The value of immunohistochemistry for CD14, CD123, CD33, myeloperoxidase and CD68R in the diagnosis of acute and chronic myelomonocytic leukaemias

Histopathology. 2012 May;60(6):933-42. doi: 10.1111/j.1365-2559.2012.04175.x. Epub 2012 Feb 20.


Aims: In the absence of adequate aspirate films and touch imprints, distinction of chronic myelomonocytic leukaemia (CMML) from acute myeloid leukaemia with monocytic differentiation (Mo-AML) may be difficult solely on the basis of bone marrow biopsy morphological features. The aim of this study was to evaluate the diagnostic utility of a novel immunohistochemical panel for the diagnosis of acute and chronic myelomonocytic leukaemias in bone marrow biopsies.

Methods and results: Immunohistochemical labelling for CD14, CD123, CD33, myeloperoxidase (MPO) and CD68R was assessed in 49 myeloid neoplasms with monocytic differentiation (24 CMMLs and 25 Mo-AMLs) and compared with that of 15 non-monocytic acute myeloid leukaemias (NM-AMLs) and 17 non-neoplastic controls. More than 20% CD14 immunohistochemistry (IHC)+ cells were seen only in Mo-AMLs and CMMLs, although Mo-AMLs showed wide variability and overlapped with other categories. More than 20% CD68R IHC+ cells had the highest sensitivity and specificity for Mo-AML. Discrepant MPO-/CD33+ expression was specific for Mo-AML but insensitive. A subset of blasts in Mo-AMLs and NM-AMLs were weakly CD123+.

Conclusions: A significantly increased number of CD14+ cells raises the possibility of a myelomonocytic neoplasm but does not distinguish between CMML and Mo-AML. Significantly increased numbers of CD68R IHC+ cells and a discrepant MPO-/CD33+ staining pattern are specific for Mo-AML but are best utilized in a comprehensive panel.

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Aged, 80 and over
  • Antigens, CD / metabolism*
  • Antigens, Differentiation, Myelomonocytic / metabolism
  • Biomarkers, Tumor / metabolism*
  • Child
  • Child, Preschool
  • Humans
  • Immunohistochemistry / methods*
  • Infant
  • Interleukin-3 Receptor alpha Subunit / metabolism
  • Leukemia, Myelomonocytic, Acute / diagnosis*
  • Leukemia, Myelomonocytic, Acute / metabolism
  • Leukemia, Myelomonocytic, Chronic / diagnosis*
  • Leukemia, Myelomonocytic, Chronic / metabolism
  • Lipopolysaccharide Receptors / metabolism
  • Middle Aged
  • Peroxidase / metabolism*
  • Retrospective Studies
  • Sialic Acid Binding Ig-like Lectin 3
  • Young Adult


  • Antigens, CD
  • Antigens, Differentiation, Myelomonocytic
  • Biomarkers, Tumor
  • CD33 protein, human
  • IL3RA protein, human
  • Interleukin-3 Receptor alpha Subunit
  • Lipopolysaccharide Receptors
  • Sialic Acid Binding Ig-like Lectin 3
  • Peroxidase