Actions

Test: Difference between revisions

From haematologyetc.co.uk

No edit summary
No edit summary
 
(88 intermediate revisions by the same user not shown)
Line 1: Line 1:
----
<gallery mode="nolines" widths="200px" heights="200px" border="1px" >
file:PC.jpg|link={{filepath:PC.jpg}}
</gallery>
----




<span style="color: navy>'''Background'''</span>


Typical CLL can be diagnosed with some confidence using flow cytometry.
<span style="color: navy>'''Background to flow cytometric diagnosis'''</span>


However, individual markers may not be expressed in all cases - this can cause diagnostic difficulty particularly in distinguishing CLL from atypical cases of MCL or MZL. If this is the case then the atypical features should be reported, and the possibility of alternative diagnoses acknowledged.
Differentiation to plasma cells involves (in mast cases) the loss of typical pan B-cell markers and surface light chains. The expression of CD45 also differs both within and between cases making standard gating strategies difficult to apply. Cells are most often identified through their co-expression of CD138 with a relatively high expression of CD38, together with the absence of typical B-cell features.
 
Note also that cases with a low lymphocytosis (<1x10<sup>9</sup>) may represent monoclonal B-lymphocytosis with CLL phenotype [[Monoclonal B lymphocytosis|(click here for more)]].  




Line 13: Line 15:
<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%">
{| class="wikitable" style="color:black; background-color:#ffffff;" cellpadding="5"
{| class="wikitable" style="color:black; background-color:#ffffff;" cellpadding="5"
!colspan="4" style = "font-size:110%; color: navy; text-align:center; background:#DEE0DE;"|'''Immunophenotype of MCL'''
!colspan="4" style = "font-size:110%; color: navy; text-align:center; background:#DEE0DE;"|'''Immunophenotype of plasma cells'''
|-
!colspan="4" style = "font-size:90%; background:#DAE8F2"|'''CD45''' expression
|-
|colspan="4" style = "font-size:90%; color:black;" |There is no consistent pattern of expression of CD45 although it is most often weak, but may be variable and is occasionally strong.
|-
|-
!colspan="4" style = "font-size:90%; background:#DAE8F2"|'''Major markers useful in CLL diagnosis'''
!colspan="4" style = "font-size:90%; background:#DAE8F2"|Major markers useful in plasma cell identification
|-
|-
|colspan="1" style = "font-size:80%; width: 4%; |'''Marker'''
|colspan="1" style = "font-size:80%; width: 4%; |'''Marker'''
Line 22: Line 28:
|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:navy;" |<u>'''κ/λ'''</u>
|colspan="1" style = "font-size:90%; color:black;" |CD38
|colspan="1" style = "width: 8%; background:#004466;"|
|colspan="1" style = "background:#004466;"|
|colspan="1" style = "font-size:80%;"|-
|colspan="1" style = "font-size:84%;"|The relatively strong expression of CD38 is typical of plasma cells
|-
|colspan="1" style = "font-size:90%;" |CD138
|colspan="1" style = "background:#004466;"|
|colspan="1" style = "font-size:80%;"|var
|colspan="1" style = "font-size:84%;"|Expression is expected although the intensity can vary
|-
|colspan="1" style = "width: 4%; font-size:90%; color:black;" |κ/λ
|colspan="1" style = "width: 8%; background:#E6FAFF;"|
|colspan="1" style = "font-size:80%; width: 8%; |
|colspan="1" style = "font-size:80%; width: 8%; |
|colspan="1" style = "font-size:80%;"|Expect moderate or strong restricted κ or λ expression
|colspan="1" style = "font-size:80%;"|Surface light chain expression is lost (internal will be detected in permeabilised cells)
|-
|-
|colspan="1" style = "font-size:90%; color:navy;" |<u>'''FMC7'''</u>
|colspan="1" style = "font-size:90%; color:black;" |CD19
|colspan="1" style = "background:#006699;"|
|colspan="1" style = "background:#66e0ff;"|
|colspan="1" style = "font-size:80%;"|-
|colspan="1" style = "font-size:80%;"|-
|colspan="1" style = "font-size:80%;"|FMC7 is frequently expressed by typical MCL
|colspan="1" style = "font-size:84%;"|Expression of CD19 may persist in some cases
|-
|-
|colspan="1" style = "font-size:90%; color:navy;" |<u>'''CD5'''</u>
!colspan="4" style = "font-size:90%; background:#DAE8F2"|Other relevant markers
|colspan="1" style = "background:#004466;"|
|-
|colspan="1" style = "font-size:90%; color:black;" |CD5
|colspan="1" style = "background:#E6FAFF;"|
|colspan="1" style = "font-size:80%;"|-
|colspan="1" style = "font-size:80%;"|-
|colspan="1" style = "font-size:80%;"|Expression of CD5 is characteristic of MCL
|colspan="1" style = "font-size:80%;"|Not detected on plasma cells
|-
|-
|colspan="1" style = "font-size:90%;" |CD10
|colspan="1" style = "font-size:90%;" |CD10
|colspan="1" style = "background:#66e0ff;"|
|colspan="1" style = "background:#E6FAFF;"|
|colspan="1" style = "font-size:80%;"|-
|colspan="1" style = "font-size:80%;"|-
|colspan="1" style = "font-size:84%;"|Rare in CLL, consider FL if detected
|colspan="1" style = "font-size:84%;"|
|-
|-
|colspan="1" style = "font-size:90%;" |CD11C
|colspan="1" style = "font-size:90%;" |CD11C
|colspan="1" style = "background:#66e0ff;"|
|colspan="1" style = "background:#E6FAFF;"|
|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:90%; color:navy;" |<u>'''CD19'''</u>
|colspan="1" style = "background:#004466;"|
|colspan="1" style = "font-size:80%;"|-
|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 = "font-size:84%;"|
|-
|-
|colspan="1" style = "font-size:90%;" |CD20
|colspan="1" style = "font-size:90%;" |CD20
|colspan="1" style = "background:#004466;"|
|colspan="1" style = "background:#66e0ff;"|
|colspan="1" style = "font-size:80%;"|wk
|colspan="1" style = "font-size:80%;"|-
|colspan="1" style = "font-size:84%;"|Expression is expected, but characteristically weak
|colspan="1" style = "font-size:84%;"|Expression retained in some cases
|-
|-
|colspan="1" style = "font-size:90%; color:navy;" |<u>'''CD23'''</u>
|colspan="1" style = "font-size:90%; color:black;" |CD23
|colspan="1" style = "background:#004466;"|
|colspan="1" style = "background:#E6FAFF;"|
|colspan="1" style = "font-size:80%;"|-
|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:84%;"|
|-
|-
|colspan="1" style = "font-size:90%; color:black;" |CD25
|colspan="1" style = "font-size:90%; color:black;" |CD25
|colspan="1" style = "background:#00b8e6;"|
|colspan="1" style = "background:#E6FAFF;"|
|colspan="1" style = "font-size:80%;"|wk
|colspan="1" style = "font-size:80%;"|-
|colspan="1" style = "font-size:84%;"|Expressed by many cases of CLL but characteristically weak
|colspan="1" style = "font-size:84%;"|
|-
|colspan="1" style = "font-size:90%; color:black;" |CD38
|colspan="1" style = "background:#66e0ff;"|
|colspan="1" style = "font-size:80%;"|wk
|colspan="1" style = "font-size:84%;"|Expressed by some cases of CLL, typically weak
|-
|-
|colspan="1" style = "font-size:90%;" |CD43
|colspan="1" style = "font-size:90%;" |CD43
|colspan="1" style = "background:#004466;"|
|colspan="1" style = "background:#006699;"|
|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%;"|Generally not expressed by LPL
|-
|-
|colspan="1" style = "font-size:90%; color:navy;" |<u>'''CD79a'''</u>
|colspan="1" style = "font-size:90%; color:black;" |CD79b
|colspan="1" style = "background:#004466;"|
|colspan="1" style = "background:#66e0ff;"|
|colspan="1" style = "font-size:80%;"|wk
|colspan="1" style = "font-size:80%;"|-
|colspan="1" style = "font-size:84%;"|Expression is expected, but characteristically weak
|colspan="1" style = "font-size:84%;"|Expressed in some cases
|-
|-
|colspan="1" style = "font-size:90%;" |CD103
|colspan="1" style = "font-size:90%;" |CD103
|colspan="1" style = "background:#E6FAFF;"|
|colspan="1" style = "background:#E6FAFF;"|
|colspan="1" style = "font-size:80%;"|-
|colspan="1" style = "font-size:80%;"|-
|colspan="1" style = "font-size:84%;"|Not expressed by CLL, consider HCL if found
|colspan="1" style = "font-size:84%;"|
|-
|-
|colspan="1" style = "font-size:90%;" |CD138
|colspan="1" style = "font-size:90%; color:black;" |CD200
|colspan="1" style = "background:#E6FAFF;"|
|colspan="1" style = "background:#006699;"|
|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%;"|Detected frequently|-|}
|-
|-
|colspan="1" style = "font-size:90%; color:navy;" |<u>'''CD200'''</u>
|colspan="1" style = "font-size:90%; color:black;" |FMC7
|colspan="1" style = "background:#004466;"|
|colspan="1" style = "background:#E6FAFF;"|
|colspan="1" style = "font-size:80%;"|-
|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:80%;"|Not expressed
|-
|-
|}
|}
Line 103: Line 111:


