Value of multi-parameter flow cytometry immunophenotyping in T/NK-cell neoplasms in cytology specimens: A retrospective study in Chinese patients

Zheng, Yuwei; Wan, Xiaochun; Gui, Xian; Chen, Ying; Gao, Lili; Zhang, Hao; Wang, Yanli

doi:10.1016/j.prp.2020.152921

Cited by 3 publications

(3 citation statements)

References 38 publications

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“…MFCI plays an integral role in the screening and diagnosis of lymphoma. In some cases, especially when observing relatively clear space-occupying lesions is difficult, MFCI is indispensable[ 17 ]. In this case, we used MFCI to help us make a correct diagnosis.…”

Section: Discussionmentioning

confidence: 99%

Intestinal natural killer/T-cell lymphoma presenting as a pancreatic head space-occupying lesion: A case report

Wang¹,

Zhu²,

Lei³

et al. 2023

World J Gastrointest Oncol

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BACKGROUND Intestinal natural killer/T-cell lymphoma (NKTCL) is a rare and aggressive non-Hodgkin’s lymphoma, and its occurrence is closely related to Epstein-Barr virus infection. In addition, the clinical symptoms of NKTCL are not obvious, and the specific pathogenesis is still uncertain. While NKTCL may occur in any segment of the intestinal tract, its distinct location in the periampullary region, which leads clinicians to consider mimics of a pancreatic head mass, should also be addressed. Therefore, there remain huge challenges in the diagnosis and treatment of intestinal NKTCL. CASE SUMMARY In this case, we introduce a male who presented to the clinic with edema of both lower limbs, accompanied by diarrhea, and abdominal pain. Endoscopic ultrasound (EUS) showed well-defined homogeneous hypoechoic lesions with abundant blood flow signals and compression signs in the head of the pancreas. Under the guidance of EUS- fine needle biopsy (FNB) with 19 gauge or 22 gauge needles, combined with multicolor flow cytometry immunophenotyping (MFCI) helped us diagnose NKTCL. During treatments, the patient was prescribed the steroid (dexamethasone), methotrexate, ifosfamide, L-asparaginase, and etoposide chemotherapy regimen. Unfortunately, he died of leukopenia and severe septic shock in a local hospital. CONCLUSION Clinicians should enhance their understanding of NKTCL. Some key factors, including EUS characteristics, the right choice of FNB needle, and combination with MFCI, are crucial for improving the diagnostic rate and reducing the misdiagnosis rate.

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Section: Discussionmentioning

confidence: 99%

Intestinal natural killer/T-cell lymphoma presenting as a pancreatic head space-occupying lesion: A case report

Wang¹,

Zhu²,

Lei³

et al. 2023

World J Gastrointest Oncol

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“…T cell populations with the loss and/or decreased expression of one or more pan-T cell markers or expression those at abnormal density were considered as aberrant populations ( 26 , 27 ). In routine practice, T cells were considered aberrant consisting of the following: (1) abnormal expression (loss, enhanced, or dimished) of pan-T cell markers such as surface CD5, CD2, CD3, or CD7 antigens and cytoplasmic CD3 (cyCD3); (2) CD4/CD8 ratio >10 or <0.1 and had a predominant CD4+/CD8+ or CD4–/CD8– cell population; (3) expression of non-T cell markers including CD10, CD30, CD56, TdT, CD34, and TCR γδ ( 28 ). B cell subpopulations were defined as aberrant by the presence of 2 main types of phenotypic abnormality: immunoglobulin light chain class restriction (κ/λ ratios >3:1 or <0.3:1, or more than 25% of mature B cells lacking or expressing low level surface immunoglobulin) and/or antigenic aberrancies ( 29 ).…”

Section: Methodsmentioning

confidence: 99%

PD-1 combined with TRBC1 and pan-T cell antibodies for robustly monitoring angioimmunoblastic T-cell lymphoma

