Blood Res.  2020 Dec;55(4):253-261. 10.5045/br.2020.2020070.

First report of the unique expression of RECAF (receptor for alfa feto-protein) in adult B-NHL/CLL patients

Affiliations
  • 1Clinical Pathology Department, Internal Medicine Department, Ain Shams University, Faculty of Medicine, Cairo, Egypt
  • 2Clinical Hematology and Bone Marrow Transplant Unit, Internal Medicine Department, Ain Shams University, Faculty of Medicine, Cairo, Egypt

Abstract

Background
Lymphoproliferative disorders (LPDs) are a heterogeneous group of diseases characterized by an uncontrolled production of monoclonal lymphocytes. RECAF is the receptor for alpha-fetoprotein, which is re-expressed on malignant cells, thus serving as a broad-spectrum tumor marker.
Methods
The current study is a retrospective study carried out on 200 archival bone marrow trephine biopsy specimens [60 normal control (NC), 38 pathological control (PC) and 102 lymphoproliferative diseases (LPD) specimens]. RECAF expression was assessed using immunohistochemistry.
Results
The percentage of cells that are positive for RECAF was significantly higher in the LPD group than in the NC group (P=0.007), while there was no significant difference between non-Hodgkin lymphoma (NHL) patients and PC regarding the number of RECAF positive cells (P=0.1). RECAF showed a unique expression pattern among the different subtypes of LPD. None of the hairy cell leukemia (HCL) expressed RECAF, while the highest percentage was seen in follicular lymphoma (FL) and diffuse large B cell lymphoma (DLBCL) (P=0.001). Compared to routine histopathology, RECAF was more sensitive in detecting bone marrow (BM) infiltration in FL, mantle cell lymphoma (MCL), and DLBCL (P=0.01).
Conclusion
RECAF is significantly expressed in the BM of NHL/chronic lymphocytic leukemia (CLL) patients. RECAF shows a unique expression pattern among the different subtypes of LPD. Furthermore, RECAF may help to detect bone marrow infiltration in lymphoma cells. This may help in the diagnosis, follow-up, and targeting of LPD.

Keyword

Lymphoma; RECAF; Hairy cell leukemia; Chronic lymphocytic leukemia; Diffuse large B cell lymphoma; Follicular lymphoma

Figure

  • Fig. 1 Diffuse RECAF positive reaction in the majority of cells in DLBCL.

  • Fig. 2 Diffuse RECAF positivity in DLBCL.

  • Fig. 3 Collections of RECAF-positive cells in DLBCL.

  • Fig. 4 Sporadic RECAF-positive cells in DLBCL.

  • Fig. 5 Many and deeply stained RECAF-positive cells in DLBCL.

  • Fig. 6 RECAF-positive follicle (on the left) and a negative follicle (right) in the FL.

  • Fig. 7 A collection of RECAF-positive cells surrounded by negative cells in FL.

  • Fig. 8 Diffuse RECAF positivity in FL.

  • Fig. 9 Many and deeply stained RECAF-positive cells in MCL.

  • Fig. 10 Many and deeply stained RECAF-positive cells in MCL.

  • Fig. 11 Scattered RECAF-positive cells in CLL.

  • Fig. 12 HCL negative for RECAF.

  • Fig. 13 HCL negative for RECAF.

  • Fig. 14 Sporadic RECAF-positive cells in neuroblastoma.

  • Fig. 15 Collections of RECAF-positive cells in ALL.

  • Fig. 16 Few RECAF-positive cells in Multiple Myeloma.

  • Fig. 17 Sporadic RECAF-positive cells in neuroblastoma.

  • Fig. 18 Placental tissue stained with RECAF (positive control).

  • Fig. 19 Normal control negative for RECAF.


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