The “CD43 Only” Phenotype: An Aberrant, Nonspecific Immunophenotype Requiring Comprehensive Analysis for Lineage Resolution
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Abstract:
Paraffin section immunohistology of leukocytic proliferations is a routine method of immunophenotyping in many clinical laboratories. Furthermore, a relatively standard antibody screening panel that includes L26 (CD20), Leu22 (CD43), and UCHLl (CD45RO) appears to be widely used. Although paraffin section immunophenotyping in general, and this panel in particular, have been shown to be very reliable in defining B-cell lineage, characterization of T-cell lineage is less definitive. This is related primarily to the relatively poor specificity of the commercially available T-cell-associated reagents. CD43 (Leu22) in particular has a broad immunoreactivity profile that has not been stressed adequately in some reports. Seventeen cases with a "CD43 only" phenotype were identified during the last several years while using the relatively standard screening panel mentioned above. These cases were quite heterogeneous with respect to cellular differentiation and most were not T-cell proliferations. Specifically, eight cases were extramedullary leukemic infiltrates (five myeloid, two monocytic, one mixed lineage), four cases were T-cell lymphomas, three cases were B-cell lymphomas and two cases were plasmacytomas. Although CD43 has demonstrable utility in a leukocyte screening panel, this report stresses the aberrancy and lack of specificity of the "CD43 only" phenotype. Caution is recommended in assigning a specific lineage to such cellular proliferations without additional immunologic or genotypic analysis. Recommendations for comprehensive diagnostic evaluation of these proliferations are provided.Keywords:
Immunophenotyping
CD43
Lineage (genetic)
We report the first case in the world literature of a pri mary cardiac lymphoma with a T cell immunophenotype. The patient was a 20 year old male, suspected of having a viral myocarditis, who died from progressive cardiac de compensation. Postmortem examination revealed a diffuse large cell lymphoma confined to the heart that demonstrated a T cell immunophenotype (CD2, CD3, CD45R0, and CD43 positive). Molecular analysis, however, showed clonal rearrangement of the immunoglobulin heavy chain by Southern blot analysis, but not by PCR. The clinical features of the case are described, and the pathologic features are discussed. Mechanisms are suggested to explain the discordant immunophenotype and genotype. (The J Histotechnol 22:325, 1999)
Immunophenotyping
CD43
T-Cell Lymphoma
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CD43
CD5
Immunophenotyping
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Adult, de novo B-cell lymphomas meeting the WHO morphologic criteria for atypical Burkitt/Burkitt-like lymphoma cause diagnostic difficulty for pathologists because the genetic and clinical characteristics of this group of lymphomas have not been clearly defined. Thirty-one such lymphomas, designated as Burkitt-like lymphomas (BLL), were selected based on morphologic features and evaluated for immunophenotype, MYC and BCL2 status, and clinical features. Nine childhood Burkitt lymphomas (BL) and 87 adult, de novo diffuse large B-cell lymphomas (DLBL) were similarly evaluated for comparison. The BL group demonstrated uniform characteristics: all had Burkitt lymphoma morphology, an identical immunophenotype (positive for CD20, CD10, bcl-6, CD43, and p53; negative for CD138, CD23, bcl-2), high MIB-1 positivity, IGH/MYC translocation, no IGH/BCL2 translocation, and all patients were alive at the last follow-up. The BLL and DLBL groups were heterogeneous. Burkitt-like morphology alone correlated with decreased survival. IGH/MYC or IGL/MYC fusion was identified in 11 of 27 (41%) BLL and 4 of 76 (5%) DLBL and was associated with decreased survival in both groups. MIB-1 positivity did not correlate with morphology, MYC abnormalities, or survival. We propose that adult B-cell lymphomas with BLL morphology are a phenotypically and genetically heterogeneous group of aggressive lymphomas, biologically distinct from childhood BL. Until biologically accurate subgroups within this morphologically defined group are identified, it is appears that both recognition of BLL morphology and direct evaluation for the presence of MYC fusion to immunoglobulin genes are important for identification of adult patients with poorer prognosis than those with DLBL.
Immunophenotyping
Burkitt's lymphoma
CD43
Gene rearrangement
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Objective:To study the clinical significance and characteristic of acute leukemia (AL) immunophenotype and cross lineage expression. Methods:128 patients with AL were investigated by immunophenotyping with 16 monoclonal antibodies. Results:According to the antigen expression ,they could be classified into three subgroups: (1) lineage specific expression; (2) cross lineage expression; (3) “null cell”type. The incidence of lineage specific expression in ANLL and ALL was 73.3 % and 78.9 % respectively , which was the highest . “null cell”type was the lowest , which was 6.7 % and 5.3 % , the incidence of cross lineage expression in ANLL and ALL was 20.0 % and 15.8 %.In ANLL with CD + 7 or B lymphocytic lineage antigen expression,the CR rate was lower,while the incidence of p170 expression was higher than that with the lineage specific expression.Conclusion:(1) AL immunophenotype might be classified into three subgroups:lineage specific expression;cross lineage expression and “null cell”type.(2) Higher p170 expression and lower CR rate was seen in the patients with cross lineage expression than that with lineage specific expression.
