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Hadžisejdić I, Klarica L, Babarović E, Marijić B, Valković T, Jonjić N. Primary Nodal Unclassifiable CD20 Negative Diffuse Large B-cell Lymphoma With Dual IgK and TCR Gene Rearrangement: A Diagnostic Challenge. CLINICAL PATHOLOGY (THOUSAND OAKS, VENTURA COUNTY, CALIF.) 2023; 16:2632010X221149978. [PMID: 36684058 PMCID: PMC9846588 DOI: 10.1177/2632010x221149978] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Accepted: 12/20/2022] [Indexed: 01/17/2023]
Abstract
Non-Hodgkin lymphomas are most frequently classified based on the lineage marker expression. However, lymphomas with aberrant marker expression as well as monoclonal IgH/IgΚ and TCR gene rearrangements may co-exist which can be misleading and confusing. Primary CD20 negative diffuse large B-cell lymphomas (DLBCL) represent a rare entity, and they account for 1% to 3% of cases. However, some CD20 negative DLBCLs could not be classified into known variants, creating both diagnostic and therapeutic dilemma's. Primary CD20 negative DLBCL are more likely to have a non-germinal centre subtype, a higher proliferation index, more frequent extra-nodal involvement, a poorer response, and poorer prognosis to conventional treatment compared to CD20 positive DLBCL. A 66- year-old postmenopausal lady, presented with palpable, bilateral neck lymphadenopathy and difficulty swallowing. She also had left leg lymphoedema, poor appetited, fatigue and weight loss. Her symptoms lasted approximately 1 month. After histological, immunohistochemical and clonality analysis of the lymph node the patient was diagnosed with primary nodal CD20 and PAX-5 negative DLBCL with dual immunoglobulin light-chain kappa (IgK) and T-cell receptor (TCR) gene rearrangement. This unusual and unique case presented a diagnostic challenge because it was CD20 and PAX-5 negative, had dual IgK and TCR gene rearrangement and, it could not be classified within the known and well established CD20 negative DLBCL variants. Describing such cases emphasises the fact that lymphomas unclassifiable within known variants of CD20 negative DLBCL do exist and that range and heterogeneity of CD20 negative DLBCL continues to evolve, and pathologist should be aware of these uncommon, atypical mature B-cell neoplasms.
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Affiliation(s)
- Ita Hadžisejdić
- Clinical Department of Pathology and
Cytology, Clinical Hospital Center Rijeka, Rijeka, Croatia,Department of Pathology, Faculty of
Medicine, University of Rijeka, Rijeka, Croatia,Ita Hadžisejdić, Clinical Department of
Pathology and Cytology, Clinical Hospital Center Rijeka, Krešimirova 42, Rijeka
51000, Croatia.
| | - Lucia Klarica
- Department of Pathology, Faculty of
Medicine, University of Rijeka, Rijeka, Croatia
| | - Emina Babarović
- Clinical Department of Pathology and
Cytology, Clinical Hospital Center Rijeka, Rijeka, Croatia,Department of Pathology, Faculty of
Medicine, University of Rijeka, Rijeka, Croatia
| | - Blažen Marijić
- Department of Otorhinolaryngology and
Head and Neck Surgery, Clinical Hospital Center Rijeka, Rijeka, Croatia,Department of Otorhinolaryngology,
Faculty of Medicine, University of Rijeka, Rijeka, Croatia
| | - Toni Valković
- Department of Haematology, Clinical
Hospital Center Rijeka, Rijeka, Croatia,Department of Internal Medicine,
Faculty of Medicine, University of Rijeka, Rijeka, Croatia
| | - Nives Jonjić
- Clinical Department of Pathology and
Cytology, Clinical Hospital Center Rijeka, Rijeka, Croatia,Department of Pathology, Faculty of
Medicine, University of Rijeka, Rijeka, Croatia
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Feline and Canine Cutaneous Lymphocytosis: Reactive Process or Indolent Neoplastic Disease? Vet Sci 2022; 9:vetsci9010026. [PMID: 35051110 PMCID: PMC8778986 DOI: 10.3390/vetsci9010026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Revised: 01/04/2022] [Accepted: 01/10/2022] [Indexed: 02/01/2023] Open
Abstract
