title: Immunoarchitectural patterns in follicular lymphoma: efficacy of HGAL and LMO2 in the detection of the interfollicular and diffuse components.
abstract: Follicular lymphoma (FL) can exhibit variant histologic patterns that can lead to confusion with other B-cell lymphomas and reactive conditions. Diagnostic markers such as CD10 and BCL2 may be difficult to interpret in variant FL patterns, and are often diminished or absent in the interfollicular and diffuse components. We evaluated 2 recently characterized germinal center B-cell markers, human germinal center associated lymphoma (HGAL), and LIM-only transcription factor 2 (LMO2), in 127 FL patient biopsies (94 nodal, 33 extranodal), and correlated the findings with histologic pattern, cellular composition, grade, and additional immunostains (CD20, CD3, CD21, CD10, BCL2, and BCL6). Architectural patterns included predominantly follicular (75%) and follicular and diffuse components (25%); 10 cases showed marginal zone differentiation and 3 were floral variants. Eighty-nine cases were low grade (38 grade 1; 51 grade 2) and 38 were grade 3 (29 grade 3A and 9 grade 3B). HGAL had the highest overall sensitivity of detecting FL and was superior in detecting the interfollicular and diffuse components compared with BCL2, LMO2, CD10, and BCL6. All 28 cases that lacked CD10, expressed HGAL, and the majority also expressed LMO2. Our results show that HGAL and LMO2 are sensitive markers for FL diagnosis. The addition of HGAL and LMO2 to the immunohistologic panel is beneficial in the work-up of nodal and extranodal B-cell lymphomas and the efficacy of HGAL in detecting the follicular, interfollicular and diffuse components of FL is of particular value in the setting of variant immunoarchitectural patterns.
authors.affiliation: Department of Pathology, Division of Oncology, Stanford University School of Medicine, Stanford, CA 94305, USA.
authors.forename: Sheren F
authors.initials: SF
authors.lastname: Younes
authors.forename: Andrew H
authors.initials: AH
authors.lastname: Beck
authors.forename: Izidore S
authors.initials: IS
authors.lastname: Lossos
authors.forename: Ronald
authors.initials: R
authors.lastname: Levy
authors.forename: Roger A
authors.initials: RA
authors.lastname: Warnke
authors.forename: Yasodha
authors.initials: Y
authors.lastname: Natkunam
mesh_terms: D048868:Adaptor Proteins, Signal Transducing; D001402:B-Lymphocytes / Q000378:metabolism; D014408:Biomarkers, Tumor / Q000378:metabolism*; D004268:DNA-Binding Proteins / Q000378:metabolism*; D018858:Germinal Center / Q000378:metabolism / Q000473:pathology; D006801:Humans; D007150:Immunohistochemistry; D047908:Intracellular Signaling Peptides and Proteins; D060588:LIM Domain Proteins; D008224:Lymphoma, Follicular / Q000175:diagnosis* / Q000378:metabolism; D008667:Metalloproteins / Q000378:metabolism*; D008840:Microfilament Proteins; D009363:Neoplasm Proteins / Q000378:metabolism*; D011237:Predictive Value of Tests; D011518:Proto-Oncogene Proteins / Q000378:metabolism
chemical_list: D048868:Adaptor Proteins, Signal Transducing; D014408:Biomarkers, Tumor; D004268:DNA-Binding Proteins; C476824:GCSAM protein, human; D047908:Intracellular Signaling Peptides and Proteins; D060588:LIM Domain Proteins; C085117:LMO2 protein, human; D008667:Metalloproteins; D008840:Microfilament Proteins; D009363:Neoplasm Proteins; D011518:Proto-Oncogene Proteins