Flow cytometry: Chronic Lymphocytic leukaemia: Difference between revisions
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file:CLL.jpg|link={{filepath:CLL.jpg}} | |||
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<span style="color: navy>'''Background to flow cytometric diagnosis'''</span> | <span style="color: navy>'''Background to flow cytometric diagnosis'''</span> | ||
Typical CLL can be diagnosed with some confidence using flow cytometry. | Typical CLL can be diagnosed with some confidence using flow cytometry. However, individual markers may not be expressed in all cases - particularly it may be difficult to distinguish atypical CLL from some cases of MCL or MZL. | ||
*Atypical features should always be reported and the possibility of alternative diagnoses acknowledged. | |||
However, individual markers may not be expressed in all cases - | *Cases with a low lymphocytosis (<1x10<sup>9</sup>) may represent monoclonal B-lymphocytosis with CLL phenotype [[Monoclonal B lymphocytosis|(click here for diagnostic criteria)]]. | ||
<div style="width: 95%; overflow: auto; border: 1px solid navy; font-size:100%"> | <div style="width: 95%; overflow: auto; border: 1px solid navy; font-size:100%"> | ||
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!colspan="4" style = "font-size:110%; color: navy; text-align:center; background:#DEE0DE;"|'''Immunophenotype of CLL''' | !colspan="4" style = "font-size:110%; color: navy; text-align:center; background:#DEE0DE;"|'''Immunophenotype of CLL''' | ||
|- | |- | ||
!colspan="4" style = "font-size:90%; background:#DAE8F2"|'''Major markers useful in CLL diagnosis | !colspan="4" style = "font-size:90%; background:#DAE8F2"|'''CD45''' expression | ||
|- | |||
|colspan="4" style = "font-size:90%; color:black;" |Typically expression of CD45 is less intense than normal T or B cells, with many cases showing variable expression with a wide spread of CD45 intensity. | |||
|- | |||
!colspan="4" style = "font-size:90%; background:#DAE8F2"|Major markers useful in CLL diagnosis | |||
|- | |- | ||
|colspan="1" style = "font-size:80%; width: 4%; |'''Marker''' | |colspan="1" style = "font-size:80%; width: 4%; |'''Marker''' | ||
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|colspan="1" style = "font-size:80%; width: 80%; |'''Comment''' | |colspan="1" style = "font-size:80%; width: 80%; |'''Comment''' | ||
|- | |- | ||
|colspan="1" style = "width: 4%; font-size:90%; color: | |colspan="1" style = "font-size:90%; color:black;" |'''CD19''' | ||
|colspan="1" style = "background:#004466;"| | |||
|colspan="1" style = "font-size:80%;"|- | |||
|colspan="1" style = "font-size:84%;"|Expression is expected, but less strong than normal B cells | |||
|- | |||
|colspan="1" style = "width: 4%; font-size:90%; color:black;" |'''κ/λ''' | |||
|colspan="1" style = "width: 8%; background:#00b8e6;"| | |colspan="1" style = "width: 8%; background:#00b8e6;"| | ||
|colspan="1" style = "font-size:80%; width: 8%; | | |colspan="1" style = "font-size:80%; width: 8%; | | ||
|colspan="1" style = "font-size:80%;"|Expect weak restricted κ or λ or absent expression | |colspan="1" style = "font-size:80%;"|Expect weak restricted κ or λ or absent expression | ||
|- | |- | ||
|colspan="1" style = "font-size:90%; color: | |colspan="1" style = "font-size:90%; color:black;" |'''CD5''' | ||
|colspan="1" style = "background:#004466;"| | |||
|colspan="1" style = "font-size:80%;"|- | |||
|colspan="1" style = "font-size:80%;"|Characteristic of CLL, usually less strong than on T cells | |||
|- | |||
|colspan="1" style = "font-size:90%; color:black;" |'''CD23''' | |||
|colspan="1" style = "background:#004466;"| | |||
|colspan="1" style = "font-size:80%;"|- | |||
|colspan="1" style = "font-size:84%;"|Characteristic of CLL, although can rarely be weak or absent | |||
|- | |||
|colspan="1" style = "font-size:90%; color:black;" |'''CD79b''' | |||
|colspan="1" style = "background:#004466;"| | |||
|colspan="1" style = "font-size:80%;"|wk | |||
|colspan="1" style = "font-size:84%;"|Expression is expected, but characteristically weak | |||
|- | |||
|colspan="1" style = "font-size:90%; color:black;" |'''CD200''' | |||
|colspan="1" style = "background:#004466;"| | |||
|colspan="1" style = "font-size:80%;"|- | |||
|colspan="1" style = "font-size:84%;"|Characteristically positive in CLL and negative in MCL | |||
|- | |||
|colspan="1" style = "font-size:90%; color:black;" |'''FMC7''' | |||
|colspan="1" style = "background:#66e0ff;"| | |colspan="1" style = "background:#66e0ff;"| | ||
|colspan="1" style = "font-size:80%;"| | |colspan="1" style = "font-size:80%;"| | ||