et al. 2022

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BackgroundThe diagnosis of AITL is challenging. It may be delayed or even missed due to critical clinical conditions and its histologic and immunophenotypic overlap with other neoplastic and reactive lymphoid proliferations.ObjectiveThe key objective is to obtain an efficient diagnosis, sensitive disease monitoring and treatment efficacy assessment of AITL using multiparameter flow cytometry (MFC).MethodsIn total, 167 de novo AITL patients were immunophenotypically profiled using sensitive MFC. We precisely identified the aberrant T-cell populations of AITL and performed an in-depth description of their phenotypic characteristics in comparison with their residual normal CD4+ T cells. A comparison of Programmed death receptor-1 (PD-1) expression was performed among AITL and other T-cell lymphomas.ResultsMFC detected a neoplastic T-cell population in 94.1% (80/85) of tissue, 71.5% (108/151) of bone marrow (BM), 100% (8/8) of peripheral blood (PB) and 78.6% (11/14) of body fluid samples. The most frequent immunophenotypic aberrations included the absence and diminished expression of CD3 (71.25% in tissues, 71.3% in BM, 75% in PB, 81.8% in hydrothorax and ascites specimens), followed by the loss or partial loss of CD7 (71.25% in LN, 67.6% in BM, 50% in PB, 81.8% in hydrothorax and ascites specimens). The immunophenotyping of neoplastic T-cell populations showed a high degree of similarity among different sites of the same patient and they might change over time but were relatively stable. Bright PD-1 expression showed high sensitivity and specificity in differentiating AITL from other T-cell lymphomas. In 14 AITL patients, neoplastic T-cell populations were initially missed by T-cell screening tube but were successfully discovered by bright PD-1 expression.ConclusionT-cell screening tube can reliably screen neoplastic T-cell populations in AITL patients with typical immunophenotyping, such as loss of surface CD3 and loss of CD7 with a relatively high ratio. Bright PD-1 expression is essential for identifying aberrant T cells in almost all AITLs. The clonality assessment antibody TRBC1 is efficient for robustly and cheaply assessing T-cell clonality. Using PD-1 and TRBC1 combined with pan-T cell antibodies can make a precise diagnosis of AITL and also sensitively monitor minimal residual disease regardless of the antigenic drift of the neoplastic T cells.

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“…Body fluid effusions are often suitable samples for flow cytometry (FC), given the samples are not fixed by alcohol or formalin. FC-based analysis is an extremely useful method when dealing with differential diagnosis of effusion-based hematolymphoid malignancy, because this technology provides a reproducible, quantitative and sensitive immunophenotyping of cells, using fluorescent-tagged antibodies targeting surface markers [5,[41][42][43][44]. Similar to ICC, FC analysis using a panel of antibodies can provide diagnostic clues in lymphoid malignancies.…”

Section: Flow Cytometrymentioning

confidence: 99%

Lymphoproliferative disorder involving body fluid: diagnostic approaches and roles of ancillary studies

Koh

Shin

Lee

et al. 2022

J Pathol Transl Med

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Lymphocyte-rich effusions represent benign reactive process or neoplastic condition. Involvement of lymphoproliferative disease in body cavity is not uncommon, and it often causes diagnostic challenge. In this review, we suggest a practical diagnostic approach toward lymphocyte-rich effusions, share representative cases, and discuss the utility of ancillary tests. Cytomorphologic features favoring neoplastic condition include high cellularity, cellular atypia/pleomorphism, monomorphic cell population, and frequent apoptosis, whereas lack of atypia, polymorphic cell population, and predominance of small T cells usually represent benign reactive process. Involvement of non-hematolymphoid malignant cells in body fluid should be ruled out first, followed by categorization of the samples into either small/medium-sized cell dominant or large-sized cell dominant fluid. Small/medium-sized cell dominant effusions require ancillary tests when either cellular atypia or history/clinical suspicion of lymphoproliferative disease is present. Large-sized cell dominant effusions usually suggest neoplastic condition, however, in the settings of initial presentation or low overall cellularity, ancillary studies are helpful for more clarification. Ancillary tests including immunocytochemistry, in situ hybridization, clonality test, and next-generation sequencing can be performed using cytologic preparations. Throughout the diagnostic process, proper review of clinical history, cytomorphologic examination, and application of adequate ancillary tests are key elements for successful diagnosis.

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Value of multi-parameter flow cytometry immunophenotyping in T/NK-cell neoplasms in cytology specimens: A retrospective study in Chinese patients

Cited by 3 publications

References 38 publications

Intestinal natural killer/T-cell lymphoma presenting as a pancreatic head space-occupying lesion: A case report

Intestinal natural killer/T-cell lymphoma presenting as a pancreatic head space-occupying lesion: A case report

PD-1 combined with TRBC1 and pan-T cell antibodies for robustly monitoring angioimmunoblastic T-cell lymphoma

Lymphoproliferative disorder involving body fluid: diagnostic approaches and roles of ancillary studies

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