Department of Hematopathology, University of Texas MD Anderson Cancer Center, Houston, TX, USA.
Department of Pathology, The Second Xiangya Hospital of Central South University, Changsha, Hunan, China.
Cytometry B Clin Cytom. 2018 Jan;94(1):148-150. doi: 10.1002/cyto.b.21512. Epub 2017 Feb 24.
Composite mantle cell lymphoma (MCL) and chronic lymphocytic leukemia/small lymphocytic lymphoma (CLL/SLL) is rare, as less than 20 cases have been reported so far. However, this entity may be under-diagnosed because the two lymphomas are very similar in morphology and immunophenotype. Previous cases were mostly diagnosed with immunohistochemistry, but flow cytometry may play an important role in the detection of two tumors in the same specimen, thus achieving an accurate diagnosis. By definition, a composite lymphoma is two demarcated lymphomas occurring at the same anatomic site. Therefore, immunohistochemistry is still needed to identify the topographic relation of these two tumors. Our reported case illustrates the pitfalls in the diagnostic process and we recommend two standard panels with new markers for an accurate diagnosis of this composite lymphoma.
FACSCanto II is used with antibodies, including CD5, CD10, CD19, CD20, CD22, CD23, CD43, CD79b, CD200, kappa, and lambda. Immunohistochemical stains include PAX-5/CD5 dual stain, Cyclin D1, SOX11, and LEF-1.
CLL/SLL is positive for CD5, CD19, CD23, CD43, and CD200, with dim expression of CD20, CD22, CD79b, and kappa. MCL is positive for CD5, CD19, CD20, CD22, CD79b, kappa, and negative for CD23, CD43, and CD200. Immunohistochemical stains show that PAX-5/CD5 stains the entire tumor population. Cyclin D1 and SOX11 only stain the central portion that represents MCL and LEF-1 stains the periphery that represents CLL/SLL.
We recommend the use of the above panels for flow cytometry and immunohistochemistry, respectively. LEF-1 is specific for CLL/SLL; and CD200 is helpful to distinguish CLL/SLL from MCL. © 2017 International Clinical Cytometry Society.
复合套细胞淋巴瘤（MCL）和慢性淋巴细胞白血病/小淋巴细胞淋巴瘤（CLL/SLL）非常罕见，因为到目前为止，报道的病例还不到 20 例。然而，由于这两种淋巴瘤在形态和免疫表型上非常相似，这种实体可能诊断不足。以前的病例大多通过免疫组织化学诊断，但流式细胞术可能在检测同一标本中的两种肿瘤方面发挥重要作用，从而实现准确诊断。根据定义，复合淋巴瘤是指两个界限分明的淋巴瘤发生在同一解剖部位。因此，仍需要免疫组织化学来确定这两种肿瘤的空间关系。我们报告的病例说明了诊断过程中的陷阱，我们建议使用包含新标记物的两个标准面板来准确诊断这种复合淋巴瘤。
使用 FACSCanto II 仪器和抗体，包括 CD5、CD10、CD19、CD20、CD22、CD23、CD43、CD79b、CD200、kappa 和 lambda。免疫组织化学染色包括 PAX-5/CD5 双重染色、Cyclin D1、SOX11 和 LEF-1。
CLL/SLL 阳性表达 CD5、CD19、CD23、CD43 和 CD200，CD20、CD22、CD79b 和 kappa 表达较弱。MCL 阳性表达 CD5、CD19、CD20、CD22、CD79b、kappa，阴性表达 CD23、CD43 和 CD200。免疫组织化学染色显示 PAX-5/CD5 染色整个肿瘤细胞群。Cyclin D1 和 SOX11 仅染色代表 MCL 的中央部分，LEF-1 染色代表 CLL/SLL 的外周部分。
我们建议分别使用上述面板进行流式细胞术和免疫组织化学染色。LEF-1 特异性标记 CLL/SLL；CD200 有助于区分 CLL/SLL 与 MCL。© 2017 年国际临床细胞学会。
