Flow cytometric approach to the diagnosis and classification of B-cell lymphoid neoplasms
| Disease entities to consider . | Distinguishing phenotypic features . | Additional diagnostic information . |
|---|---|---|
| CD5+ CD10− | ||
| Chronic lymphocytic leukemia | Typical phenotype: CD20 (d), CD22 (d), sIg (d), CD23+, FMC-7− | Characteristic morphology |
| Mantle cell lymphoma | Variable phenotype not typical for CLL; often CD20 (i), sIg (i), CD23+/−, FMC-7+/− | Cyclin-D1 IHC, t(11;14)/CCND rearrangement |
| Prolymphocytic leukemia | Variable phenotype, may overlap with CLL and MCL CD20 (+i), sIg (+i), FMC-7+/−, CD5+/− | Large cells prominent nucleoli; exclude blastic MCL |
| Marginal zone B-cell lymphoma | Variable phenotype, not typical for CLL: CD23−; often CD11c+/−, CD103+/− but not typical for HCL, sometimes cIg only | Growth around and into follicles, may demonstrate plasmacytic differentiation, t(11;18), t(1;14), t(14;18)/MALT-1 rearrangement |
| Diffuse large B-cell lymphoma | Variable phenotype | Large cells, diffuse growth pattern; consider Richter transformation CLL and MCL |
| Lymphoplasmacytic lymphoma | Phenotype not typical for CLL, often CD23(-/d), sometimes sIg− but cIg+ | Small cells, subset with plasmacytic differentiation Primarily PB and BM |
| CD5− CD10+ | ||
| Follicular lymphoma | Usually bcl-2+, CD43− | Some follicular growth, t(14;18)/BCL-2 rearrangement |
| Diffuse large B-cell lymphoma | Variable phenotype, bcl-2+/−, CD43+/− | Large cells somewhat pleomorphic, diffuse growth |
| Burkitt lymphoma | Usually bcl-2−,CD10 (+b), CD43+ | Uniform intermediate size cells; MYC rearrangement, Ki-67 approximately 100% |
| Hairy cell leukemia | Typical phenotype: CD20 (b), CD22 (b), CD11c (b), CD25+, CD103+, sIg (i), CD123+ | Characteristic morphology; Annexin-A1+ |
| CD5+ CD10+ | ||
| Follicular lymphoma | Usually bcl-2+, CD43− | Some follicular growth, t(14;18)/BCL-2 rearrangement |
| Diffuse large B-cell lymphoma | Variable phenotype, bcl-2+/−, CD43+/− | Large cells, diffuse growth pattern |
| Mantle cell lymphoma | Variable phenotype not typical for CLL; often CD20 (i), sIg (i), CD23+/−, FMC-7+/− | Cyclin-D1 IHC, t(11;14)/CCND rearrangement |
| Burkitt lymphoma | Usually bcl-2−, CD10 (b), CD43+ | Uniform intermediate size cells; MYC rearrangement, Ki-67 approximately 100% |
| CD5− CD10− | ||
| Hairy cell leukemia | Typical pheotype: CD20 (b), CD22 (b), CD11c (b), CD25+, CD103+, sIg (i) | Confirm characteristic morphology |
| Marginal zone B-cell lymphoma | Often CD11c+/−, CD103+/− but not typical for HCL, sometimes sIg− but cIg+ | Growth around and into follicles, maybe plasmacytic t(11;18), t(1;14), t(14;18)/MALT-1 rearrangement |
| Diffuse large B-cell lymphoma | Variable phenotype | Large cells, diffuse growth pattern |
| Follicular lymphoma CD10− | Variable phenotype | Some follicular growth, t(14;18)/BCL-2 rearrangement |
| Mantle cell lymphoma CD5− | Variable phenotype | Cyclin-D1 IHC, t(11;14)/CCND rearrangement |
| Disease entities to consider . | Distinguishing phenotypic features . | Additional diagnostic information . |
