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American Journal of Surgical Pathology:
doi: 10.1097/PAS.0b013e318213e90e
Original Articles

Diagnosis and Immunophenotype of 188 Pediatric Lymphoblastic Lymphomas Treated Within a Randomized Prospective Trial: Experiences and Preliminary Recommendations From the European Childhood Lymphoma Pathology Panel

Oschlies, Ilske MD*; Burkhardt, Birgit MD, PhD; Chassagne-Clement, Catherine MD; d'Amore, Emanuel S. MD§; Hansson, Ulrika MD; Hebeda, Konnie MD; Mc Carthy, Keith MD; Kodet, Roman MD**; Maldyk, Jadwiga MD††; Müllauer, Leonhard MD‡‡; Porwit, Anna MD§§; Schmatz, Ana-Iris MD∥∥; Tinguely, Marianne MD¶¶; Abramov, Dimitry MD*; Wotherspoon, Andrew FRCPath♯♯; Zimmermann, Martin PhD; Reiter, Alfred MD; Klapper, Wolfram MD*

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The majority of lymphoblastic (precursor cell) neoplasms presents as leukemias. Consequently, the guidelines for lineage determination and subtyping of precursor cell neoplasms were primarily established for flow cytometry methods. Large-scale studies of nonleukemic lymphoblastic lymphomas are lacking so far. We analyzed a large series of pediatric patients with lymphoblastic lymphoma treated within a prospective randomized trial (the Euro-LB 02 study). Among 193 lymphomas, in which a detailed immunohistochemical analysis was carried out, there were several unusual and diagnostically challenging morphologic and immunophenotypical variants. These included 11 lymphomas with mixed phenotypes expressing markers of at least 2 hematopoietic lineages, 7 terminal deoxynucleotide transferase-negative lymphoblastic lymphomas, and 3 undifferentiated hematopoietic neoplasms that could not be assigned to any lineage with certainty. Our data indicate that World Health Organzation guidelines for lineage determination and subtyping of precursor cell leukemia need to be adapted before they can be applied to immunohistochemical diagnosis of lymphoma. Using the experience from this cohort we suggest a resource-saving diagnostic staining panel for the immunohistochemical analysis of precursor cell neoplasms in formalin-fixed paraffin-embedded tissue.

© 2011 Lippincott Williams & Wilkins, Inc.


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