浆细胞样淋巴细胞：流式细胞术分析骨髓标本时潜在的诊断陷阱

Hematogones with light chain restriction: A potential diagnostic pitfall when using flow cytometry analysis to assess bone marrow specimens.

机构信息

University of Rochester Medical Center, Department of Pathology, Rochester, New York, USA; The University of Texas MD Anderson Cancer Center, Department of Hematopathology, Houston, Texas, USA.

The University of Texas MD Anderson Cancer Center, Department of Hematopathology, Houston, Texas, USA.

出版信息

Leuk Res. 2021 Dec;111:106704. doi: 10.1016/j.leukres.2021.106704. Epub 2021 Sep 8.

DOI:10.1016/j.leukres.2021.106704

PMID:34735934

Abstract

Light-chain restricted hematogones (LCR HGs) detected by flow cytometry analysis can mimic bone marrow involvement by B-cell lymphoma. This phenomenon can present a diagnostic pitfall and negatively impact patient management, as misinterpretation may upgrade disease stage. In this study, we characterized the immunophenotype of LCR HGs with an aim to differentiate them from B-cell lymphoma. We analyzed 24 patients with LCR HGs, 12 (50 %) were kappa light chain restricted and 12 (50 %) were lambda light chain restricted. LCR HGs account for 51 % (range, 1.5%-99%) of B cells, and 0.5 % (range, 0.1%-3.7%) of total cells. In 15 patients in whom multiple specimens were analyzed, 10 (67 %) showed persistent LCR HGs in more than 1 specimen, and the duration of the light chain restriction ranged from 4 months to 2 years. Among 24 patients, 4 (16.6 %) cases were concurrently involved by B-cell lymphoma/myeloma in addition to LCR HGs. With the exception of light chain restriction, LCR HGs showed a similar immunophenotype as normal HGs and had a distinct location on the CD45/Side Scatter (SSC) plot. They were also consistently positive for CD10, CD19, CD38 (bright), CD43, and CD200. CD20 expression showed a spectrum from dim/negative to positive.

摘要

流式细胞术分析检测到的轻链限制性血红细胞（LCR HGs）可模拟 B 细胞淋巴瘤骨髓受累。这种现象可能会导致诊断陷阱，并对患者管理产生负面影响，因为错误解读可能会升级疾病分期。在本研究中，我们对 LCR HGs 的免疫表型进行了特征分析，旨在将其与 B 细胞淋巴瘤区分开来。我们分析了 24 例 LCR HGs 患者，其中 12 例（50%）为κ轻链受限，12 例（50%）为λ轻链受限。LCR HGs 占 B 细胞的 51%（范围为 1.5%-99%），占总细胞的 0.5%（范围为 0.1%-3.7%）。在对 15 例患者的多个样本进行分析时，10 例（67%）患者在超过 1 个样本中持续存在 LCR HGs，轻链限制的持续时间从 4 个月到 2 年不等。在 24 例患者中，除了 LCR HGs 外，还有 4 例（16.6%）患者同时伴有 B 细胞淋巴瘤/骨髓瘤。除了轻链限制外，LCR HGs 还表现出与正常 HGs 相似的免疫表型，在 CD45/侧向散射（SSC）图谱上具有独特的位置。它们还一致表达 CD10、CD19、CD38（明亮）、CD43 和 CD200。CD20 表达从弱/阴性到阳性呈谱状分布。