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[[file:HCL.jpg|200px|link=HCL.jpg]]   
[[file:CLL.jpg|200px|link=CLL.jpg]]   
 
<span style="font-size:90%">''Typical HCL morphology, cells are medium size, with a partly activated chromatin pattern and oval or indented nuclear shape, the cytoplasm is typically blue/grey with irregular and fine projections (hairs)''</span>




<span style="color: navy>'''Background to flow cytometric diagnosis'''</span>
<span style="color: navy>'''Background to flow cytometric diagnosis'''</span>


HCL expresses typical and unusual markers that together with morphology can allow 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, no marker is unique to HCL and unusual marker patterns can lead to diagnostic difficulty. If this is the case then the atypical features should be reported, since histopathology and molecular testing can each be used to further evaluate these 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)]].
 
 
'''CD45 expression'''
 
 
[[file:CLLCD45.jpg|300px|link=CLLCD45.jpg]]
 
 
<span style="font-size:90%">blah blah</span>




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<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'''
!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 diagnosis
!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: 8%; |'''Level'''
|colspan="1" style = "font-size:80%; width: 8%; |'''Level'''
|colspan="1" style = "font-size:80%; width: 80%; |'''Comment'''
|colspan="1" style = "font-size:80%; width: 80%; |'''Comment'''
|-
|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: 4%; font-size:90%; color:black;" |'''κ/λ'''
|colspan="1" style = "background:#004466;"|
|colspan="1" style = "width: 8%; background:#00b8e6;"|
|colspan="1" style = "font-size:80%; width: 8%; |Stg
|colspan="1" style = "font-size:80%; width: 8%; |
|colspan="1" style = "font-size:80%;"|Expect strong restricted expression of κ or λ
|colspan="1" style = "font-size:80%;"|Expect weak restricted κ or λ or absent expression
|-
|-
|colspan="1" style = "font-size:90%; color:black;" |'''CD19'''
|colspan="1" style = "font-size:90%; color:black;" |'''CD5'''
|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 and may be strong in HCL
|colspan="1" style = "font-size:80%;"|Characteristic of CLL, usually less strong than on T cells
|-
|-
|colspan="1" style = "font-size:90%;" |'''CD11C'''
|colspan="1" style = "font-size:90%; color:black;" |'''CD23'''
|colspan="1" style = "background:#004466;"|
|colspan="1" style = "background:#004466;"|
|colspan="1" style = "font-size:80%;"|Stg
|colspan="1" style = "font-size:80%;"|-
|colspan="1" style = "font-size:84%;"|Strong expression of CD11c is typical of HCL
|colspan="1" style = "font-size:84%;"|Characteristic of CLL, although can rarely be weak or absent
|-
|-
|colspan="1" style = "font-size:90%; color:black;" |'''CD25'''
|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%;"|wk
|colspan="1" style = "font-size:80%;"|wk
|colspan="1" style = "font-size:84%;"|A typical and most frequently strongly expressed marker
|colspan="1" style = "font-size:84%;"|Expression is expected, but characteristically weak
|-
|-
|colspan="1" style = "font-size:90%; color:black;" |'''FMC7'''
|colspan="1" style = "font-size:90%; color:black;" |'''CD200'''
|colspan="1" style = "background:#004466;"|
|colspan="1" style = "background:#004466;"|
|colspan="1" style = "font-size:80%;"|Stg
|colspan="1" style = "font-size:80%;"|-
|colspan="1" style = "font-size:80%;"|Typically this marker is strongly expressed
|colspan="1" style = "font-size:84%;"|Characteristically positive in CLL and negative in MCL
|-
|-
|colspan="1" style = "font-size:90%;" |'''CD103'''
|colspan="1" style = "font-size:90%; color:black;" |'''FMC7'''
|colspan="1" style = "background:#004466;"|
|colspan="1" style = "background:#66e0ff;"|
|colspan="1" style = "font-size:80%;"|-
