B-Cell Neoplasms |
Immature B-Cell Neoplasms |
Lymphoblastic leukemia (see Chap. 55) | Medium to large cells with finely stippled chromatin and scant cytoplasm | TdT+, sIg-, CD10+, CD13+/-, CD19+, CD20-, CD22+, CD34+/-, CD33+/-, CD45+/-, CD79a+ | t(1;19), t(9;22), and defects at 11q23-defects associated with poor prognosis |
Lymphoblastic lymphoma (see Chap. 65) | Medium-sized cells with high nuclear to cytoplasmic ratio | See above | See above |
Mature B-cell Neoplasms |
Leukemias | | | |
Chronic lymphocytic leukemia (see Chap. 56) | Small cells with round, dense nuclei | sIg+(dim), CD5+, CD10-, CD19+, CD20+(dim), CD22+(dim), CD23+, CD38+/-, CD45+, FMC-7- | IgR, trisomy 12 (~30%), del at 13q14 (~50%), 11q- (15%) |
Prolymphocytic leukemia (see Chap. 56) | ≥55% prolymphocytes | sIg+(bright), CD5+/-, CD10-, CD19+, CD22+, CD23+/-, CD45+ | IgR, trisomy 12 (~30%) |
Hairy cell leukemia (see Chap. 57) | Small cells with cytoplasmic projections | sIg+(bright), CD5-, CD10-, CD11c+(bright), CD19+, CD20+, CD25+, CD45+, CD103+, Annexin A+ | IgR, |
Lymphomas | | | |
Small lymphocytic lymphoma (see Chap. 56) | Small round cells | sIg+(dim), CD5+, CD19+, dim CD20+, CD23+, CD45+ | IgR, trisomy 12 (~30%), del at 13q14 (~40%), 11q- (~15%) |
Lymphoplasmacytic lymphoma (see Chap. 70) | Small cells with plasmacytoid differentiation | cIg+, CD5-, CD10-, CD19+, CD20+/– Plasma cell population: CD38+, CD138+, cIgM+ | IgR, 6q- in 50% of marrow-based cases [the t(9;14) was proved to be wrong] |
Mantle cell lymphoma (see Chap. 63) | Small- to medium-sized cells | sIgM+, sIgD+, CD5+, CD10-, CD19+, CD20+, CD23–, Cyclin D1+, FMC-7+ | IgR, t(11;14)(q13;q32) (~100% by FISH), involving BCL1 and IgH |
Follicular lymphoma (follicle center lymphoma; see Chap. 62) | Small, medium, or large cells with cleaved nuclei | sIg, CD5-, CD10+, CD19+, bright CD20+, CD23-/+, CD38+, CD45+ | IgR, t(14;18)(q32;q21) (~85%) involving BCL2 and IgH |
Marginal zone B-cell lymphoma (see Chap. 64) | Small or large monocytoid cells | sIgM+, sIgD-, cIg+ (~50%), CD5-, CD10-, CD11c+/-, CD19+, CD20+, CD23-, CD43+/- | IgR, commonly with trisomy 3 and/or t(11;18)(q21;q21) involving API2, MLT, or t(1;14)(p22;q32) involving BCL10 |
Mucosa-associated lymphoid tissue (MALT) type (see Chap. 64) | See above | See above | See above |
Nodal type | See above | See above | See above |
Splenic type | Small to large monocytoid and/or villous lymphocytes | sIgM+, sIgD-, CD5+/-, CD19+, CD20+, CD23- | IgR, |
Diffuse large B-cell lymphoma (see Chap. 61) | Large, irregular cells that can resemble centroblasts, immunoblasts, multilobate cells, or even RS-like cells | sIgM+, sIgD+/-, CD5-/+, CD10-/+, CD19+, CD20+, CD45+, PAX5+ | IgR, 3q27 abnormalities and/or t(3;14)(q27;q32) involving BCL6 (~40%) or t(14;18)(q32;q21) (~25%) involving BCL2 |
Primary mediastinal (thymic) large B-cell lymphoma (see Chap. 61) | Same as above | sIg-, CD5-, CD10-/+, CD15-, CD19+, CD20+, CD22+, CD30+/-, CD45+, CD79a+ | Gain of 9q24 (75%), gain 2p15 (50%) Lack of rearrangements of BCL2, BCL6, or MYC |
