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Flow cytometry: Marginal Zone Lymphoma: Difference between revisions

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file:MZL.jpg|link={{filepath:MZL.jpg}}
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[[file:MZL.jpg|200px|link=MZL.jpg]] 
<span style="font-size:90%">''Typical MZL morphology, note the small/medium size, bland chromatin pattern in a slightly squared nucleus, and the tendency of cytoplasm to gently engage adjacent red cells''</span>




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A difficult diagnosis - flow cytometry can suggest a diagnosis, but the immunophenotype may overlap with related diagnoses including atypical cases of CLL and MCL. Generally it is correct to suggest the diagnosis, but recognise that the profile is not fully specific, and confirmation by other modalities may be required.
A difficult diagnosis - flow cytometry can suggest a diagnosis, but the immunophenotype may overlap with related diagnoses including atypical cases of CLL and MCL. Generally it is correct to suggest the diagnosis, but recognise that the profile is not fully specific, and confirmation by other modalities may be required.
'''CD45 Expression'''
[[file:MZLCD45.jpg|300px|link=MZLCD45.jpg]] 
<span style="font-size:90%">''Side scatter of CLL cells is typically low, with a broad range and relatively weak expression of CD45 compared with normal lymphocytes. The CLL cells (highlighted in blue) therefore tend to the left of normal T cells (red) - giving the CLL population a rather elongated "slug-like" shape.'




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!colspan="4" style = "font-size:110%; color: navy; text-align:center; background:#DEE0DE;"|'''Immunophenotype of MZL'''
!colspan="4" style = "font-size:110%; color: navy; text-align:center; background:#DEE0DE;"|'''Immunophenotype of MZL'''
|-
|-
!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 approaches that of normal T and B cells.
|-
!colspan="4" style = "font-size:90%; background:#DAE8F2"|Major markers useful in 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:navy;" |<u>'''κ/λ'''</u>
|colspan="1" style = "width: 4%; font-size:90%; color:black;" |κ/λ
|colspan="1" style = "width: 8%; background:#004466;"|
|colspan="1" style = "width: 8%; background:#004466;"|
|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%;"|Expect moderate or strong restricted κ or λ expression
|-
|-
|colspan="1" style = "font-size:90%; color:navy;" |<u>'''FMC7'''</u>
|colspan="1" style = "font-size:90%; color:black;" |FMC7
|colspan="1" style = "background:#006699;"|
|colspan="1" style = "background:#006699;"|
|colspan="1" style = "font-size:80%;"|-
|colspan="1" style = "font-size:80%;"|-
|colspan="1" style = "font-size:80%;"|FMC7 may be expressed in MZL and may be strong
|colspan="1" style = "font-size:80%;"|FMC7 may be expressed in MZL and may be strong
|-
|-
|colspan="1" style = "font-size:90%; color:navy;" |<u>'''CD5'''</u>
|colspan="1" style = "font-size:90%; color:black;" |CD5
|colspan="1" style = "background:#66e0ff;"|
|colspan="1" style = "background:#66e0ff;"|
|colspan="1" style = "font-size:80%;"|-
|colspan="1" style = "font-size:80%;"|-
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|colspan="1" style = "font-size:84%;"|Frequently expressed in MZL and should be looked for
|colspan="1" style = "font-size:84%;"|Frequently expressed in MZL and should be looked for
|-
|-
|colspan="1" style = "font-size:90%; color:navy;" |<u>'''CD19'''</u>
|colspan="1" style = "font-size:90%; color:black;" |CD19
|colspan="1" style = "background:#004466;"|
|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, typically more strongly than in CLL
|colspan="1" style = "font-size:84%;"|Expression is expected, typically more strongly than in CLL
|-
!colspan="4" style = "font-size:90%; background:#DAE8F2"|Other relevant markers
|-
|-
|colspan="1" style = "font-size:90%;" |CD20
|colspan="1" style = "font-size:90%;" |CD20
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|colspan="1" style = "font-size:84%;"|Expression is expected, typically stronger than CLL
|colspan="1" style = "font-size:84%;"|Expression is expected, typically stronger than CLL
|-
|-
|colspan="1" style = "font-size:90%; color:navy;" |<u>'''CD23'''</u>
|colspan="1" style = "font-size:90%; color:black;" |CD23
|colspan="1" style = "background:#66e0ff;"|
|colspan="1" style = "background:#66e0ff;"|
|colspan="1" style = "font-size:80%;"|-
|colspan="1" style = "font-size:80%;"|-
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|colspan="1" style = "background:#004466;"|
|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 in MCL but CD138 should be absent
|colspan="1" style = "font-size:84%;"|Expression is expected in MZL but CD138 should be absent
|-
|-
|colspan="1" style = "font-size:90%;" |CD43
|colspan="1" style = "font-size:90%;" |CD43
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|colspan="1" style = "font-size:84%;"|Lower expression than in CLL, may be helpful in some cases
|colspan="1" style = "font-size:84%;"|Lower expression than in CLL, may be helpful in some cases
|-
|-
|colspan="1" style = "font-size:90%; color:navy;" |<u>'''CD79b'''</u>
|colspan="1" style = "font-size:90%; color:black;" |CD79b
|colspan="1" style = "background:#004466;"|
|colspan="1" style = "background:#004466;"|
|colspan="1" style = "font-size:80%;"|
|colspan="1" style = "font-size:80%;"|
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|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 MCL, consider HCL if found
|colspan="1" style = "font-size:84%;"|Not expected in MZL, consider HCL if found
|-
|-
|colspan="1" style = "font-size:90%;" |CD138
|colspan="1" style = "font-size:90%;" |CD138
|colspan="1" style = "background:#E6FAFF;"|
|colspan="1" style = "background:#66e0ff;"|
|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%;"|Expression may occur in MZL
|-
|-
|colspan="1" style = "font-size:90%; color:navy;" |<u>'''CD200'''</u>
|colspan="1" style = "font-size:90%; color:black;" |CD200
|colspan="1" style = "background:#E6FAFF;"|
|colspan="1" style = "background:#66e0ff;"|
|colspan="1" style = "font-size:80%;"|-
|colspan="1" style = "font-size:80%;"|-
|colspan="1" style = "font-size:84%;"|Characteristically (though not always) negative in MCL
|colspan="1" style = "font-size:84%;"|Expression is obseved in MZL
|-
|-
|}
|}
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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% ">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 17:18, 13 July 2023

