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A comprehensive immunophenotypic marker analysis of hairy cell leukemia in paraffin-embedded bone marrow trephine
Judit Tóth-Lipták1, Klára Piukovics, Zita Borbényi
1Laboratory of Tumor Pathology and Molecular Diagnostics, Jobb fasor 23/B, 6726, Szeged, Hungary.
Insights
This study evaluates immunohistochemical markers for diagnosing Hairy Cell Leukemia (HCL), finding Annexin A1 and pERK highly specific. Standard markers like CD11c and CD103 are also valuable for HCL diagnosis in bone marrow biopsies.
Area of Science:
- Hematology
- Oncology
- Immunohistochemistry
Background:
- Hairy cell leukemia (HCL) is a rare B-cell malignancy.
- Diagnosis can be challenging due to low cell counts and 'dry tap' bone marrow aspirations.
- Immunohistochemistry on bone marrow trephine biopsies is often crucial for diagnosis.
Purpose of the Study:
- To assess the diagnostic utility of various immunohistochemical markers for HCL.
- To evaluate marker performance against fixation-resistant epitopes in paraffin-embedded samples.
- To identify reliable markers for differentiating HCL from its mimics.
Main Methods:
- Consecutive immunohistochemical analysis of 73 small B-cell lymphoma cases.
- Inclusion of HCL (n=32) and various other lymphoma subtypes.
- Evaluation of markers including CD11c, CD25, CD103, CD123, Annexin A1, and pERK.
Main Results:
- HCL cases showed high positivity for most evaluated markers.
- Annexin A1 demonstrated 100% specificity and accuracy.
- CD123, pERK, CD103, CD11c, and CD25 were also highly effective markers for HCL diagnosis.
Conclusions:
- Annexin A1 and pERK are highly specific markers for HCL diagnosis.
- Standard markers (CD11c, CD25, CD103, CD123) retain diagnostic value in paraffin-embedded bone marrow.
- Additional markers like HBME-1, cyclin D1, CD200, and T-bet aid in differential diagnosis.
Abstract:
Hairy cell leukemia (HCL) is an uncommon B cell lymphoproliferation characterized by a unique immunophenotype. Due to low number of circulating neoplastic cells and 'dry tap' aspiration, the diagnosis is often based on BM trephine biopsy. We have performed a consecutive immunohistochemical analysis to evaluate diagnostic usefulness of various HCL markers (CD11c, CD25, CD68, CD103, CD123, CD200, annexin A1, cyclin D1, DBA.44, HBME-1, phospho-ERK1/2, TRAP, and T-bet) currently available against fixation resistant epitopes. We analyzed tissue microarrays consisting of samples gained from 73 small B-cell lymphoma cases, including hairy cell leukemia (HCL) (n = 32), HCL variant (HCL-v) (n = 4), B-cell chronic lymphocytic leukemia (B-CLL) (n = 11), lymphoplasmacytic lymphoma (LPL) (n = 3), mantle cell lymphoma (MCL) (n = 10), splenic diffuse red pulp small B cell lymphoma (SDRPL) (n = 2), splenic B cell marginal zone lymphoma (SMZL) (n = 8), and splenic B cell lymphoma/leukemia, unclassifiable (SBCL) (n = 3) cases. The HCL cases were 100% positive for all but 2 (DBA.44 and CD123) of these markers. Annexin A1 showed 100% specificity and accuracy, which was followed by CD123, pERK, CD103, HBME-1, CD11c, CD25, CD68, cyclin D1, CD200, T-bet, DBA.44, and TRAP, in decreasing order. In conclusion, our results reassured the high specificity of annexin A1 and pERK, as well as the diagnostic value of standard HCL markers of CD11c, CD25, CD103, and CD123 also in paraffin-embedded BM samples. Additional markers, including HBME-1, cyclin D1, CD200, and T-bet also represent valuable tools in the differential diagnosis of HCL and its mimics.
