Immunophenotypic analysis of CD103+ B-lymphoproliferative disorders: hairy cell leukemia and its mimics

Am J Clin Pathol. 2009 Apr;131(4):586-95. doi: 10.1309/AJCPL13YDUHFKPJU.

Abstract

CD103 is characteristically expressed in hairy cell leukemia (HCL), a B-lymphoproliferative disorder highly responsive to treatment with purine analogs. Other CD103+ diseases are rare and do not respond well to the same therapy, including HCL variant (HCLv) and splenic marginal zone B-cell lymphoma (SMZL) variants. We analyzed 215 cases of CD103+ B-lymphoproliferative disorders to further delineate their immunophenotypic features. Flow cytometric analysis revealed that 78.6% of all cases expressed CD25 and CD103, characteristic of classical HCL. Cases analyzed immunohistochemically were also invariably positive for annexin-A1; a subset coexpressed CD10 (33/169 [19.5%]) or BCL1 (26/65 [36.9%]). In contrast, 21.4% of cases lacked CD25, a subset of which was analyzed and was invariably negative for annexin-A1, CD10, and BCL1. The CD25- cases had variable morphologic features ranging from HCLv and SMZL to prolymphocytic leukemia and diffuse large B-cell lymphoma. Clinically, patients with CD25- disease tended to be older (P= .001), typically had leukocytosis (P= .014), and did not respond well to cladribine or pentostatin. We suggest categorizing CD103+ B-lymphoproliferative disorders into 2 groups. While HCL coexpresses CD25 and annexin-A1, diseases lacking CD25 and annexin-A1 behave clinically differently and can be separated from HCL on diagnosis.

MeSH terms

  • Antigens, CD / biosynthesis*
  • Diagnosis, Differential
  • Flow Cytometry
  • Humans
  • Immunohistochemistry
  • Immunophenotyping
  • Integrin alpha Chains / biosynthesis*
  • Interleukin-2 Receptor alpha Subunit / biosynthesis*
  • Leukemia, Hairy Cell / classification*
  • Leukemia, Hairy Cell / metabolism
  • Leukemia, Hairy Cell / pathology
  • Lymphoma, B-Cell / classification
  • Lymphoma, B-Cell / metabolism
  • Lymphoma, B-Cell / pathology
  • Receptors, Peptide / biosynthesis*

Substances

  • Antigens, CD
  • Integrin alpha Chains
  • Interleukin-2 Receptor alpha Subunit
  • Receptors, Peptide
  • alpha E integrins
  • annexin-A1 receptor, human