  • MZL.jpg


Background to flow cytometric diagnosis

A difficult diagnosis - flow cytometry can suggest a diagnosis, but the immunophenotype may overlap with related diagnoses including atypical cases of CLL and MCL. Generally it is correct to suggest the diagnosis, but recognise that the profile is not fully specific, and confirmation by other modalities may be required.


Immunophenotype of MZL
CD45 expression
Typically expression of CD45 approaches that of normal T and B cells.
Major markers useful in diagnosis
Marker Freq Level Comment
κ/λ Expect moderate or strong restricted κ or λ expression
FMC7 - FMC7 may be expressed in MZL and may be strong
CD5 - Expression of CD5 is uncommon in MZL
CD10 - Infrequently expressed, expression may suggest FL
CD11C Frequently expressed in MZL and should be looked for
CD19 - Expression is expected, typically more strongly than in CLL
Other relevant markers
CD20 - Expression is expected, typically stronger than CLL
CD23 - Typically not expressed by MZL, may rarely be expressed
CD25 May be expressed by MZL, not generally strong as HCL
CD38 - Expression is expected in MZL but CD138 should be absent
CD43 - Lower expression than in CLL, may be helpful in some cases
CD79b Expression is expected and should be stronger than CLL
CD103 - Not expected in MZL, consider HCL if found
CD138 - Expression may occur in MZL
CD200 - Expression is obseved in MZL


Key to table:

Key to colour code for expression frequency Click for link

Key to expression strength code and use Click for link


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