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Chapter 132 : Malignancies of the Immune System: Use of Immunologic and Molecular Tumor Markers in Classification and Diagnostics

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Abstract:

Malignancies of the immune system are primarily represented by the malignant lymphomas and a smaller number of nonlymphoid neoplasms that originate from cells involved in antigen presentation and processing. The ability to correctly diagnose tumors of the immune system, which in many instances show little morphological variation, requires the careful application of both immunologic tumor markers and molecular (DNA- or RNA-based) tumor markers. The application of modern immunologic techniques and concepts has permitted the development of a conceptual framework that may be used to decipher the morphological diversity of these neoplasms and has shown the relationship of lymphoid and mononuclear phagocytic neoplasms to the normal immune and hematopoietic systems. In recent years, an increasing number of mouse monoclonal antibodies have become available for use in paraffin sections, eliminating the need to perform immunohistochemistry on frozen tissue sections. Lymphoblastic malignancies (LBL) are neoplasms of precursor T and B lymphocytes. They may present clinically as either lymphoblastic lymphoma or acute lymphocytic leukemia (ALL), and morphologically the T and B-lineage varieties of LBL are indistinguishable. The ability of the cells to form follicles correlates with the presence of dendritic reticulum cells (DRC), which can be identified in frozen and paraffin sections by using monoclonal antibodies reactive with CD21, CD23, CD35, or clusterin. Hodgkin’s Lymphoma (HD) is an unusual neoplastic disorder because the neoplastic cells represent only a minority of the cells present in the tumor mass.

Citation: Raffeld M, Jaffe E. 2006. Malignancies of the Immune System: Use of Immunologic and Molecular Tumor Markers in Classification and Diagnostics, p 1152-1170. In Detrick B, Hamilton R, Folds J (ed), Manual of Molecular and Clinical Laboratory Immunology, 7th Edition. ASM Press, Washington, DC. doi: 10.1128/9781555815905.ch132

Key Concept Ranking

Acute Myeloid Leukemia
0.6687423
Immune Systems
0.6006828
Cytotoxic T Cell
0.49002045
Primary Effusion Lymphoma
0.48926634
Human herpesvirus 8
0.48605376
DNA Restriction Enzymes
0.46977407
0.6687423
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Figures

Image of FIGURE 1
FIGURE 1

Schematic diagram showing stages of T-cell differentiation. Neoplasms can be related to precursor and mature or peripheral T lymphocytes. Antigenic phenotype correlates with matu-rational stage. Note that CD7 is the earliest T-associated antigen.

Citation: Raffeld M, Jaffe E. 2006. Malignancies of the Immune System: Use of Immunologic and Molecular Tumor Markers in Classification and Diagnostics, p 1152-1170. In Detrick B, Hamilton R, Folds J (ed), Manual of Molecular and Clinical Laboratory Immunology, 7th Edition. ASM Press, Washington, DC. doi: 10.1128/9781555815905.ch132
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Image of FIGURE 2
FIGURE 2

Schematic diagram showing stages of B-cell differentiation. Lymphomas can be related to precursor B-cell, mature B-cell, and secretory B-cell (plasma cell) stages of differentiation. Note that CD79a has the broadest range of reactivity, staining precursor, mature, and secretory B cells. Abbreviations: PRE, precursor; IMMAT, immature; MAT, mature; ACTIVD, activated; HCR, heavy-chain gene rearrangement; κ and R/D, κ and λ light-chain gene rearrangement/deletion; sIg, surface immunoglobulin; LPL, lymphoplasmacytic lymphoma.

