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J Clin Pathol 55:892 doi:10.1136/jcp.55.12.892
  • Diagnostic brief

Immunohistochemical classification of T cell and NK cell neoplasms

Table 1

Interpretation of immunohistochemistry

TdT CD3 CD4 CD8 GB/P TIA1 CD56 EBV CD30 ALK Characteristic feature(s)
*The T cell origin of this entity is disputed; †these tumours are usually CD57+.
ALCL, anaplastic large cell lymphoma; EBV, Epstein-Barr virus; GB, granzyme B; HTLV1, human T cell lymphotropic virus 1; NK, natural killer; NOS, not otherwise specified; P, perforin; PLL, prolymphocytic leukaemia; TdT, terminal deoxynucleotidyl transferase; +, positive; −, negative; +/−, usually positive, sometimes negative; −/+, usually negative, sometimes positive.
Predominantly leukaemic
    Precursor T lymphoblastic leukaemia + + +/− +/− Frequent presentation with mediastinal mass
    T cell PLL + +/− −/+ Multi-organ involvement including the skin
    T cell large granular lymphocytic leukaemia + −/+ +/− + + +/−* Indolent behaviour
    Aggressive NK cell leukaemia + + + + + Multi-organ involvement, highly aggressive
    Adult T cell lymphoma/leukaemia (HTLV1+) + + +/− Usually widely disseminated, very rare in non-endemic areas
Predominantly extranodal
    Extranodal NK/T cell lymphoma, nasal type + + + + + −/+ Nearly always primary nasal localisation
    Enteropathy-type T cell lymphoma + −/+ + + −/+ −/+ −/+ Usually, but not always associated with coeliac disease
    Hepatosplenic γλ T cell lymphoma + + + Involvement of liver, spleen, and bone marrow
Predominantly cutaneous
    Blastic NK cell lymphoma† −/+ + −/+ −/+ + Difficult distinction from T cell acute lymphoblastic leukaemia and myeloblastic leukaemia
    Subcutaneous panniculitis-like T cell + + + + −/+ Rimming of adipocytes
    Mycosis fungoides/Sezary syndrome + −/+ −/+ −/+ Epidermotropism and Pautrier abscess formation
    ALCL primary cutaneous −/+ +/− −/+ +/− +/− + Distinction with lymphomatoid papulosis only on basis of clinical behaviour
Predominantly nodal
    ALCL systemic −/+ +/− −/+ +/− +/− + +/− ALK positive cases demonstrate favourable clinical outcome
    Peripheral T cell lymphoma, NOS + +/− −/+ +/− Usually generalised disease
    Angio immunoblastic T cell lymphoma + + + + Aggregates of CD21 positive dendritic cells, outside follicle centres. EBV positive B cells

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