Immunophenotyping
Lineage (genetic)
Null cell
Lineage markers
Cell lineage
Clinical Significance
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Paraffin section immunohistology of leukocytic proliferations is a routine method of immunophenotyping in many clinical laboratories. Furthermore, a relatively standard antibody screening panel that includes L26 (CD20), Leu22 (CD43), and UCHLl (CD45RO) appears to be widely used. Although paraffin section immunophenotyping in general, and this panel in particular, have been shown to be very reliable in defining B-cell lineage, characterization of T-cell lineage is less definitive. This is related primarily to the relatively poor specificity of the commercially available T-cell-associated reagents. CD43 (Leu22) in particular has a broad immunoreactivity profile that has not been stressed adequately in some reports. Seventeen cases with a "CD43 only" phenotype were identified during the last several years while using the relatively standard screening panel mentioned above. These cases were quite heterogeneous with respect to cellular differentiation and most were not T-cell proliferations. Specifically, eight cases were extramedullary leukemic infiltrates (five myeloid, two monocytic, one mixed lineage), four cases were T-cell lymphomas, three cases were B-cell lymphomas and two cases were plasmacytomas. Although CD43 has demonstrable utility in a leukocyte screening panel, this report stresses the aberrancy and lack of specificity of the "CD43 only" phenotype. Caution is recommended in assigning a specific lineage to such cellular proliferations without additional immunologic or genotypic analysis. Recommendations for comprehensive diagnostic evaluation of these proliferations are provided.
Immunophenotyping
CD43
Lineage (genetic)
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Little information has been reported describing antigen stability in plasma cell myeloma. In this study, the expression frequency and stability of 2 potential therapeutic targets, CD20 and CD52, along with the frequently aberrantly expressed CD56 antigen, were evaluated by flow cytometric analyses in 56 patients with plasma cell myeloma. Of the 56 patients, 23 (41%) showed immunophenotype change, including CD56 in 6 cases, CD20 in 7 cases, and CD52 in 17 cases. Combined CD56/CD52 change was seen in 3 cases and combined CD20/CD52 in 4 cases. No correlation was found between immunophenotype change and age, sex, stage, plasma cell morphologic features, extent of marrow involvement, time between analyses, type of therapy, or response to therapy. Immunophenotype shift was more common in patients with IgA than in patients with IgG paraprotein. Recognition of lack of stability in immunophenotype may be important, especially in antigen-directed treatment decisions and when specific phenotypes are used to detect residual disease.
Immunophenotyping
Plasma Cell Myeloma
CD52
Minimal Residual Disease
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To retrospectively analyze the laborotary test results and clinical data of 31 patients with mixed phenotype acute leukemia (MPAL) in order to summarize and discuss the biological characteristics, curative effect, and prognosis of each subtype of MPAL based on immunophenotype results.MPAL patients diagnosed and treated in our hospital from July 2013 to January 2019 were selected to analyze the data of cell morphology, immunophenotyping, cytogenetics, molecular biology (MICM), and routine blood at initial diagnosis. Follow-up was carried out until the last discharge time.Among 31 patients, there were 19 males and 12 females, with a median age of 41(12-76) years old. According to the results of immunophenotyping and EGIL score, there were 16 cases of myeloid-T lymphoid mixed phenotype (myeloid-T group), 9 cases of myeloid-B lymphoid mixed phenotype (myeloid-B group), 5 cases of T-B lymphoid mixed phenotype (T-B group), and 1 case of myeloid-T-B lymphoid mixed phenotype. Compared between different subtypes, the antigen expression characteristics were the highest positive rate and expression rate of HLA-DR in myeloid-B group, and the positive rate of CD2 in T-B group was significantly higher than that in the myeloid-T group. Meanwhile, the expression rates of CD7 and cCD3 (cytoplasmic CD3) in T-B group were higher than those in myeloid-T group, and cCD79a