can occasionally yield false-negative results for certain proteins like MYC and Bcl2.
  • Accurate proliferation assessment is vital for lymphoma diagnosis and classification.

Purpose of the Study:

  • To report a unique case of diffuse large B-cell lymphoma (DLBCL) with unexpectedly low Ki67 staining in specific tumor areas.
  • To investigate the potential for false-negative Ki67 immunohistochemical staining in DLBCL.
  • To emphasize the diagnostic implications of potential Ki67 staining artifacts.

Main Methods:

  • Case presentation of a 47-year-old male diagnosed with DLBCL.
Keywords:
B-cell lymphomaKi67Proliferation index

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  • Histopathological and cytological examination of tumor tissue.
  • Immunohistochemical staining for Ki67 using a primary antibody.
  • Repeat Ki67 staining using an alternative antibody clone.
  • Comparison of staining results between different Ki67 clones and tumor areas.

    • Main Results:

    • Observed areas of DLBCL with significantly low Ki67 staining, lacking apparent histologic or cytologic differences from high-proliferating areas.
    • An alternative Ki67 antibody clone revealed a substantially higher proliferation index.
    • Identification of a weakly positive Ki67-expressing cell population with the alternative clone.
    • Findings suggest a partial false-negative staining phenomenon for Ki67 in this DLBCL case.

    Conclusions:

    • This case represents the first reported instance of potential false-negative Ki67 staining in diffuse large B-cell lymphoma.
    • False-negative Ki67 staining, though rare, can occur and may lead to misdiagnosis, potentially classifying aggressive lymphomas as indolent.
    • Clinicians and pathologists should be aware of this rare immunohistochemical pitfall, especially when interpreting limited biopsy samples, to ensure accurate lymphoma diagnosis and patient management.