Burkitt lymphoma (see Chap. 65) | Medium-sized, round cells with abundant cytoplasm | sIgM+, CD5-, CD10+, CD19+, CD20+, CD23-, CD45+ | t(8;14)(q24;q32), t(2;8)(q11;q24), or t(8;22)(q24;q11), involving Ig loci and C-MYC at 8q24 |
Burkitt-like lymphoma (see Chap. 65) | Medium-sized, round cells with abundant cytoplasm | Same as above except sIg-, cIg+/-, and CD10- | Same as above except more typically expresses high levels of BCL2 and ~30% have BCL2 rearrangements |
B-Cell Neoplasms |
Plasma cell neoplasms |
Myeloma (see Chap. 69) | Plasma cells with occasional plasmablasts | cIg+, sIg-, CD5-, CD10-, CD19-, CD20-, CD38+(bright), CD45-/+, CD56+, CD117+/-(bright), CD138+(bright) | IgR, commonly with complex karyotypes and/or t(6;14)(p25;q32) involving MUM1. t(11;14)(q23;q32) can be found in 15–25% of cases |
Plasma cell leukemia (see Chap. 69) | Plasmablastic cells with prominent nucleoli | Same as above except usually CD56- | Same as above |
Plasmacytoma (see Chap. 69) | Plasma cells | Same as plasma cell myeloma | Same as above |
Waldenström macroglobulinemia (see Chap. 70) | Lymphocytes, plasmacytoid cells, and plasma cells | CD5+/-, CD10-, CD19, CD20+, CD22+, CD38+/- | IgR, complex karyotypes common |
Hodgkin Lymphoma (HL) |
Nodular lymphocyte predominant HL (see Chap. 59) | "Popcorn cells" with nuclei resembling those of centroblasts | BCL6+, CD19+, CD20+, CD22+, CD45+, CD79a+, CD15-, and rarely CD30+/-, Bob1+, Oct2+, PAX5+ | IgR, with high-level expression of BCL6 |
Classic HL |
Nodular sclerosis HL | R-S cells and lacunar cells dispersed in reactive lymphoid nodules | R-S cells typically are CD15+, CD20+/-, CD30+, CD45-, CD79a-, PAX5+(dim) | R-S cells generally express PAX5 and MUM1, variable expression of BCL6, and have IgR, without functional Ig |
Lymphocyte-rich HL | Few R-S cells with occasional "popcorn" appearance dispersed in lymphoid nodules | Same as above | Same as above |
Mixed cellularity HL | R-S cells dispersed among plasma cells, epithelioid histiocytes, eosinophils, and T cells | R-S cells typically are CD15+, CD20-/+, CD30+, CD45-, CD79a- | R-S cells generally express PAX5 and MUM1, variable expression of BCL6, and have IgR, without functional Ig |
Lymphocyte-depleted HL | Prominent numbers of R-S cells with effacement of the nodal structure | Same as above | Same as above |
T-Cell Neoplasms |
Immature T-Cell Neoplasms |
Lymphoblastic leukemia (see Chap. 55) | Medium to large cells with finely stippled chromatin and scant cytoplasm | TdT+, CD2+/-, cytoplasmic CD3+, CD1a+/-, CD5+/-, CD7+, CD10+/-, CD4/+CD8+ or CD4-/CD8-, CD34+/- | Abnormalities in TCR loci at 14q11 (TCR-α), 7q34 (TCR-β), or 7p15 (TCR-γ), and/or t(1;14)(p32–34; q11) involving TAL1 |
Lymphoblastic lymphoma (see Chap. 55) | Same as above | Same as above | Same as above |
Mature T-Cell Neoplasms Leukemias |
T-cell prolymphocytic leukemia (see Chap. 67) | Small to medium size cells with cytoplasmic protrusions or blebs | TdT-, CD2+, CD3+, CD5+, CD7+, CD4+ and CD8- is more common than CD4- and CD8+, but can be CD4+ and CD8+ | α/β TCR rearrangement, inv14(q11;q32)(~ 75–80%) |
T-cell large granular lymphocytic leukemia (see Chap. 58) | Abundant cytoplasm and sparse azurophilic granules | CD2+, CD3+, CD4 -/+, CD5+, CD7+, CD8+/-, CD16+/-, CD56-, CD57+/- | α/β TCR rearrangement, γ/δ rearrangement can be seen. |
