Korean J Hematol.  2009 Mar;44(1):8-13. 10.5045/kjh.2009.44.1.8.

Characterization of the Proliferated Histiocytes in Acute Leukemia by Performing Immunohistochemistry

• Chae H
• Park HH

• KMID: 2252167
• DOI: http://doi.org/10.5045/kjh.2009.44.1.8

Abstract

BACKGROUND
The bone marrow biopsy sections of acute leukemia patients occasionally reveal a proliferation of large mononuclear cells that accompany the leukemic blasts, and this proliferation shows a starry sky pattern. We characterized these large mononuclear cells by performing immunohistochemistry with 12 different antibodies. The clinical characteristics were examined and then we determined their difference from hemophagocytic lymphohistiocytosis (HLH) and malignant histiocytic disorders.
METHODS
Of the 200 acute leukemic bone marrow biopsy samples, 11 ALL and 10 AML cases showed large mononuclear cell proliferations. The panel of antibodies used for immunohistochemistry included those against the mononuclear phagocyte system, and immunohistochemistry was performed on the patients' initial specimens and the complete remission specimens. 10 normal specimens, 4 initial CML specimens and their complete hematologic response specimens were included as controls.
RESULTS
The large mononuclear cells showed immunohistochemical results consistent with histiocytes. They were negative for the markers of dendritic cells the histiocytes and cytokines that are involved in the pathogenesis of HLH and vascular proliferation. Histiocyte proliferation was not observed in the complete remission specimens and in the initial and complete hematological response specimens of the CML patients and the normal bone marrow specimens. None of the cases fulfilled the criteria of HLH, and all 5 ALL cases, for which the immunophenotype results were available, showed a B cell phenotype.
CONCLUSION
We characterized the large mononuclear cell proliferations as reactive histiocyte proliferations and we differentiated these from those of secondary HLH and malignant histiocytic disorders. A proportion of the large mononuclear cells showed negative results for all 12 antibodies and they showed characteristics that were suggestive of small fat cells. The pathophysiology and the prognostic effect of the reactive histiocyte proliferation accompanying acute leukemia require further study.

Keyword

Histiocyte; Immunohistochemistry; Acute leukemia

MeSH Terms

Adipocytes
Antibodies
Biopsy
Bone Marrow
Cytokines
Dendritic Cells
Histiocytes
Histiocytic Disorders, Malignant
Humans
Immunohistochemistry
Leukemia
Lymphohistiocytosis, Hemophagocytic
Mononuclear Phagocyte System
Phenotype
Antibodies
Cytokines

Figure

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  Fig. 1. Bone marrow biopsy specimen of acute leukemia showing prominent starry sky pattern (H&E stain, ×400).

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  Fig. 2. Histiocytes showing positive staining with anti-CD68 monoclonal antibody (Immunohistochemical stain, ×400).

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  Fig. 3. Histiocytes showing positive staining with S-100 monoclonal antibody (Immunohistochemical stain, ×400).

Reference

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