Cutaneous lymphocytosis (CL) is an uncommon and controversial lymphoproliferative disorder described in dogs and cats. CL is generally characterized by a heterogeneous clinical presentation and histological features that may overlap with epitheliotropic lymphoma. Therefore, its neoplastic or reactive nature is still debated. Here, we describe clinicopathological, immunohistochemical, and clonality features of a retrospective case series of 19 cats and 10 dogs with lesions histologically compatible with CL. In both species, alopecia, erythema, and scales were the most frequent clinical signs. Histologically, a dermal infiltrate of small to medium-sized lymphocytes, occasionally extending to the subcutis, was always identified. Conversely, when present, epitheliotropism was generally mild. In cats, the infiltrate was consistently CD3+; in dogs, a mixture of CD3+ and CD20+ lymphocytes was observed only in 4 cases. The infiltrate was polyclonal in all cats, while BCR and TCR clonal rearrangements were identified in dogs. Overall, cats had a long-term survival (median overall survival = 1080 days) regardless of the treatment received, while dogs showed a shorter and variable clinical course, with no evident associations with clinicopathological features. In conclusion, our results support a reactive nature of the disease in cats, associated with prolonged survival; despite a similar histological picture, canine CL is associated with a more heterogeneous lymphocytic infiltrate, clonality results, and response to treatment, implying a more challenging discrimination between CL and CEL in this species. A complete diagnostic workup and detailed follow-up information on a higher number of cases is warrant for dogs.
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Nicoletti A, Aresu L, Marino M, Massaro M, Martignani E, Caporali E, Capuccini S, Bonfanti U, Gola C. CD3-CD20-positive nodal lymphoma with cross-lineage rearrangement in a dog. J Vet Diagn Invest 2020; 32:964-967. [PMID: 33000710 DOI: 10.1177/1040638720963132] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
A 7-y-old mixed-breed male dog was presented with a history of generalized lymphadenopathy. Fine-needle aspirates of the enlarged peripheral lymph nodes were suggestive of lymphoma. Histologic examination of a retromandibular lymph node was suggestive of high-grade, medium large-cell lymphoma. Immunohistochemistry revealed concurrent expression of CD3 and CD20. The co-localization of the 2 antigens was confirmed by immunofluorescence. PCR for antigen receptor gene rearrangements (PARR) detected clonal rearrangements for both T-cell receptor gamma and B-cell receptor. The final diagnosis was CD3-CD20-positive anaplastic lymphoma with cross-lineage rearrangement.
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Affiliation(s)
- Arturo Nicoletti
- School of Agriculture and Veterinary Medicine, University of Turin, Grugliasco, Turin, Italy
| | - Luca Aresu
- School of Agriculture and Veterinary Medicine, University of Turin, Grugliasco, Turin, Italy
| | - Michele Marino
- Laboratorio La Vallonea, Passirana di Rho, Milano, Italy
| | - Maria Massaro
- Laboratorio La Vallonea, Passirana di Rho, Milano, Italy
| | - Eugenio Martignani
- School of Agriculture and Veterinary Medicine, University of Turin, Grugliasco, Turin, Italy
| | - Elisa Caporali
- Clinica Veterinaria San Rocco, Foiana della Chiana, Arezzo, Italy
| | - Silvia Capuccini
- Clinica Veterinaria San Rocco, Foiana della Chiana, Arezzo, Italy
| | - Ugo Bonfanti
- Laboratorio La Vallonea, Passirana di Rho, Milano, Italy
| | - Cecilia Gola
- School of Agriculture and Veterinary Medicine, University of Turin, Grugliasco, Turin, Italy
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Svachova M, Tichy M, Flodr P, Steigerova J, Kolar Z, Bouchal J. Clonality testing of lymphoproliferative disorders in a large cohort of primary and consultant biopsies. Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub 2017; 161:197-205. [DOI: 10.5507/bp.2017.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2016] [Accepted: 02/24/2017] [Indexed: 12/15/2022] Open
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Ismail A, Mallick JA, Qin D, Hussaini MO. Sentinel case of Richter transformation from chronic lymphocytic leukaemia/small lymphocytic lymphoma to CD3+ diffuse large B-cell lymphoma. J Clin Pathol 2016; 70:575-578. [PMID: 27899414 DOI: 10.1136/jclinpath-2016-204024] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2016] [Revised: 11/02/2016] [Accepted: 11/04/2016] [Indexed: 11/04/2022]
Abstract
AIM To report the first case of a Richter syndrome where small lymphocytic lymphoma (SLL) progressed to a CD3+ diffuse large B-cell lymphoma (DLBCL). METHODS Macrodissection of small and large cell lymphomatous components was performed. This was followed by flow cytometric analysis along with molecular B-cell immunoglobulin (heavy and light chains) and T-cell receptor (γ and β chains) gene rearrangement studies to investigate a clonal relationship between the components. RESULTS The immunophenotypic profile was similar between small and large cell components of the lymphoma by flow cytometry. Furthermore, shared clonal peaks were observed between both components based on molecular B-cell and T-cell receptor gene rearrangement studies, confirming a clonal relationship. CONCLUSIONS Chronic lymphocytic leukaemia/SLL may rarely undergo Richter transformation to a DLBCL demonstrating lineage infidelity. This is a potentially important diagnostic pitfall and such cases should not be confused with a de novo T-cell lymphoma.
