Flow cytometry: Chronic Lymphocytic leukaemia: Difference between revisions
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(Created page with "<span style="color: navy>'''Background'''</span> Typical CLL can be diagnosed with some confidence using flow cytometry. 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. Note also that cases with a low lymphocytosis (<1x10<...") |
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<span style="color: navy>'''Background to flow cytometric diagnosis'''</span> | |||
However, individual markers may not be expressed in all cases - | 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 (<1x10<sup>9</sup>) may represent monoclonal B-lymphocytosis with CLL phenotype [[Monoclonal B lymphocytosis|(click here for diagnostic criteria)]]. | |||
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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