T-Cell Neoplasms |
Lymphomas |
Extranodal T/NK-cell lymphoma, nasal type ("angiocentric lymphoma"; see Chaps. 58 and 67) | Angiocentric and angiodestructive growth | CD2+, cytoplasmic CD3+, CD4-, CD5-/+, CD7+, CD8-, CD56+, EBV+ | TCR rearrangements variable, EBV present by in situ hybridization |
Cutaneous T-cell lymphoma (mycosis fungoides; see Chap. 66) | Small to large cells with cerebriform nuclei | CD2+, CD3+, CD4+, CD5+, CD7+/-, CD8-, CD25-, CD26+ | α/β TCR rearrangements |
Sézary syndrome (see Chap. 66) | Same as above | Same as above | Same as above |
Angioimmunoblastic T-cell lymphoma | Small to medium size immunoblasts with clear to pale cytoplasm around follicles and high endothelial venules | CD3+/-, CD4+, CD10+, CXCL13+, PD-1+, EBV+ | α/β TCR rearrangement (75–90%), IgR, (25–30%), trisomy 3 or 5 noted |
Peripheral T-cell lymphoma (not otherwise unspecified; see Chap. 67) | Highly variable | CD2+, CD3+, CD5+, CD7-, CD4+CD8- more often than CD4-CD8+, which is more often than CD4+CD8+ | α/β TCR rearrangement |
Subcutaneous panniculitis-like T-cell lymphoma | Variably-sized atypical cells with hyperchromasia infiltrating fat lobule | CD2+, CD3+, CD4-, CD5+, CD7-, CD8+, and cytoxic molecules (perforin, granzyme B, and TIA1) | α/β TCR rearrangement |
Enteropathy-associated T-cell lymphoma | Small to large atypical lymphocytes | CD2+, CD3+, CD5-, CD7+, CD8-/+, CD4-, CD103+ | β TCR rearrangement |
Hepatosplenic T-cell lymphoma | Small to medium size cells with condensed chromatin and round nuclei | CD2+, CD3+, CD4-, CD5+, CD7+/-, CD8+/- | γ/δ TCR rearrangement, rarely α/β TCR rearrangement, isochromosome 7q |
Adult T-cell leukemia/lymphoma (see Chap. 55) | Highly pleomorphic with multilobed nuclei | CD2+, CD3+, CD5+, CD7-, CD25+, CD4+CD8- more often than CD4-CD8+ | α/β TCR rearrangement, integrated HTLV-1 |
Anaplastic large-cell lymphoma | Large pleomorphic cells with "horseshoe"-shaped nuclei, prominent nucleoli, and abundant cytoplasm | TdT-, ALK1+, CD2+/-, CD3+/-, CD4-/+, CD5-/+, CD7+/-, CD8-/+, CD13-/+, CD25+/-, CD30+, CD33-/+, CD45+, HLA-DR+, TIA+/- | TCR rearrangement, t(2;5)(p23;q35) resulting in nucleophosmin–-anaplastic lymphoma kinase fusion protein (NPM/ALK); other translocations involving 2p23 are also seen |
Primary cutaneous CD30+ anaplastic large cell lymphoma | Anaplastic large cells as above in cutaneous nodules | TdT-, CD2-/+, CD3-/+, CD4+, CD5-/+, CD7+/-, CD25+/-, CD30+, CD45+ | TCR rearrangement but without t(2;5)(p23;q35), therefore, ALK1 |
Natural Killer Cell Neoplasms |
Large granular lymphocytic leukemia (see Chap. 58) | Abundant cytoplasm and sparse azurophilic granules | TdT-, CD2+, CD3-, CD4-, CD5-/+, CD7+, CD8-/+, CD11b+, CD16+, CD56+, CD57+/- | No TCR rearrangement |
Aggressive NK-cell leukemia | Same as above | Same as above | No TCR rearrangement, EBV present |
Extranodal NK-cell lymphoma, nasal-type ("angiocentric lymphoma") | Angiocentric and angiodestructive growth | CD2+, cytoplasmic CD3ε+, CD4-, CD5-/+, CD7+, CD8-, CD56+ | No TCR rearrangement, EBV present |