Dear Sharon,
I appreciate the comments from Maryalice and Anna.
We had many of these discussions among collgues here in Germany. For the
benefit of the patient and clinician: The way to go is to extirpate the
lymph node in total and send it (or pass on) to a reference pathologist who
is well trained (belongs to the REAL group). They hate fine needle biopsies
as the architecture of the lymph node gets lost. Your given immunophenotype
(by "feeling", missing morphology and conjugation) does not suggest a CLL
and lymphoma diagnosis by flow is a difficult game even including morpholgy
and experience. The discussion of your data is complicated by the fact that
the missing fluorochrome is crucial: PE gives positive signals eg. for CD25
or CD11c while FITC conjugates give negative results.
Lymphoma classification and treatment of lymphoma is based upon lymph node
pathology. The extended marker panel you anticipated we use for a while.
It helps to exclude B CLL but does not give a safe diagnosis of other B-NHL
(except HCL, may be Immunocytoma). The so called atypical B-CLL has never
been defined and even very experienced collegues refused to give a
presentation on that subject.
SLL from the working formulation is not a well defined clinical entity and
therefore did not exist in the KIEL classification.
Harald Stein (Berlin, REAL group) just presented at the german hematologist
meeting in Jena the new concept of a B1 and B2 CLL, where the latter is CD38
positive and forms lymphoma. (The concept behind is based on B cell
development in the lymph node). This provoqued a lively discussion esp.
among those who used CD38 in the past. We also found CD38-FITC surface
positive (dim compared to immunocytoma or plasmocytoma) in those CLL
patients with spleen and lymph node infiltration (total CLL n=85). Possibly
cytoplasmic staining resolves the controversial issue.
I dont want to be bouring but it would be helpful to have a minimum report
format (combinations / fluorochrome / surface or cytoplasmic / intensity
compared to normal counterparts) when discussing such cases.
Best regards
Thomas Nebe
Dr.med. C. Thomas Nebe
Universitaetsklinikum Mannheim
Zentrallabor
Theodor-Kutzer-Ufer 1-3
D-68167 Mannheim
Tel. +49 621 383-3485
FAX +49 621 383-73 3485
+49 621 383-3819
e-mail: thomas.nebe@ikc.ma.uni-heidelberg.de
Bitte besuchen Sie unsere sehr informativen Webseiten unter
http://www.ma.uni-heidelberg.de/inst/ikc/
> -----Ursprüngliche Nachricht-----
> Von: Gerhard Nebe-von-Caron [SMTP:Gerhard.Nebe-von-Caron@unilever.com]
> Gesendet am: Mittwoch, 20. Oktober 1999 16:58
> An: Nebe, Thomas C.
> Betreff: FW: Clinical case, lymphoma
>
>
>
> -----Original Message-----
> From: Sharon Vogt [SMTP:svogt@bellsouth.net]
> Sent: Saturday, October 16, 1999 1:14 AM
> To: Cytometry Mailing List
> Subject: Clinical case, lymphoma
>
>
> Hi all,
>
> We have a clinical case that's interesting to the point of frustration.
> Any
> comments?
>
> 53 y male, 3 years ago and now (recurrent) lymphoma, B-cell type.
> Phenotype is
> similar in both flow cytometric studies:
>
> CD19+ CD20+ CD22 dim, CD5 dim before, partial now, CD25+, CD23 partial,
> CD11c
> partial, with kappa light chain restriction. Negative for CD10. We do not
> stock
> FMC7 (but will soon), CD21 or CD24.
>
> By morphology and flow (considering dim CD5 as negative), the diagnosis of
> follicular center cell lymphoma (noting that 20-30% of these are known not
> to
> express CD10) was made. None of us are entirely sure of that diagnosis
> now, and
> there appears to be a tad more CD5 expression (recent specimen was FNA of
> cervical node); it was suggested that this may be a mantle cell lymphoma.
>
> OK, simple enough - immunohistochemical stains bcl-2 and cyclin D1 should
> answer
> that question. Those are difficult stains to optimize, however, and are
> affected
> by variations in fixation. In other words, they didn't help much. CD20 nor
> kappa
> light chain expression is remarkable for staining intensity, but I'd favor
> a CLL
> based on the rest of the phenotype. The pathologists say small cell, low
> grade,
> but not really CLL-like and definitely not PLL.
>
> ?? Thanks for any discussion.
>
> sharon
>
> Sharon F. Vogt
> svogt@bellsouth.net
> Dekalb Medical Center
> Atlanta, GA 30033
>
>
>
>
> << Datei: ATT01392.ATT >>
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