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Published on: October 9, 2018
Contribution of flow cytometric immunophenotyping to the evaluation of tissues with suspected lymphoma?
1Division of Hematopathology, Department of Pathology, St. Louis University Health Sciences Center, St. Louis, Missouri 63104, USA. dunphyc@slucare1.sluh.edu
Insights
Flow cytometric immunophenotyping (FCI) aids lymphoma diagnosis in most cases. While less useful for Hodgkin's lymphoma (HL), FCI effectively excludes non-Hodgkin's lymphoma (NHL) and aids in diagnosing other hematologic malignancies.
Area of Science:
- Hematopathology
- Immunophenotyping
- Diagnostic Cytology
Background:
- Flow cytometric immunophenotyping (FCI) is a valuable tool in diagnosing hematologic malignancies.
- Previous large-scale retrospective analyses of FCI's contribution to lymph node and extranodal tissue evaluation for lymphoma are limited.
Purpose of the Study:
- To critically analyze the contribution of flow cytometric immunophenotyping (FCI) to the evaluation of lymph nodes and extranodal tissues with suspected lymphoma.
- To assess the utility of FCI in differentiating various lymphoid and non-lymphoid malignancies.
Main Methods:
- Retrospective analysis of 278 lymph nodes and 95 extranodal tissue specimens.
- Inclusion of complete histologic, FCI, and immunohistochemical (IH) data for all specimens.
- Evaluation of FCI marker utility, including CD15, CD30, and CD56.
Main Results:
- FCI data contributed to or was consistent with the final diagnosis in 94% of cases.
- FCI was useful in excluding non-Hodgkin's lymphoma (NHL) and identifying specific hematopoietic tumors like thymoma and plasma cell dyscrasia.
- FCI supported diagnoses of Ewing sarcoma/primitive neuroectodermal tumor (CD56+) and identified limitations in Hodgkin's lymphoma (HL) diagnosis due to cell scarcity.
Conclusions:
- FCI data is highly valuable, especially when positive and indisputable, potentially reducing the need for extensive microscopic examination.
- Correlation with light microscopy is recommended when FCI abnormalities are absent; immunohistochemistry (IH) may be necessary in selected cases.
- FCI, combined with cytomorphology, is effective in excluding NHL and diagnosing specific hematologic malignancies.
Background:
A critical analysis of the contribution of flow cytometric immunophenotyping (FCI) to the evaluation of lymph nodes and extranodal tissues with suspected lymphoma by a large, retrospective approach has not been reported previously and represents the purpose of this study.
Methods:
A total of 278 lymph nodes and 95 extranodal tissue specimens submitted over a 2-year period with complete histologic, FCI, and immunohistochemical (IH) data formed the basis of the study.
Results:
The FCI data contributed significantly to or was consistent with the final tissue diagnosis in the majority (94%) of the tissue samples. There is no well-described utility of flow cytometry markers for Hodgkin's lymphoma (HL) due to the usual scarcity of tumor cells in the final cell suspensions obtained from these tumors. However, the FCI data excluded non-Hodgkin's lymphoma (NHL) and suggested the possible usefulness of CD15 and CD30 by FCI in HL. In addition, immunophenotypic data by FCI in combination with touch imprint cytomorphology was useful in excluding a diagnosis of NHL in cases of nonhematopoietic malignancies and was particularly useful in defining the following hematopoietic tumors and malignancies: thymoma, T-cell lymphoblastic lymphoma, leukemia cutis, and plasma cell dyscrasia. Thus, IH was not essential for the diagnosis in these latter cases and was performed in only two cases (one thymoma and one plasma cell dyscrasia). Of interest, FCI supported the diagnosis in 3 cases of Ewing's sarcoma/primitive neuroectodermal tumor by detection of CD56 on the surface of the malignant cell. Only 11% of NHL were "negative" by FCI (i.e., an aberrant T-cell or monoclonal B-cell population was not identified). Reasons for these discrepancies included partial tissue involvement by the NHL with sampling differences, T-cell rich or lymphohistiocytic-rich variants with a small population of monoclonal B cells, marked tumoral sclerosis, poor tumor preservation, and T-cell NHL without an aberrant immunophenotype. Only 60% of CD30+ anaplastic large cell lymphomas (ALCL) were CD30+ by FCI.
Conclusions:
FCI data should always be correlated with light microscopy if no FCI abnormalities are detected; IH may need to be performed in selected cases. It is less necessary to perform microscopic examination of tissues when the FCI data are positive and indisputable. However, in selected cases in which FCI data is diagnostic, microscopic observations may provide additional information due to sampling.
