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Published on: January 7, 2019
Abnormal patterns of antigenic expression in follicular lymphoma: a flow cytometric study
Sourav Ray1, Fiona E Craig, Steven H Swerdlow
1Department of Pathology, Division of Hematopathology, University of Pittsburgh School of Medicine, Pittsburgh, PA 15213, USA.
Insights
Flow cytometry (FC) can identify follicular lymphoma (FL) by detecting specific B cell markers. Differentiating FL from reactive hyperplasia (RH) is improved by analyzing CD19, CD10, and CD20 expression levels.
Area of Science:
- Hematology
- Immunology
- Oncology
Background:
- Distinguishing follicular lymphoma (FL) from reactive hyperplasia (RH) is crucial for accurate diagnosis and treatment.
- Flow cytometry (FC) immunophenotyping is a key tool, typically focusing on CD5- CD10+ B cells.
Purpose of the Study:
- To investigate additional diagnostic information obtainable from routine FC studies for differentiating FL from RH.
- To explore phenotypic differences in B cell markers between FL and RH cases.
Main Methods:
- Retrospective analysis of 90 follicular lymphoma (FL) and 91 reactive hyperplasia (RH) cases.
- Utilized routine flow cytometric (FC) immunophenotyping to assess B cell markers including CD19, CD10, and CD20 expression.
Main Results:
- Significant differences observed: dimmer CD19 on CD10+ B cells in FL, brighter CD10 and more numerous CD10+ B cells in FL, and brighter CD20 on neoplastic B cells in FL.
- Grade 3 FL showed dimmer CD10 expression compared to lower grades.
- Dimmer CD19 on CD10+ cells was identified in 44% of evaluable FL cases but none of the RH cases.
Conclusions:
- Routine FC studies offer expanded diagnostic utility for follicular lymphoma (FL).
- Identified phenotypic aberrations in FL suggest deviations from normal B cell developmental pathways.
- FC analysis of CD19, CD10, and CD20 expression provides valuable insights for distinguishing FL from RH.
Abstract:
In order to distinguish follicular lymphoma (FL) from reactive hyperplasia (RH), flow cytometric (FC) immunophenotypic studies have been used primarily to look for monotypic CD5- CD10(+) B cells with much more limited use of bcl-2 stains. We studied what additional diagnostic information could be extracted from routine FC studies in a retrospective study of 90 FL and 91 RH cases. The following significant differences were identified: dimmer CD19 on CD10+ B cells in FL (P < .0001), brighter CD10 and more numerous CD10(+) B cells in FL (P < .0001), and brighter CD20 on neoplastic B cells than on other B cells in FL (P = .002) or in RH (P = .05). In the FL cases, no correlations could be documented between any phenotypic findings. Grade 3 FL had significantly dimmer CD10 expression than lower grades (P = .05). Visual analysis of CD10(+) vs CD10(-) smaller B cells showed dimmer CD19 on the CD10(+) cells in 28 (44%) of 64 evaluable FL cases and 0 of 87 evaluable RH cases. These findings expand the ways in which FC studies can be used to help diagnose FL and suggest that the phenotypic aberrations identified do not represent normal developmental pathways.