|colspan="1" style = "font-size:80%;"|May be expressed by atypical cases, generally absent | |colspan="1" style = "font-size:80%;"|May be expressed by atypical cases, generally absent | ||
|- | |- | ||
!colspan="4" style = "font-size:90%; background:#DAE8F2"|Other relevant markers | |||
|- | |- | ||
|colspan="1" style = "font-size:90%;" |CD10 | |colspan="1" style = "font-size:90%;" |CD10 | ||
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|colspan="1" style = "font-size:80%;"|wk | |colspan="1" style = "font-size:80%;"|wk | ||
|colspan="1" style = "font-size:84%;"|Expressed in some cases, but tends to be weak | |colspan="1" style = "font-size:84%;"|Expressed in some cases, but tends to be weak | ||
|- | |- | ||
|colspan="1" style = "font-size:90%;" |CD20 | |colspan="1" style = "font-size:90%;" |CD20 | ||
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|colspan="1" style = "font-size:80%;"|wk | |colspan="1" style = "font-size:80%;"|wk | ||
|colspan="1" style = "font-size:84%;"|Expression is expected, but characteristically weak | |colspan="1" style = "font-size:84%;"|Expression is expected, but characteristically weak | ||
|- | |- | ||
|colspan="1" style = "font-size:90%; color:black;" |CD25 | |colspan="1" style = "font-size:90%; color:black;" |CD25 | ||
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|colspan="1" style = "font-size:80%;"|- | |colspan="1" style = "font-size:80%;"|- | ||
|colspan="1" style = "font-size:84%;"|Similar to CD200, may be helpful in some cases | |colspan="1" style = "font-size:84%;"|Similar to CD200, may be helpful in some cases | ||
|- | |- | ||
|colspan="1" style = "font-size:90%;" |CD103 | |colspan="1" style = "font-size:90%;" |CD103 | ||
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|colspan="1" style = "font-size:80%;"|- | |colspan="1" style = "font-size:80%;"|- | ||
|colspan="1" style = "font-size:84%;"|Predominantly expressed at plasma cell differentiation | |colspan="1" style = "font-size:84%;"|Predominantly expressed at plasma cell differentiation | ||
|- | |- | ||
|} | |} | ||
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<span style="color:navy;font-size:80% ">'''Key to table: '''</span> | <span style="color:navy;font-size:80% ">'''Key to table: '''</span> | ||
<span style="font-size:80% ">Key to colour code for expression frequency [[Key_to_marker_expression_table|Click for link]]</span> | <span style="font-size:80% ">Key to colour code for expression frequency [[Key_to_marker_expression_table|Click for link]]</span> |
Latest revision as of 17:11, 13 July 2023
Background to flow cytometric diagnosis
Typical CLL can be diagnosed with some confidence using flow cytometry. However, individual markers may not be expressed in all cases - particularly it may be difficult to distinguish atypical CLL from some cases of MCL or MZL.
- Atypical features should always be reported and the possibility of alternative diagnoses acknowledged.
- Cases with a low lymphocytosis (<1x109) may represent monoclonal B-lymphocytosis with CLL phenotype (click here for diagnostic criteria).
Immunophenotype of CLL | |||
---|---|---|---|
CD45 expression | |||
Typically expression of CD45 is less intense than normal T or B cells, with many cases showing variable expression with a wide spread of CD45 intensity. | |||
Major markers useful in CLL diagnosis | |||
Marker | Freq | Level | Comment |
CD19 | - | Expression is expected, but less strong than normal B cells | |
κ/λ | Expect weak restricted κ or λ or absent expression | ||
CD5 | - | Characteristic of CLL, usually less strong than on T cells | |
CD23 | - | Characteristic of CLL, although can rarely be weak or absent | |
CD79b | wk | Expression is expected, but characteristically weak | |
CD200 | - | Characteristically positive in CLL and negative in MCL | |
FMC7 | May be expressed by atypical cases, generally absent | ||
Other relevant markers | |||
CD10 | - | Infrequent in CLL, consider FL if detected | |
CD11C | wk | Expressed in some cases, but tends to be weak | |
CD20 | wk | Expression is expected, but characteristically weak | |
CD25 | wk | Expressed by many cases of CLL but characteristically weak | |
CD38 | wk | Expressed by some cases of CLL, typically weak | |
CD43 | - | Similar to CD200, may be helpful in some cases | |
CD103 | - | Not expressed by CLL, consider HCL if found | |
CD138 | - | Predominantly expressed at plasma cell differentiation |
Key to table:
Key to colour code for expression frequency Click for link
Key to expression strength code and use Click for link