|colspan="1" style = "font-size:80%;"|
|colspan="1" style = "font-size:84%;"|A characteristic marker of HCL with good specificity
|colspan="1" style = "font-size:80%;"|May be expressed by atypical cases, generally absent
|-
|-
!colspan="4" style = "font-size:90%; background:#DAE8F2"|Other useful markers
!colspan="4" style = "font-size:90%; background:#DAE8F2"|Other relevant markers  
|-
|-
|colspan="1" style = "font-size:90%; color:black;" |CD5
|colspan="1" style = "font-size:90%;" |CD10
|colspan="1" style = "background:#00b8e6;"|
|colspan="1" style = "background:#00b8e6;"|
|colspan="1" style = "font-size:80%;"|-
|colspan="1" style = "font-size:80%;"|-
|colspan="1" style = "font-size:80%;"|Infrequent but reported in some cases
|colspan="1" style = "font-size:84%;"|Infrequent in CLL, consider FL if detected
|-
|-
|colspan="1" style = "font-size:90%;" |CD10
|colspan="1" style = "font-size:90%;" |CD11C
|colspan="1" style = "background:#00b8e6;"|
|colspan="1" style = "background:#00b8e6;"|
|colspan="1" style = "font-size:80%;"|-
|colspan="1" style = "font-size:80%;"|wk
|colspan="1" style = "font-size:84%;"|Infrequently expressed in typical HCL
|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
|colspan="1" style = "background:#004466;"|
|colspan="1" style = "background:#004466;"|
|colspan="1" style = "font-size:80%;"|Stg
|colspan="1" style = "font-size:80%;"|wk
|colspan="1" style = "font-size:84%;"|Expression is expected, and typically strong
|colspan="1" style = "font-size:84%;"|Expression is expected, but characteristically weak
|-
|-
|colspan="1" style = "font-size:90%; color:black;" |CD23
|colspan="1" style = "font-size:90%; color:black;" |CD25
|colspan="1" style = "background:#E6FAFF;"|
|colspan="1" style = "background:#00b8e6;"|
|colspan="1" style = "font-size:80%;"|-
|colspan="1" style = "font-size:80%;"|wk
|colspan="1" style = "font-size:84%;"|Expression of CD23 is infrequent in HCL
|colspan="1" style = "font-size:84%;"|Expressed by many cases of CLL but characteristically weak
|-
|-
|colspan="1" style = "font-size:90%; color:black;" |CD38
|colspan="1" style = "font-size:90%; color:black;" |CD38
|colspan="1" style = "background:#00b8e6;"|
|colspan="1" style = "background:#66e0ff;"|
|colspan="1" style = "font-size:80%;"|wk
|colspan="1" style = "font-size:80%;"|wk
|colspan="1" style = "font-size:84%;"|Not typically expressed by HCL, may be seen
|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:#004466;"|
|colspan="1" style = "font-size:80%;"|-
|colspan="1" style = "font-size:80%;"|-
|colspan="1" style = "font-size:84%;"|Tends to be expressed at relatively high intensity
|colspan="1" style = "font-size:84%;"|Similar to CD200, may be helpful in some cases
|-
|-
|colspan="1" style = "font-size:90%; color:black;" |CD79b
|colspan="1" style = "font-size:90%;" |CD103
|colspan="1" style = "background:#004466;"|
|colspan="1" style = "background:#E6FAFF;"|
|colspan="1" style = "font-size:80%;"|wk
|colspan="1" style = "font-size:80%;"|-
|colspan="1" style = "font-size:84%;"|Expression is expected
|colspan="1" style = "font-size:84%;"|Not expressed by CLL, 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:#E6FAFF;"|
|colspan="1" style = "font-size:80%;"|-
|colspan="1" style = "font-size:80%;"|-
|colspan="1" style = "font-size:84%;"|Predominantly by cells with plasma cell differentiation  
|colspan="1" style = "font-size:84%;"|Predominantly expressed at plasma cell differentiation  
|-
|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 HCL and often strong
|-
|-
|}
|}
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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>

Revision as of 16:15, 11 July 2023

CLL.jpg


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
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


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