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Affiliation(s)
- Ali Ismail
- University of Pikeville Kentucky College of Osteopathic Medicine, Pikeville, Kentucky, USA
| | | | - Dahui Qin
- Moffitt Cancer Center, Tampa, Florida, USA
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Optimisation and validation of a PCR for antigen receptor rearrangement (PARR) assay to detect clonality in canine lymphoid malignancies. Vet Immunol Immunopathol 2016; 182:115-124. [PMID: 27863542 PMCID: PMC5119497 DOI: 10.1016/j.vetimm.2016.10.008] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2016] [Revised: 09/19/2016] [Accepted: 10/19/2016] [Indexed: 12/05/2022]
Abstract
Ten primer sets detected clonality with high specificity and sensitivity. Four extra primer sets may detect clonality in samples with equivocal results. Knowledge of sample quality is needed for interpretation of results. Samples generating dominant peaks require careful interpretation.
PCR for antigen receptor gene rearrangements (PARR) analysis is being increasingly used to assist diagnosis of canine lymphoma. In this study, PARR was carried out on consecutive samples received as part of routine diagnostic practice from 271 patients: 195 with lymphoid malignancies, 53 with reactive conditions and 23 with other neoplasms. Initially, published primer sets were used but later minor primer modifications were introduced and primers were rationalised to give a PARR panel that provides a good compromise between sensitivity and cost. Results were compared to diagnoses made by histology or cytology, coupled with immunophenotyping by flow cytometry or immunohistochemistry where possible. After exclusion of 11 poor quality samples, 230/260 (88%) gave a clear result with 162/163 (99%) of samples classified as clonal and 56/67 (84%) classified as polyclonal giving results concordant with the cytological/histological diagnosis. Among 30 samples with equivocal results, 21 had clonal peaks in a polyclonal background and nine showed little amplification. These were from patients with a range of neoplastic and non-neoplastic conditions emphasising the need to interpret such results carefully in concert with other diagnostic tests. The combination of primer sets used in this study resulted in a robust, highly specific and sensitive assay for detecting clonality.
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Peluso AL, Ieni A, Mignogna C, Zeppa P. Lymph Node Fine-Needle Cytology: Beyond Flow Cytometry. Acta Cytol 2016; 60:372-384. [PMID: 27560152 DOI: 10.1159/000447734] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2016] [Accepted: 06/20/2016] [Indexed: 12/16/2022]
Abstract
Lymph node (LN) fine-needle cytology (FNC) coupled with flow cytometry immunophenotyping provides relevant information for the diagnosis of non-Hodgkin lymphoma (NHL). Numerous studies have shown FNC samples to be suitable for different molecular procedures; in this review, some of the molecular procedures most commonly employed for NHL are briefly described and evaluated in this perspective. Fluorescence in situ hybridization and chromogenic in situ hybridization are briefly described. Polymerase chain reaction (PCR)-based assays are used to identify and quantify mutations and translocations, namely immunoglobulin (IGH) and T-cell receptor rearrangements by clonality testing and IGVH somatic hypermutations either by Sanger sequencing, single-strand conformational polymorphisms or RT-PCR strategies. High-throughput technologies (HTT) encompass numerous and different diagnostic tools that share the capacity of multiple molecular investigation and sample processing in a fast and reproducible manner. HTT includes gene expression profiling, comparative genomic hybridization, single-nucleotide polymorphism arrays and next-generation sequencing technologies. A brief description of these tools and their potential application to LN FNC is reported. The challenge for FNC will be to achieve new knowledge and apply new technologies to FNC, exploiting its own basic qualities.