was positive in all cases of myeloid-B group and T-B group. The median WBC of T-B group was 81.92×109/L, which was significantly higher than that of the other two groups (P<0.05). The quantitative results of WT1 were higher than 10-4 in 92.6% of the patients, and the WT1 expression level in myeloid-B group was significantly lower than the other two groups (P<0.01). Among the 9 patients with myeloid-B mixed phenotype, 5 cases showed BCR-ABL positive. Among 28 patients followed up, 21 cases achieved complete remission (CR), the median time to first obtain CR was 32.5(9-75) days, and the median follow-up time was 16 months (range from 21 days to 6 years). The CR rate and median overall survival (OS) time in myeloid-B group were 88.9% and 40 months, which were higher than the other two groups. The CR rate and 3-year OS rate in T-B group were relatively lower (50.0%, 0).WT1 gene is highly expressed in patients with MPAL, and each subgroup of MPAL based on immuophenotype has its unique antigen expression characteristics. Compared with myeloid-T group and T-B group, myeloid-B group can acquire higher remission rate and have better prognosis.混合表型急性白血病患者免疫表型特点及临床预后特征分析.回顾性分析31例混合表型急性白血病（MPAL）患者的实验室结果和临床资料，以总结和探讨基于免疫表型结果的MPAL各亚型生物学特性及疗效和预后特征。.选择2013年7月至2019年1月经本院诊治的MPAL患者，分析初诊时细胞形态学、免疫分型、细胞遗传学、分子生物学（MICM）及血常规等数据，病例随访截至末次出院时间。.31例患者中，男性19例，女性12例，中位年龄41（12-76）岁；依据免疫分型结果，参照EGIL积分，髓-T混合表型16例（髓-T组），髓-B混合表型9例（髓-B组），T-B混合表型5例（T-B组），髓-T-B三系混合表型1例。各亚型比较，抗原表达特征为髓-B组HLA-DR阳性率、表达率最高，T-B组CD2阳性率显著高于髓-T组，同时T-B组CD7、cCD3（胞浆CD3）表达率高于髓-T组，髓-B组和T-B组全部病例均阳性表达cCD79a；T-B组中位WBC（81.92×109/L）显著高于其他两组（P<0.05）；92.6%的病例WT1定量结果高于10-4，髓-B组WT1表达水平显著低于其他两组（P<0.01），9例髓-B患者中，5例BCR-ABL阳性。28例随访患者中，21例达到完全缓解，首次获得完全缓解的中位时间为32.5（9-75）d，中位随访时间16个月（21天-6年）；分组结果显示，髓-B组完全缓解率为88.9%，中位总生存时间为40个月，均高于其他两组，T-B组完全缓解率和3年总生存率相对较低（50.0%，0）。.MPAL患者高表达WT1基因，基于免疫表型的MPAL各亚型有其独特的抗原表达特征。相较于髓-T和T-B患者，髓-B患者可获得较高的缓解率，预后良好。.
Immunophenotyping
Group B
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We report the first case in the world literature of a pri mary cardiac lymphoma with a T cell immunophenotype. The patient was a 20 year old male, suspected of having a viral myocarditis, who died from progressive cardiac de compensation. Postmortem examination revealed a diffuse large cell lymphoma confined to the heart that demonstrated a T cell immunophenotype (CD2, CD3, CD45R0, and CD43 positive). Molecular analysis, however, showed clonal rearrangement of the immunoglobulin heavy chain by Southern blot analysis, but not by PCR. The clinical features of the case are described, and the pathologic features are discussed. Mechanisms are suggested to explain the discordant immunophenotype and genotype. (The J Histotechnol 22:325, 1999)
Immunophenotyping
CD43
T-Cell Lymphoma
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Abstract CD20‐positive T‐cell lymphoma (TCL) is a very rare disease entity that is associated with the co‐expressions of a range of T cell lineage makers, such as, CD2, CD3, CD5, or CD7, and CD20. The biological and clinical significance of CD20 antigen expressed in TCL has been unclear. Here, we are reporting an unusual case of CD20‐positive primary nasal peripheral T‐cell lymphoma, not otherwise specified (PTCL‐NOS) in a 62‐year‐old female with both peripheral blood (PB) and bone marrow (BM) involvement. Flow cytometry (FC) analysis revealed CD20+ lymphoma cells in PB, BM, and lymph node (LN) and was consistent with pathological findings. FC immunophenotyping was proved of great diagnostic contribution.
Immunophenotyping
CD43
CD5
Peripheral T-cell lymphoma
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Aim:To study antigen expression characteristic of acute leukemia(AL) immunophenotype by FCM and clinical significance.Methods: Fourteen patients with AL were investigated with MoAb and immunofluorescence.Results: Five cases were characteristic of double lineage expression,namely two lineage antigen expression simultaneously(AML 3 cases,ALL 2 cases);9 cases were characteristic of one lineage expression(AML 5 cases,ALL 4 cases).Conclusion: ALL with double lineage expression is related to poor prognosis;FCM have a characteristic of detecting large quantity of cells,rapidness and accuracy.
Immunophenotyping
Lineage (genetic)
Immunofluorescence
Cell lineage
Clinical Significance
Expression (computer science)
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