Application of a BRAF V600E mutation-specific antibody for the diagnosis of hairy cell leukemia

Am J Surg Pathol. 2012 Dec;36(12):1796-800. doi: 10.1097/PAS.0b013e3182549b50.

Abstract

In recent times BRAF V600E mutations have emerged as a genetic hallmark of hairy cell leukemia (HCL). This specific point mutation is present in virtually all cases of HCL but is exceedingly rare in other peripheral B-cell neoplasms. In this study we investigated the application of a BRAF V600E mutation-specific antibody (clone VE1) to differentiate HCL from HCL mimics, such as HCL variant and splenic marginal zone lymphoma. A total of 52 routinely processed formalin-fixed paraffin-embedded tissue specimens were investigated (bone marrow, n=46; spleen, n=6) for expression of V600E-mutated BRAF protein. All 32 cases of HCL were scored positive, and all non-HCL cases were scored negative. In 28 of 30 HCL cases the presence of a BRAF V600E mutation could be confirmed by direct sequencing, whereas no BRAF mutations were detected among 20 HCL mimics. We further screened 228 mature B-cell neoplasms with VE1 and detected 1 positive case of chronic lymphocytic leukemia. Sequencing confirmed the presence of a BRAF V600E mutation. In conclusion, we demonstrate that VE1 immunohistochemistry can be used to reliably differentiate HCL from HCL-mimicking entities. This on-slide technique might be particularly helpful in interpreting challenging biopsies with low tumor content.

Publication types

  • Evaluation Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Antibodies, Monoclonal*
  • Antibody Specificity
  • Biomarkers, Tumor / analysis*
  • Biomarkers, Tumor / genetics
  • Biomarkers, Tumor / immunology
  • Biopsy
  • DNA Mutational Analysis
  • Diagnosis, Differential
  • Exons
  • Humans
  • Immunohistochemistry*
  • Leukemia, Hairy Cell / diagnosis*
  • Leukemia, Hairy Cell / enzymology
  • Leukemia, Hairy Cell / genetics
  • Leukemia, Hairy Cell / pathology
  • Point Mutation*
  • Predictive Value of Tests
  • Proto-Oncogene Proteins B-raf / analysis*
  • Proto-Oncogene Proteins B-raf / genetics
  • Proto-Oncogene Proteins B-raf / immunology

Substances

  • Antibodies, Monoclonal
  • Biomarkers, Tumor
  • BRAF protein, human
  • Proto-Oncogene Proteins B-raf