Toth B, Wehrmann M, Kaiserling E, Horny H P
Institute of Pathology, University of Tübingen, Germany.
J Clin Pathol. 1999 Sep;52(9):688-92. doi: 10.1136/jcp.52.9.688.
To assess the value of immunophenotyping of acute lymphoblastic leukaemia (ALL) in routinely processed bone marrow trephine biopsy specimens and to establish a minimum panel of antibodies to assess lymphoid lineage and enable differentiation from acute myeloid leukaemia.
45 routinely processed bone marrow biopsy specimens (formalin fixed, paraffin embedded and mildly decalcified in EDTA) reported to contain leukaemic infiltrates on the basis of cytomorphological and enzyme-cytochemical analysis of bone marrow smears (22 c-ALL, 11 T-ALL, 2 B-ALL, 10 u-ALL (unclassified)) were immunostained by the ABC method with a broad panel of 26 antibodies against various haemopoietic antigens.
Staining with antibodies directed against myeloperoxidase and lysozyme showed that seven cases were either biphenotypic or mixed leukaemias (2), or of myelogenous origin (acute myeloid leukaemia (AML)-M1 (2); AML-M4 (2); AML-M5a (1)). Five of these seven cases had been diagnosed initially as u-ALL. Three further cases with no compact leukaemic infiltrates were excluded. ALL was confirmed in the remaining 35 cases. Because of revised diagnoses, the total numbers of ALL subtypes changed (23 c-ALL, 8 T-ALL, 2 B-ALL, 2 u-ALL). Immunostaining of more than 10% of blast cells in at least one case was found with 19 of the 26 antibodies. The most sensitive lineage specific antibodies for diagnosis were found to be anti-CD10 for c-ALL (22/23) and beta F1 for T-ALL (6/8). Expression of aberrant antigens was fairly common--for example, 7/23 cases of c-ALL stained with antibodies against T cell associated antigens.
Immunohistochemical investigation of routinely processed bone marrow biopsy specimens enables reliable detection of ALL subtypes c-ALL and T-ALL. A minimum panel of antibodies, against TdT, CD34, myeloperoxidase, lysozyme, CD10, CD79a, and CD20, and the antibody beta F1, is proposed for the immunophenotyping of acute leukaemia.
评估在常规处理的骨髓活检标本中急性淋巴细胞白血病（ALL）免疫表型分析的价值，并确定一组最少的抗体，用于评估淋巴系起源并实现与急性髓细胞白血病的鉴别。
45份常规处理的骨髓活检标本（经福尔马林固定、石蜡包埋并在乙二胺四乙酸中轻度脱钙），根据骨髓涂片的细胞形态学和酶细胞化学分析报告含有白血病浸润（22例普通型ALL（c-ALL）、11例T细胞ALL（T-ALL）、2例B细胞ALL（B-ALL）、10例未分类ALL（u-ALL）），采用ABC法用一组针对多种造血抗原的26种抗体进行免疫染色。
用抗髓过氧化物酶和溶菌酶的抗体染色显示，7例为双表型或混合性白血病（2例），或髓系起源（急性髓细胞白血病（AML）-M1（2例）；AML-M4（2例）；AML-M5a（1例））。这7例中的5例最初被诊断为u-ALL。另外3例无致密白血病浸润的病例被排除。其余35例确诊为ALL。由于诊断修正，ALL亚型的总数发生了变化（23例c-ALL、8例T-ALL、2例B-ALL、2例u-ALL）。26种抗体中的19种在至少1例中发现有超过10%的原始细胞呈免疫染色阳性。发现诊断最敏感的系特异性抗体对c-ALL是抗CD10（22/23），对T-ALL是βF1（6/8）。异常抗原的表达相当常见——例如，23例c-ALL中有7例用抗T细胞相关抗原的抗体染色阳性。
对常规处理的骨髓活检标本进行免疫组织化学研究能够可靠地检测ALL亚型c-ALL和T-ALL。建议使用一组最少的抗体，即抗末端脱氧核苷酸转移酶（TdT）、CD34、髓过氧化物酶、溶菌酶、CD10、CD79a和CD20以及抗体βF1，用于急性白血病的免疫表型分析。
