Abstract
Classical Hodgkin lymphoma (CHL) is a relatively uncommon B cell-derived neoplasm that presents with rare malignant cells in an abundant reactive background. The diagnosis of CHL currently relies on a combination of morphologic findings and immunohistochemical stains. With the exception of rare cases with dramatically increased malignant populations, isolation of pure viable tumor cells has not been historically possible. Recently, a reliable flow cytometric assay for direct detection and isolation of the malignant cells in this disease has been developed. This assay has proven useful diagnostically and has been clinically validated to have a very high sensitivity and nearly absolute specificity for the diagnosis of CHL in routine clinical samples. This paper describes the methodology for the flow cytometric detection of CHL in clinical samples as well as current state of evaluation of background lymphocytes as an adjunct diagnostic test. Also discussed are exciting research applications of the direct isolation of viable tumor cells in CHL. The current state of flow cytometric evaluation of nodular lymphocyte predominant Hodgkin lymphoma and T cell-rich large B cell lymphoma is also briefly discussed.
Highlights
Classical Hodgkin lymphoma (CHL) is a relatively uncommon B cell-derived neoplasm that presents with rare malignant cells in an abundant reactive background
Classical Hodgkin lymphoma is a B cell neoplasm where the neoplastic population represents less than 1% and frequently less than 0.01% of the total cells [5]
Flow cytometry offers several potential benefits in the diagnosis of CHL. These include: (1) increased diagnostic certainty in cases which may be equivocal or possibly negative by initial morphologic review; our study identified four such cases, which were subsequently confirmed by extensive immunohistochemical panels or tissue section morphology on a subsequent biopsy; (2) rapid turn around time required for confirmation of CHL by immunohistochemistry; and (3) significant cost savings compared to extensive immunohistochemical panels that have become common in the morphologic diagnosis of CHL
Summary
Classical Hodgkin lymphoma (CHL) is a relatively uncommon B cell-derived neoplasm that presents with rare malignant cells in an abundant reactive background. This paper describes the methodology for the flow cytometric detection of CHL in clinical samples as well as current state of evaluation of background lymphocytes as an adjunct diagnostic test. The development of the technique to stain cells in tissue sections with antibody (immunohistochemistry) has added significantly to the specificity of the diagnosis and allowed for further tissue-based analysis of the immunophenotype of the HRS cells.
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