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Affiliation(s)
- Anna Lucia Peluso
- Department of Medicine and Surgery, University of Salerno, Baronissi, Italy
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Epstein-Barr virus-negative diffuse large B cell lymphoma with aberrant expression of CD3 and other T cell-associated antigens: report of three cases with a review of the literature. Ann Hematol 2016; 95:1671-83. [PMID: 27431583 DOI: 10.1007/s00277-016-2749-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2016] [Accepted: 06/28/2016] [Indexed: 02/07/2023]
Abstract
Expression of CD3 on a mature B cell neoplasm, such as diffuse large B cell lymphoma (DLBCL), is extremely rare. When it is present, it will cause diagnostic confusion since the classification of lymphoid neoplasms is largely based on immunophenotyping to determine the cell lineage. We report three cases of DLBCL with CD3 and other T cell-associated antigens. A literature search identifies 30 additional cases of DLBCL expressing CD3, with the majority (78.6 %) displaying cytoplasmic expression, while two of our cases demonstrate membranous staining. Additionally, expression of CD3 tends to be partial and weak in both our series and the reported cases. Of the 28 cases reported in the literature that were tested for Epstein Barr Virus (EBV), 16 (57.1 %) are positive, suggesting an important role of EBV in promoting lineage ambiguity/infidelity, whereas, all three cases in our series are negative for the virus. All three cases in our series show homogeneous expression of multiple B cell specific antigens, while the reported cases show variable expression with some having B cell antigens downregulated, particularly in those cases with EBV association or anaplastic morphology. A low threshold for testing EBV status is advocated in DLBCL with phenotypic ambiguity along with panels of immunohistochemical stains and B/T cell receptor gene rearrangement analysis.
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Hussaini M. Biomarkers in Hematological Malignancies: A Review of Molecular Testing in Hematopathology. Cancer Control 2016; 22:158-66. [PMID: 26068760 DOI: 10.1177/107327481502200206] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Molecular interrogation of genetic information has transformed our understanding of disease and is now routinely integrated into the workup and monitoring of hematological malignancies. In this article, a brief but comprehensive review is presented of state-of-the-art testing in hematological disease. METHODS The primary medical literature and standard textbooks in the field were queried and reviewed to assess current practices and trends for molecular testing in hematopathology by disease. RESULTS Pertinent materials were summarized under appropriate disease categories. CONCLUSION Molecular testing is well entrenched in the diagnostic and therapeutic pathways for hematological malignancies, with rapid growth and insights emerging following the integration of next-generation sequencing into the clinical workflow.
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Affiliation(s)
- Mohammad Hussaini
- Department of Hematopathology and Laboratory Medicine, Moffitt Cancer Center, Tampa, FL 33612, USA.
