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Published on: March 30, 2018
Distinction between small lymphocytic and mantle cell lymphoma by immunoreactivity for CD23
1Department of Pathology, Brigham and Women's Hospital, Boston, Massachusetts.
Insights
CD23 antigen expression helps differentiate small lymphocytic lymphoma/chronic lymphocytic leukemia (SLL/CLL) from mantle cell lymphoma (MCL). Most SLL/CLL cases show CD23 reactivity, while MCL cases typically do not, aiding in diagnosis.
Area of Science:
- Hematology
- Immunology
- Oncology
Background:
- Distinguishing between low-grade B-cell lymphoproliferative disorders like small lymphocytic lymphoma/chronic lymphocytic leukemia (SLL/CLL) and mantle cell lymphoma (MCL) is crucial for accurate diagnosis and treatment.
- Immunophenotyping plays a key role in classifying B-cell lymphomas, but overlap in antigen expression can present diagnostic challenges.
Purpose of the Study:
- To evaluate the utility of CD23 immunoreactivity as a diagnostic marker to differentiate SLL/CLL from MCL.
- To assess the association of CD23 expression with specific subtypes of SLL/CLL, including plasmacytoid differentiation.
Main Methods:
- Comparative analysis of CD23 antigen expression using immunohistochemistry.
- Study included 22 cases of SLL/CLL and 15 cases of MCL.
- Evaluation of pan-B-cell antigens (CD20, CD22) for uniform reactivity across the studied groups.
Main Results:
- CD23 immunoreactivity was present in 95% of SLL/CLL cases versus only 13% of MCL cases.
- Lack of CD23 reactivity was statistically significantly associated with MCL (P < 0.0001).
- Lack of CD23 reactivity was also significantly associated with SLL with plasmacytoid differentiation compared to typical SLL (P < 0.0003).
Conclusions:
- CD23 immunoreactivity is a valuable marker for distinguishing SLL/CLL from MCL.
- The absence of CD23 expression is a strong indicator for MCL.
- CD23 can aid in routine immunophenotypic screening of low-grade B-cell lymphoproliferative processes.
Abstract:
Immunoreactivity for CD23, a B-cell activation antigen, was compared in 22 cases of B-cell small lymphocytic lymphoma (SLL)/chronic lymphocytic leukemia (CLL) and 15 cases of mantle cell lymphoma (MCL) (intermediate lymphocytic lymphoma or centrocytic lymphoma) to determine if the presence of this antigen can be used as a criterion to distinguish between these two low-grade B-cell lymphoproliferative processes. CD23 immunoreactivity was observed in 21 of 22 cases (95%) of SLL/CLL, whereas only 2 of 15 cases (13%) of MCL were reactive for this antigen; therefore, lack of CD23 reactivity is statistically significantly associated with MCL (P < 0.0001). In addition, lack of CD23 immunoreactivity is also statistically significantly associated with SLL with plasmacytoid differentiation in comparison with typical SLL (P < 0.0003), although only a small number of cases were evaluated. SLL/CLL, MCL, and SLL with plasmacytoid differentiation cases were all uniformly immunoreactive for pan-B-cell antigens such as CD20 and CD22. Immunoreactivity for CD23 appears to be a useful marker to aid in distinguishing SLL/CLL from MCL and may be helpful in routine immunophenotypic screening of low-grade B-cell derived lymphoproliferative processes.
