Contribution of immunophenotype to the investigation and differential diagnosis of Burkitt lymphoma, double‐hit high‐grade B‐cell lymphoma, and single‐hit MYC‐rearranged diffuse large B‐cell lymphoma

• Published in: Cytometry. Part B, Clinical cytometry Clinical cytometry, 2020-09, Vol.98 (5), p.412-420
• Main Authors: Tsagarakis, Nikolaos J., Papadhimitriou, Stefanos I., Pavlidis, Dimitris, Liapis, Konstantinos, Gortzolidis, Georgios, Kostopoulos, Ioannis V., Marinakis, Theodoros, Paterakis, Georgios
• Format: Article
• Language: English
• Subjects: Antibodies; Antigens; Bcl-6 protein; Burkitt lymphoma; Burkitt's lymphoma; CD20 antigen; CD22 antigen; CD23 antigen; CD27 antigen; CD38 antigen; CD43 antigen; Cytogenetics; Diagnosis; Diagnostic systems; Differential diagnosis; DLBCL; double‐hit lymphoma; Flow cytometry; Fluorescence; Fluorescence in situ hybridization; immunophenotype; Lymphoma; Myc protein; MYC rearrangement; Scattering
• ISSN: 1552-4949; 1552-4957
• DOI: 10.1002/cyto.b.21887

Background There are no immunophenotypic guidelines for the investigation of MYC‐rearranged lymphomas. We aimed to identify simple immunophenotypic features that would help to differentiate between MYC‐rearranged lymphomas and guide cytogenetic analysis. Methods We reviewed diagnostic samples from patients diagnosed with Burkitt lymphoma (BL), double‐hit lymphoma (DHL), MYC‐rearranged diffuse large B‐cell lymphoma (MYC‐DLBCL), and standard (non‐MYC‐rearranged) DLBCL over the last decade in our Institution. Using flow cytometry (with antibodies CD20, CD10, CD38, bcl‐2, Ki‐67, FMC‐7, CD43, CD27, CD79b, CD23, and CD22) we determined antigen% expression and median‐fluorescence intensity ratios (MFIR). The forward scatter (FS) and side scatter (SS) characteristics of tumor B‐cells were compared with normal T‐cells (B/T ratios) for patients with MYC‐rearranged lymphomas. Results We identified 51 patients of whom 14 had BL, 10 had DHL (6 MYC+/BCL2+; 4 MYC+/BCL6+), 8 MYC‐DLBCL, and 19 standard DLBCL. The significant differences (p  90, CD10% > 80, CD10MFIR > 10, bcl‐2%  70 was characteristic of BL. “Deviation” from these cut‐offs should raise suspicion for DHL and, therefore, BCL2 and/or BCL6 FISH is required. We also found that a diagnosis of DHL rather than of MYC‐DLBCL was significantly associated with CD10% > 60, Ki‐67% > 50, and SS (B/T)