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Hematopathology
Emina Emilia Torlakovic, MD, PhD
College of Medicine
University of Saskatchewan
Saskatoon, SK, Canada
1
IHC in BM pathology
Acute Leukemia
2
MDS and MDS/MPN
Myeloproliferative Neoplasms
(MPN)
3
CD34 Counts & Estimates
(%) in 500
cell count
> 3 pos. cells
> 5 pos. cells
4
CD20 and CD3 are always
interpreted together
CD20 ≠ Pax-5
J Pathol
5
Pax-5 in FL
CD20: Lymphoma
6
Cyclin D1
MCL HCL MM
7
Hodgkin Lymphoma
NLPHL: Pax-
Pax-5, CD20, CD3, Bcl-
Bcl-6, Oct-
Oct-2, CD57
Classical:
For presentation in the BM: CD30, CD15, CD3,
CD20, Pax-
Pax-5, MUM1
– To consider:
consider: EBV, PU.1, Oct2, BOB.1
For staging when malignant cells present: CD30,
CD15
For staging when abnormal cells not
morphologically obvious: CD3, Pax-
Pax-5, CD30
8
Histiocytic and Dendritic Cell
Neoplasms
Mastocytosis
9
Lymphoma
Basic Panel
10
Always Interpreted
Together
Lymphoplasmacytic
lymphoma
CD3
CD45RO-UCHL1≠CD3
11
Cytoplasmic CD3
•T-lymphoblastic
•T/NK lymphomas
T/HRBCL
CD3 CD8
CD8 CD20
12
CD20
CD20 CD21
CD75 CD79a
NLPHL
CD75 CD75
CD79a CD20
13
CD57
Oct-2
14
Ki-67 in
Hematopathology
Burkitt lymphoma: “nearly 100%”
100%” (class I)I)
Mantle cell lymphoma: > 40% adverse prognostic
indicator (class
(class II)
II)
ALL (low – better prognosis): higher in adults than
in children and higher in T-
T-ALL than in B-
B-ALL; good
prognosis ALL <25% (class
(class II)
II)
Very high in ALPS (class
(class I)
I)
Low in most low-
low-grade LPD (class
(class I)
I)
Plasmablastic lymphoma: minimum 75%, usually
>90% (class
(class I)
I)
Other…
Other…
Control
15
ALK-1 in ALCL with t(2;5)
Skin Bx:
Blastic morphology,
TdT+, Pax-5+,
CD45-
Answer:
Merkel Cell Carcinoma
(CK20+)
16
Critical B-Cell Markers
– CD5 – Pax-
Pax-5
– CD10 – CD138 &
– CD20 – Bcl-
Bcl-2
– CD21 – Bcl-
Bcl-6
– Cyclin D1
– CD23
– Ki-
Ki-67
– CD43
– TdT
– CD45
– CD34
– CD79a
– EBV (EBER or LMP1)
Additional Important B-
Cell Markers
HHV-8 (PEL, CD)
CD30
IgM
IgG, IgD, IgA
MUM1
PU.1
17
Critical T-Cell Markers
– CD56
– CD2, CD3, CD5, CD7
– ALK
– CD10, CD57, PD-
PD-1, CLCX-
CLCX-1
– TdT
– CD21
– CD34
– CD30
– CD4
– CD43
– CD8
– CD45, CD45RO
– TIA-
TIA-1
– Granzyme B/perforin
– EBV (EBER or LMP1)
Hodgkin Lymphoma
18
CD20 (Membranous)
CD79a (Cytoplasmic)
It is considered as a back-
back-up B cell antibody;
It is very valuable in providing additional
information
Expressed at all stages of B-
B-cell differentiation
(best marker for lymphoplasmacytic
lymphoma)
It is not lineage marker; Expressed in some
AML, and also some T- T-ALL
Malignant plasma cells express CD79a variably
Very unusual to see in cHL;
cHL; CD20 is much
more common than CD79a
19
Pax-5 and MUM1/IRF4
(Nuclear)
Pitfalls
– Extremely difficult to optimize to detect surface
light chain and to reliably interpret results of
cytoplasmic light chains
– Consider in situ hybridization for light chain
mRNA: the sensitivity is the same but the
specificity is higher
20
CD21, CD23 (Pan B)
Bcl-2 (Cytoplasmic)
CRITICAL MARKER FOR:
– FL vs. reactive follicular hyperplasia
Pitfalls
– Negative in minority of FLs (just like CD10)
– Negative in primary cutaneous FL
– Colonizing marginal zone cells will be bcl-
bcl-2(+):
correlate with Bcl-
Bcl-6 and CD10 expression.
21
CD5 (Membranous)
22
CD56
CD30
(Golgi, Cyotplasmic, Membranous)
23