|---|---|---|
| CD5+ CD10− | ||
| Chronic lymphocytic leukemia | Typical phenotype: CD20 (d), CD22 (d), sIg (d), CD23+, FMC-7− | Characteristic morphology |
| Mantle cell lymphoma | Variable phenotype not typical for CLL; often CD20 (i), sIg (i), CD23+/−, FMC-7+/− | Cyclin-D1 IHC, t(11;14)/CCND rearrangement |
| Prolymphocytic leukemia | Variable phenotype, may overlap with CLL and MCL CD20 (+i), sIg (+i), FMC-7+/−, CD5+/− | Large cells prominent nucleoli; exclude blastic MCL |
| Marginal zone B-cell lymphoma | Variable phenotype, not typical for CLL: CD23−; often CD11c+/−, CD103+/− but not typical for HCL, sometimes cIg only | Growth around and into follicles, may demonstrate plasmacytic differentiation, t(11;18), t(1;14), t(14;18)/MALT-1 rearrangement |
| Diffuse large B-cell lymphoma | Variable phenotype | Large cells, diffuse growth pattern; consider Richter transformation CLL and MCL |
| Lymphoplasmacytic lymphoma | Phenotype not typical for CLL, often CD23(-/d), sometimes sIg− but cIg+ | Small cells, subset with plasmacytic differentiation Primarily PB and BM |
| CD5− CD10+ | ||
| Follicular lymphoma | Usually bcl-2+, CD43− | Some follicular growth, t(14;18)/BCL-2 rearrangement |
| Diffuse large B-cell lymphoma | Variable phenotype, bcl-2+/−, CD43+/− | Large cells somewhat pleomorphic, diffuse growth |
| Burkitt lymphoma | Usually bcl-2−,CD10 (+b), CD43+ | Uniform intermediate size cells; MYC rearrangement, Ki-67 approximately 100% |
| Hairy cell leukemia | Typical phenotype: CD20 (b), CD22 (b), CD11c (b), CD25+, CD103+, sIg (i), CD123+ | Characteristic morphology; Annexin-A1+ |
| CD5+ CD10+ | ||
| Follicular lymphoma | Usually bcl-2+, CD43− | Some follicular growth, t(14;18)/BCL-2 rearrangement |
| Diffuse large B-cell lymphoma | Variable phenotype, bcl-2+/−, CD43+/− | Large cells, diffuse growth pattern |
| Mantle cell lymphoma | Variable phenotype not typical for CLL; often CD20 (i), sIg (i), CD23+/−, FMC-7+/− | Cyclin-D1 IHC, t(11;14)/CCND rearrangement |
| Burkitt lymphoma | Usually bcl-2−, CD10 (b), CD43+ | Uniform intermediate size cells; MYC rearrangement, Ki-67 approximately 100% |
| CD5− CD10− | ||
| Hairy cell leukemia | Typical pheotype: CD20 (b), CD22 (b), CD11c (b), CD25+, CD103+, sIg (i) | Confirm characteristic morphology |
| Marginal zone B-cell lymphoma | Often CD11c+/−, CD103+/− but not typical for HCL, sometimes sIg− but cIg+ | Growth around and into follicles, maybe plasmacytic t(11;18), t(1;14), t(14;18)/MALT-1 rearrangement |
| Diffuse large B-cell lymphoma | Variable phenotype | Large cells, diffuse growth pattern |
| Follicular lymphoma CD10− | Variable phenotype | Some follicular growth, t(14;18)/BCL-2 rearrangement |
| Mantle cell lymphoma CD5− | Variable phenotype | Cyclin-D1 IHC, t(11;14)/CCND rearrangement |
+ indicates usually positive; −, usually negative; +/−, may be positive or negative; d, dim or weak intensity; i, intermediate intensity; b, bright or strong intensity; sIg, surface immunoglobulin; and cIg, cytoplasmic immunoglobulin.