Lymphoplasmacytic lymphoma differential diagnosis: Difference between revisions

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* [[CD79a]]
* [[CD79a]]
* VS38c
* VS38c
*Infrequently expresses [[CD19]].
*Infrequently expresses [[CD19]].
*[[CD56]] (expressed by 70% of myeloma cells)
*[[CD56]] (expressed by 70% of myeloma cells)

Revision as of 16:54, 22 February 2019


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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Sara Mohsin, M.D.[2]

Overview

Lymphoplasmacytic lymphoma must be differentiated from multiple myeloma, chronic lymphocytic leukemia/small lymphocytic lymphoma, b-cell prolymphocytic leukemia, follicular lymphoma, mantle cell lymphoma, and marginal zone lymphoma.

Differentiating Lymphoplasmacytic lymphoma from other Diseases

Lymphoplasmacytic lymphoma must be differentiated from other B cell lymphoid neoplasms including:

  • Expresses B cell markers CD19, CD20, and CD22.
  • Infiltrates the bone marrow with a characteristic intertrabecular and intrasinusoidal pattern
  • Most common cytogenetic abnormalities are loss of 7q (19%) along with +3q (19%) and +5q (10% )[9][10]
Histopathology, immunophenotype, and genetic features of differential diagnosis of lymphoplasmacytic lymphoma
Disease entity Histopathology Immunophenotype Genetic or other features
Lymphoplasmacytic lymphoma
Chronic lymphocytic leukemia/small lymphocytic lymphoma
  • Always express CD5.
  • Del13q, del 11q, del17p, trisomy 12
B-cell prolymphocytic leukemia
  • t(11;14) must be excluded.
Follicular lymphoma
  • Nodular growth pattern of follicle center cells (centrocytes and centroblasts).
  • t(14;18)
Multiple myeloma
  • Absent Surface Ig.
  • Expresses CD138, CD38, CD79a, and VS38c.
  • Infrequently expresses CD19.
  • Approximately 70 percent of myeloma cells will express CD56.
Mantle cell lymphoma
  • Typically co-express surface IgM and IgD.
  • The vast majority over-express cyclin D1.
  • t(11;14)
Marginal zone lymphoma
Disease Etiology (Genetic or other) Clinical manifestations Paraclinical findings Associated findings
Lab findings
Symptoms Signs Immunochemistry Histopathology
Constitutional symptoms Rash Abdominal pain Diarrhea Mass Other
Lymphoplasmacytic lymphoma (Waldenstrom’s macroglobulinemia)
[11][12][13][14][15]
+ Express pan B-cell antigens

Variable expression of

Majority express

Fewer express

Lack expression of

B cell chronic lymphocytic leukemia/small lymphocytic lymphoma
[16]

33% of patients present with:

Always express

Usually express

Dim expression of

Follicular lymphoma
[17][18][19][20][21]
20% of patients present with: + + ± Express

Express Surface

  • Most common clinically indolent NHL
  • Peripheral nerve compression
Mantle cell lymphoma
[22][23][24][25][26]
Abdominal distention +

Co-express surface

_
Marginal zone lymphoma Extranodal marginal zone B-cell lymphoma of mucosa-associated lymphoid tissue (MALT) type
[27][28][29][30][31][32][33][34][35][36]
± + + B-cell associated antigens that co-express

Negative for

Splenic marginal zone lymphoma
[37][38][39][40][41][42][43]
+ +
Nodal marginal zone B-cell lymphoma
[44][45]
+
Multiple Myeloma
Expresses
  • CD138
  • CD38,
  • CD79a
  • VS38c
  • Infrequently expresses CD19.
  • CD56 (expressed by 70% of myeloma cells)
  • Absent surface Ig
B-cell prolymphocytic leukemia
Express bright surface IgM +/- IgD and bright CD20 as well as other B-cell antigens (CD19, CD22, CD79a, FMC7)
  • t(11;14) must be excluded
GC-associated lymphoid clones infiltrating the BM osteoblastic niche exhibit mesenchymal features in common with SLO germinal centers.(A–D) Histological examination of B-cell non-Hodgkin lymphoma (B-NHL) patient specimens. (A) The frequency of para-trabecular/osteoblastic localization of lymphoid malignant clones in 197 cases of B-NHL with bone marrow (BM) infiltration. Lymphoid clones of germinal center (GC)-derivation exhibiting preferential tropism for the BM osteoblastic niche include: follicular lymphoma (FL), T-cell rich histiocyte rich diffuse large B-cell lymphoma (TCRBCL), and diffuse large B-cell lymphoma of GC type (DLBCL-GC). Non-GC-related lymphoid clones include: DLBCL- activated B-cell type (ABC); mantle-cell lymmphoma, (MCL); marginal-zone lymphoma, (MZL); lymphoplasmacytic lymphoma, (LPL). (B) Para-trabecular (left panel) and inter-trabecular (right panel) localization of two representative cases of FL with BM infiltration. The distribution of the lymphomatous infiltrates around bone trabeculae or in the inter-trabecular lacunae is highlighted by CD20 immunostaining (inserts). (C–D) FL lymphoid infiltrates localizing within the osteoblastic niche area (left panels) and inter-trabecular BM (right panels) display a stromal architecture reminiscent of that of secondary lymphoid organ (SLO) GCs and are characterized by the expression of BM-MSC markers SPARC (C) and CD146 (right D).Source: Sangaletti S. et al, Molecular Immunology Unit; Department of Experimental Oncology and Molecular Medicine; Fondazione IRCCS Istituto Nazionale Tumori; Milan, Italy.
Expression of CD19 and CD20 in B-cell lineage.Notes: Illustrative representation of B-cell differentiation, maturation, antigen expression and B-cell neoplasm associated with different stages of B-cell development. Cell lines used in the research study.47–51Abbreviations: GC, germinal center; ALL, acute lymphoblastic leukemia; MCL, Mantle cell lymphoma; FL, follicular lymphoma; BL, Burkitt lymphoma; DLBCL, Diffuse Large B-Cell Lymphoma; MZL, Marginal Zone Lymphoma; CLL/SLL, Chronic Lymphocytic Leukemia/Small Lymphocytic Lymphoma; MALT, Mucosa-Associated lymphoid tissue; WM, Waldenstrom macroglobulinemia; MM, plasma cell myeloma; WSU-BL, Wayne State University-Burkitt lymphoma cell line; WSU-FSCCL, Wayne State University-follicular small cleaved cell lymphoma Cell line; WSU-NHL, Wayne State University-FL grade 3 Cell line; WSU-DLCL and WSU-DLCL2, Wayne State University-Diffuse large B-Cell lymphoma cell line; WSU-WM, Wayne State University-Waldenstrom macroglobulinemia Cell line.Source: Raufi A. et al, Lymphoma Research Laboratory, Wayne State University School of Medicine (WSU-SOM), Gordon Scott Hall for Basic Medical Sciences, Detroit, MI, USA.

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