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Molecular genetic data favoring a sequential clonal transformation of a large B cell lymphoma into an anaplastic large T cell lymphoma, ALK-negative. J Hematop 2015. [DOI: 10.1007/s12308-015-0245-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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11
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Thalheim L, Williams L, Borst L, Fogle J, Suter S. Lymphoma Immunophenotype of Dogs Determined by Immunohistochemistry, Flow Cytometry, and Polymerase Chain Reaction for Antigen Receptor Rearrangements. J Vet Intern Med 2013; 27:1509-16. [DOI: 10.1111/jvim.12185] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2013] [Revised: 07/12/2013] [Accepted: 08/06/2013] [Indexed: 12/22/2022] Open
Affiliation(s)
- L. Thalheim
- Department of Clinical Sciences; College of Veterinary Medicine; North Carolina State University; Raleigh NC
| | - L.E. Williams
- Department of Clinical Sciences; College of Veterinary Medicine; North Carolina State University; Raleigh NC
- Center for Comparative Medicine and Translational Research; North Carolina State University; Raleigh NC
| | - L.B. Borst
- Center for Comparative Medicine and Translational Research; North Carolina State University; Raleigh NC
- Department of Population Health and Pathobiology; College of Veterinary Medicine; North Carolina State University; Raleigh NC
| | - J.E. Fogle
- Center for Comparative Medicine and Translational Research; North Carolina State University; Raleigh NC
- Department of Population Health and Pathobiology; College of Veterinary Medicine; North Carolina State University; Raleigh NC
| | - S.E. Suter
- Department of Clinical Sciences; College of Veterinary Medicine; North Carolina State University; Raleigh NC
- Center for Comparative Medicine and Translational Research; North Carolina State University; Raleigh NC
- Lineberger Comprehensive Cancer Center; Chapel Hill NC
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The role of molecular pathology in the diagnosis of cutaneous lymphomas. PATHOLOGY RESEARCH INTERNATIONAL 2012; 2012:913523. [PMID: 23213624 PMCID: PMC3506916 DOI: 10.1155/2012/913523] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/01/2012] [Accepted: 10/18/2012] [Indexed: 01/17/2023]
Abstract
Primary cutaneous lymphomas can be difficult to be distinguished from reactive mimics, even when integrating histologic, immunophenotypic, and clinical findings. Molecular studies, especially PCR-based antigen receptor gene rearrangement (ARGR) analysis, are frequently useful ancillary studies in the evaluation of cutaneous lymphoproliferations. The biologic basis of ARGR studies is discussed, as well as a comparison of various current protocols. The pitfalls and limitations of ARGR analysis are also highlighted. Recent advances in the understanding of the molecular pathogenesis of various cutaneous lymphomas are discussed. Some of these nascent discoveries may lead to the development of diagnostically useful molecular assays.
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Qi Z, Li Y, Hu J, Guo H, Zhao X, Wang G, Gao J, Hu Q. The DG75 B-cell lymphoma line exhibits biclonal immunoglobulin gene rearrangement. Biomed Rep 2012; 1:111-114. [PMID: 24648904 DOI: 10.3892/br.2012.22] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2012] [Accepted: 10/03/2012] [Indexed: 11/05/2022] Open
Abstract
Immunoglobulin (Ig) and T-cell receptor (TCR) gene rearrangement (GR) studies have been successfully employed to investigate the clonality and cell lineage of various lymphoid malignancies. Several lymphoma cell lines, such as BJAB, RAJI, DG75 and Jurkat cell lines, were often used as the positive controls in GR detection assays. Of those, the DG75 B-cell lymphoma line was found to exhibit biclonality [two or more homoduplex and heteroduplex bands in a polymerase chain reaction (PCR) product of clonality assay] in the PCR of GR detection assays. To further explore these characteristics of the biclonal phenomenon, the PCR products were purified and cloned into a pEGM-T clone vector. The sequences were analyzed using DNA analysis software. The results demonstrated that the two bands originated from two forms of GR of DG75 cell lines, i.e., DG75 is a biclonal cell line in Ig GRs, which has not been reported before.