<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% ">Markers most useful in initial diagnosis are <span style=color:navy><u>underlined in blue text</u></span></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 18:09, 14 July 2023

  • PC.jpg


Background to flow cytometric diagnosis

Differentiation to plasma cells involves (in mast cases) the loss of typical pan B-cell markers and surface light chains. The expression of CD45 also differs both within and between cases making standard gating strategies difficult to apply. Cells are most often identified through their co-expression of CD138 with a relatively high expression of CD38, together with the absence of typical B-cell features.


Immunophenotype of plasma cells
CD45 expression
There is no consistent pattern of expression of CD45 although it is most often weak, but may be variable and is occasionally strong.
Major markers useful in plasma cell identification
Marker Freq Level Comment
CD38 - The relatively strong expression of CD38 is typical of plasma cells
CD138 var Expression is expected although the intensity can vary
κ/λ Surface light chain expression is lost (internal will be detected in permeabilised cells)
CD19 - Expression of CD19 may persist in some cases
Other relevant markers
CD5 - Not detected on plasma cells
CD10 -
CD11C -
CD20 - Expression retained in some cases
CD23 -
CD25 -
CD43 - Generally not expressed by LPL
CD79b - Expressed in some cases
CD103 -
CD200 - Detected frequently|-|}
FMC7 Not expressed


Key to table:

Key to colour code for expression frequency Click for link

Key to expression strength code and use Click for link


Retrieved from ‘https://haematologyetc.co.uk/index.php?title=Test&oldid=2733’