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Ki-67 Labeling Indices in 'Classic' versus 'Blastoid' Mantle Cell Lymphomas--Proposed Cutoff Values for Routine
Shahid Pervez1, Saroona Haroon, Dreema Awan
1Department of Pathology and Laboratory Medicine, Aga Khan University Hospital, Karachi, Pakistan
Insights
This study analyzed Ki-67 proliferation indices in classic (c-MCL) and blastoid (b-MCL) mantle cell lymphoma variants. Findings suggest differential cut-off values can reliably classify these MCL subtypes.
Area of Science:
- Hematology
- Oncology
- Pathology
Background:
- Mantle cell lymphoma (MCL) is an aggressive B-cell lymphoma with distinct variants.
- Classic (c-MCL) and blastoid (b-MCL) variants have different clinical courses.
- Objective classification of MCL variants is crucial for treatment decisions.
Purpose of the Study:
- To analyze Ki-67 proliferation indices in c-MCL and b-MCL.
- To establish reliable cut-off values for Ki-67 in differentiating MCL variants.
- To improve diagnostic accuracy for MCL subtypes.
Main Methods:
- Retrospective review of 90 MCL cases diagnosed over 4.5 years.
- Ki-67 labeling index scoring and statistical analysis.
- Comparison of proliferation indices between c-MCL and b-MCL.
Main Results:
- 75% of cases were c-MCL (n=67) and 25% were b-MCL (n=23).
- Mean Ki-67 index was 29.5% in c-MCL vs. 64.4% in b-MCL (p=0.029).
- Significant difference in proliferation indices between the two variants was observed.
Conclusions:
- Differential Ki-67 cut-off values can objectively classify MCL variants.
- Proposed cut-offs: <40% for c-MCL and >50% for b-MCL.
- This aids diagnostic pathologists in reliable MCL subtyping.
Background:
Mantle-cell lymphoma (MCL) is a unique entity of peripheral B-cell lymphoma that has a discrete morphologic, immunologic, and genetic phenotype, with more common 'classic' and less frequent 'blastoid' and 'pleomorphic' variants, associated with an aggressive clinical course. The aim of this study was to analyze proliferation (Ki-67) indices of 'classic' (c-MCL) and 'blastoid' (b-MCL) variants of a cohort of MCL and to suggest cut off values for the Ki-67 proliferation index in these two subsets.
Materials And Methods:
MCL cases diagnosed over 4 1/2 years at Section of Histopathology, Department of Pathology and Laboratory Medicine, Aga Khan University Hospital, Karachi were retrieved and reviewed. Ki-67 labelling was scored and analysed.
Results:
A total of 90 of cases of MCL were scrutinized. Mean age±SD was 60.2±12.5 years and the male to female ratio was 4:1, with 67 (75%) cases of c-MCL and 23 (25%) cases of b-MCL. Most samples were lymph node biopsies (n=68), whereas the remainder were from various extranodal sites The mean Ki-67 proliferation index was 29.5%±14.4% in classic variants and 64.4±15.2% for the blastoid variant, the difference being statistically significant (p=0.029).
Conclusions:
It was concluded that differential cut-off values of Ki-67 labeling may be used in more objective way to reliably classify MCL into classic or blastoid variants by diagnostic pathologists. We propose a <40 proliferative index to be suggestive of c-MCL and one of >50 for the blastoid variant.
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