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Ipertesto Neoplasie

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Leucemia linfatica cronica B

(linfoma linfocitico) ICD-O code 9823/3

L'analisi immunofenotipica proposta nella REAL è basata sull'analisi citometrica su cellule fresche. La caratterizzazione precisa può essere però effettuata anche su materiale di routine (linfonodo o biopsia osteomidollare).

PROGNOSI

DIAGNOSI

Caso 1. Biopsia osteomidollare

infiltrato linfoide interstiziale e diffuso costituito da elementi di piccola taglia a fenotipo: CD79+, CD20+-, CD5+, CD23+, p27+

E.E.

CD20

L'espressione di CD20 è spesso molto debole nella B-CLL, con maggiore intensità nelle cellule dei centri di replicazione

Per la definizione della natura B dei linfociti della B CLL è più indicato il CD79a 

CD79a

 La caratterizzazione precisa della B CLL prevede la dimostrazione dell'espressione di CD23

e CD5+

Intensa espressione di CD5 di membrana nelle cellule linfoidi neoplastiche

la Ciclina D1/prad1 deve essere negativa (intensa espressione -controllo interno- in una cellula stromale)

Appl Immunohistochem Molecul Morphol 2000 Mar;8(1):1-11

Classification of small B-cell lymphoid neoplasms using a paraffin section immunohistochemical panel.

Chen CC, Raikow RB, Sonmez-Alpan E, Swerdlow SH

Department of Pathology, University of Pittsburgh School of Medicine, Pennsylvania 15213-2582, USA.

Immunophenotypic analysis is critical in categorizing small B-cell neoplasms; however, many recommended antibody panels have required fresh or frozen tissue. Many paraffin-reactive antibodies are now available but have been studied mostly in isolation. Therefore, the utility of a panel of paraffin-reactive antibodies in differentiating small B-cell neoplasms was investigated. Paraffin-embedded sections of small lymphocytic lymphoma/B-chronic lymphocytic leukemia (SLL/B-CLL; 12), mantle cell (MCL; 15), follicular (FL; 11), and marginal zone B-cell (MZL; eight) lymphomas were stained with CD20/L26, CD3, CD43/DF-T1 or Leu22, CD5/4C7, CD23/BU38, cyclin D1/H295, and CD10/56C6 antibodies. For select antibodies, results were compared to flow cytometric data (FC). Formalin and B5 fixation were also compared. Seven of 11 SLL/B-CLL were CD43+ CD5+ CD23+ cyclin D1- CD10-; seven of 11 MCL were CD43+ CD5+ CD23- cyclin D1+ CD10-; nine of 10 FL were CD43- CD5- CD23- cyclin D1- CD10+; and five of six MZL were CD43+ CD5- CD23- cyclin D1- CD10-. CD5, CD23, and CD10 stains showed sensitivities of 81, 88, and 100%, respectively, compared to FC. With B5 fixation, cyclin D1 was more often negative and CD5 more often equivocal. A panel of paraffin-reactive antibodies aids in classification of small B-cell neoplasms, although a small number of cases have indeterminate phenotypes and MZL have no defining features. CD5 separates most SLL/B-CLL and MCL from FL and MZL. CD23 separates SLL/B-CLL from most MCL, but cyclin D1 is most important for identifying MCL. CD10 positivity distinguishes most FL from other small B-cell lymphoid neoplasms.