Citation: Raffeld M, Jaffe E. 2006. Malignancies of the Immune System: Use of Immunologic and Molecular Tumor Markers in Classification and Diagnostics, p 1152-1170. In Detrick B, Hamilton R, Folds J (ed), Manual of Molecular and Clinical Laboratory Immunology, 7th Edition. ASM Press, Washington, DC. doi: 10.1128/9781555815905.ch132
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Tables

Generic image for table
TABLE 1

WHO classification of lymphoid neoplasms

Citation: Raffeld M, Jaffe E. 2006. Malignancies of the Immune System: Use of Immunologic and Molecular Tumor Markers in Classification and Diagnostics, p 1152-1170. In Detrick B, Hamilton R, Folds J (ed), Manual of Molecular and Clinical Laboratory Immunology, 7th Edition. ASM Press, Washington, DC. doi: 10.1128/9781555815905.ch132
Generic image for table
TABLE 2

Antigens detectable in paraffin sections by immunohistochemistry

Citation: Raffeld M, Jaffe E. 2006. Malignancies of the Immune System: Use of Immunologic and Molecular Tumor Markers in Classification and Diagnostics, p 1152-1170. In Detrick B, Hamilton R, Folds J (ed), Manual of Molecular and Clinical Laboratory Immunology, 7th Edition. ASM Press, Washington, DC. doi: 10.1128/9781555815905.ch132
Generic image for table
TABLE 3

Chromosomal translocations, involved genes, and detection methods in B- and T-cell lymphoma/leukemias

Citation: Raffeld M, Jaffe E. 2006. Malignancies of the Immune System: Use of Immunologic and Molecular Tumor Markers in Classification and Diagnostics, p 1152-1170. In Detrick B, Hamilton R, Folds J (ed), Manual of Molecular and Clinical Laboratory Immunology, 7th Edition. ASM Press, Washington, DC. doi: 10.1128/9781555815905.ch132
Generic image for table
TABLE 4

Differential diagnosis of small B-cell lymphomas

Citation: Raffeld M, Jaffe E. 2006. Malignancies of the Immune System: Use of Immunologic and Molecular Tumor Markers in Classification and Diagnostics, p 1152-1170. In Detrick B, Hamilton R, Folds J (ed), Manual of Molecular and Clinical Laboratory Immunology, 7th Edition. ASM Press, Washington, DC. doi: 10.1128/9781555815905.ch132
Generic image for table
TABLE 5

Evaluation of oncogenes and tumor suppressor genes by immunohistochemistry and molecular diagnostic techniques

Citation: Raffeld M, Jaffe E. 2006. Malignancies of the Immune System: Use of Immunologic and Molecular Tumor Markers in Classification and Diagnostics, p 1152-1170. In Detrick B, Hamilton R, Folds J (ed), Manual of Molecular and Clinical Laboratory Immunology, 7th Edition. ASM Press, Washington, DC. doi: 10.1128/9781555815905.ch132
Generic image for table
TABLE 6

Immunophenotype in the differential diagnosis of nodal PTLs

Citation: Raffeld M, Jaffe E. 2006. Malignancies of the Immune System: Use of Immunologic and Molecular Tumor Markers in Classification and Diagnostics, p 1152-1170. In Detrick B, Hamilton R, Folds J (ed), Manual of Molecular and Clinical Laboratory Immunology, 7th Edition. ASM Press, Washington, DC. doi: 10.1128/9781555815905.ch132
Generic image for table
TABLE 7

Extranodal NK/T-cell lymphomas

Citation: Raffeld M, Jaffe E. 2006. Malignancies of the Immune System: Use of Immunologic and Molecular Tumor Markers in Classification and Diagnostics, p 1152-1170. In Detrick B, Hamilton R, Folds J (ed), Manual of Molecular and Clinical Laboratory Immunology, 7th Edition. ASM Press, Washington, DC. doi: 10.1128/9781555815905.ch132
Generic image for table
TABLE 8

Differential diagnosis of ALCL and HD

Citation: Raffeld M, Jaffe E. 2006. Malignancies of the Immune System: Use of Immunologic and Molecular Tumor Markers in Classification and Diagnostics, p 1152-1170. In Detrick B, Hamilton R, Folds J (ed), Manual of Molecular and Clinical Laboratory Immunology, 7th Edition. ASM Press, Washington, DC. doi: 10.1128/9781555815905.ch132

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