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Affiliation(s)
- Zongli Qi
- Laboratory Center, Shaanxi Provincial People's Hospital and The Third Affiliated Hospital, Xi'an Jiaotong University, Xi'an, Shaanxi 710068, P.R. China
| | - Yuan Li
- Laboratory Center, Shaanxi Provincial People's Hospital and The Third Affiliated Hospital, Xi'an Jiaotong University, Xi'an, Shaanxi 710068, P.R. China
| | - Jun Hu
- Laboratory Center, Shaanxi Provincial People's Hospital and The Third Affiliated Hospital, Xi'an Jiaotong University, Xi'an, Shaanxi 710068, P.R. China
| | - Hua Guo
- Laboratory Center, Shaanxi Provincial People's Hospital and The Third Affiliated Hospital, Xi'an Jiaotong University, Xi'an, Shaanxi 710068, P.R. China
| | - Xiangrong Zhao
- Laboratory Center, Shaanxi Provincial People's Hospital and The Third Affiliated Hospital, Xi'an Jiaotong University, Xi'an, Shaanxi 710068, P.R. China
| | - Guanghua Wang
- Laboratory Center, Shaanxi Provincial People's Hospital and The Third Affiliated Hospital, Xi'an Jiaotong University, Xi'an, Shaanxi 710068, P.R. China
| | - Jinwei Gao
- Laboratory Center, Shaanxi Provincial People's Hospital and The Third Affiliated Hospital, Xi'an Jiaotong University, Xi'an, Shaanxi 710068, P.R. China
| | - Qiaoxia Hu
- Laboratory Center, Shaanxi Provincial People's Hospital and The Third Affiliated Hospital, Xi'an Jiaotong University, Xi'an, Shaanxi 710068, P.R. China
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Ochs RC, Bagg A. Molecular genetic characterization of lymphoma: Application to cytology diagnosis. Diagn Cytopathol 2012; 40:542-55. [DOI: 10.1002/dc.22819] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
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Primary mediastinal (thymic) large B cell lymphoma with aberrant expression of CD3: a case report with review of the literature. Int J Hematol 2010; 91:509-15. [PMID: 20131102 DOI: 10.1007/s12185-010-0501-4] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2009] [Revised: 01/05/2010] [Accepted: 01/12/2010] [Indexed: 10/19/2022]
Abstract
We report the first case of primary mediastinal large B cell lymphoma (PMBL) with aberrant expression of CD3. PMBL is a subtype of diffuse large B cell lymphoma (DLBCL) and usually presents with bulky mediastinal lesions. Lineage ambiguity/infidelity is uncommon in DLBCL but has been described in sporadic case reports/series. A literature search identifies 13 additional cases of DLBCL expressing CD3, with the majority displaying cytoplasmic expression. Of the 14 total cases, 6 are pyothorax-associated lymphoma, 4 are conventional DLBCL, 2 are plasmablastic lymphoma, one is primary effusion lymphoma and one is PMBL. Two cases show genotypic ambiguity/infidelity with dual clonal IG and TCR gene rearrangements in addition to ambiguous immunophenotypes. Of the 13 cases tested for EBV status, 11 are positive, suggesting an important role of EBV in promoting lineage ambiguity/infidelity. A low threshold for testing EBV status is advocated in DLBCL with phenotypic ambiguity along with panels of immunohistochemical and molecular studies.
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Bagg A. Malleable immunoglobulin genes and hematopathology - the good, the bad, and the ugly: a paper from the 2007 William Beaumont hospital symposium on molecular pathology. J Mol Diagn 2008; 10:396-410. [PMID: 18687793 DOI: 10.2353/jmoldx.2008.080061] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
Immunoglobulin gene rearrangement analysis is one of the more commonly performed assays available on the hematopathology menu of clinical molecular pathology laboratories. The analysis of these rearrangements provides useful information on a number of different levels in the evaluation of lymphoproliferations. An appreciation of the various mechanisms involved in the numerous physiological pathways affecting the immunoglobulin genes, and hence antibody molecules, is central to an understanding of B-cell development vis-à-vis the generation of immunological diversity. Knowledge about the intricate complexities of these mechanisms is also germane to an evaluation of testing methodologies. With this information, it is easier to develop an understanding of how contemporary molecular testing of immunoglobulin gene rearrangements has evolved, from historically quite heterogeneous, fairly flawed, and rather ugly approaches to current more-standardized protocols. In addition, recognition of how such genetic changes with good intentions can turn bad has fostered increasing insights into the pathogenesis of B-cell lymphomas and leukemias. Despite the significant improvements in the design of immunoglobulin gene rearrangement assays, numerous pitfalls and caveats remain. Accordingly, it is crucial to consider such testing a tool, and although most useful, it is one of many tools that may be required to build cogent diagnoses.
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Affiliation(s)
- Adam Bagg
- Hematology, Department of Pathology and Laboratory Medicine, University of Pennsylvania, 7.103 Founders Pavilion, 3400 Spruce St., Philadelphia, PA 19104-4283, USA.
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