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There Are No Magic Bullets in Hematopathology: Even Immunostains for CD20 and CD3 Can Get You Into Trouble

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Immunohistochemistry is a powerful tool for the diagnosis and subclassification of hematolymphoid neoplasms. However, the expression of certain markers is not always as expected, and unusual patterns of staining can lead to misdiagnosis. CD20 and CD3 are our most commonly used markers for identification of B cells and T cells, respectively, and they almost always yield reliable, specific staining. This discussion focuses on diagnostic pitfalls related to the use of immunohistochemistry for CD20 and CD3 in hematopathology, and specifically on diagnostic challenges that arise when (1) CD20 is not expressed in B-cell lymphomas, when (2) CD20 is expressed in plasma cell neoplasms and T-cell lymphomas, and when (3) CD3 is expressed in B-cell lymphomas and Hodgkin lymphoma.
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Keywords: ALK+ large B-cell lymphoma; CD20; CD20+ T-cell lymphoma; CD3; HHV8+ lymphoma; IgM plasma cell myeloma; T-antigen+ Hodgkin lymphoma; immunohistochemistry; plasmablastic lymphoma

Document Type: Research Article

Affiliations: Massachusetts General Hospital, James Homer Wright Pathology Laboratories of the Massachusetts General Hospital, Department of Pathology, Harvard Medical School, Boston, MA

Publication date: January 1, 2018

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