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file:PC.jpg|link={{filepath:PC.jpg}}
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[[file:HCL.jpg|200px|link=HCL.jpg]] 
<span style="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.  
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.
 
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.
 
 
'''CD45 expression'''
 
 
[[file:CLLCD45.jpg|300px|link=CLLCD45.jpg]] 




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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 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 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'''
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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:black;" |'''κ/λ'''
|colspan="1" style = "font-size:90%; color:black;" |CD38
|colspan="1" style = "background:#004466;"|
|colspan="1" style = "font-size:80%; width: 8%; |Stg
|colspan="1" style = "font-size:80%;"|Expect strong restricted expression of κ or λ
|-
|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 and may be strong in HCL
|colspan="1" style = "font-size:84%;"|The relatively strong expression of CD38 is typical of plasma cells
|-
|-
|colspan="1" style = "font-size:90%;" |'''CD11C'''
|colspan="1" style = "font-size:90%;" |CD138
|colspan="1" style = "background:#004466;"|
|colspan="1" style = "font-size:80%;"|Stg
|colspan="1" style = "font-size:84%;"|Strong expression of CD11c is typical of HCL
|-
|colspan="1" style = "font-size:90%; color:black;" |'''CD25'''
|colspan="1" style = "background:#004466;"|
|colspan="1" style = "background:#004466;"|
|colspan="1" style = "font-size:80%;"|wk
|colspan="1" style = "font-size:80%;"|var
|colspan="1" style = "font-size:84%;"|A typical and most frequently strongly expressed marker
|colspan="1" style = "font-size:84%;"|Expression is expected although the intensity can vary
|-
|-
|colspan="1" style = "font-size:90%; color:black;" |'''FMC7'''
|colspan="1" style = "width: 4%; font-size:90%; color:black;" |κ/λ
|colspan="1" style = "background:#004466;"|
|colspan="1" style = "width: 8%; background:#E6FAFF;"|
|colspan="1" style = "font-size:80%;"|Stg
|colspan="1" style = "font-size:80%; width: 8%; |
|colspan="1" style = "font-size:80%;"|Typically this marker is strongly expressed
|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%;" |'''CD103'''
|colspan="1" style = "font-size:90%; color:black;" |CD19
|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:84%;"|Expression of CD19 may persist in some cases
|-
|-
!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%; color:black;" |CD5
|colspan="1" style = "background:#00b8e6;"|
|colspan="1" style = "background:#E6FAFF;"|
|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:80%;"|Not detected on plasma cells
|-
|-
|colspan="1" style = "font-size:90%;" |CD10
|colspan="1" style = "font-size:90%;" |CD10
|colspan="1" style = "background:#00b8e6;"|
|colspan="1" style = "background:#E6FAFF;"|
|colspan="1" style = "font-size:80%;"|-
|colspan="1" style = "font-size:80%;"|-
|colspan="1" style = "font-size:84%;"|Infrequently expressed in typical HCL
|colspan="1" style = "font-size:84%;"|
|-
|colspan="1" style = "font-size:90%;" |CD11C
|colspan="1" style = "background:#E6FAFF;"|
|colspan="1" style = "font-size:80%;"|-
|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%;"|Stg
|colspan="1" style = "font-size:80%;"|-
|colspan="1" style = "font-size:84%;"|Expression is expected, and typically strong
|colspan="1" style = "font-size:84%;"|Expression retained in some cases
|-
|-
|colspan="1" style = "font-size:90%; color:black;" |CD23
|colspan="1" style = "font-size:90%; color:black;" |CD23
|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%;"|Expression of CD23 is infrequent in HCL
|colspan="1" style = "font-size:84%;"|
|-
|-
|colspan="1" style = "font-size:90%; color:black;" |CD38
|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%;"|Not typically expressed by HCL, may be seen
|colspan="1" style = "font-size:84%;"|
|-
|-
|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%;"|Tends to be expressed at relatively high intensity
|colspan="1" style = "font-size:84%;"|Generally not expressed by LPL
|-
|-
|colspan="1" style = "font-size:90%; color:black;" |CD79b
|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
|colspan="1" style = "font-size:84%;"|Expressed in some cases
|-
|-
|colspan="1" style = "font-size:90%;" |CD138
|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%;"|Predominantly by cells with plasma cell differentiation
|colspan="1" style = "font-size:84%;"|
|-
|-
|colspan="1" style = "font-size:90%; color:black;" |CD200
|colspan="1" style = "font-size:90%; color:black;" |CD200
|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%;"|Characteristically positive in HCL and often strong
|colspan="1" style = "font-size:84%;"|Detected frequently|-|}
|-
|colspan="1" style = "font-size:90%; color:black;" |FMC7
|colspan="1" style = "background:#E6FAFF;"|
|colspan="1" style = "font-size:80%;"|
|colspan="1" style = "font-size:80%;"|Not expressed
|-
|-
|}
|}
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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 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


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