CD30 in the differential diagnosis of NHL

The judicious use of tailored panels of immunohistochemical stains will permit the hematopathologist to establish a diagnosis in virtually all instances. The algorithm presented here, developed using information from the National Comprehensive Cancer Network Clinical Practice Guidelines in Oncology for non-Hodgkin lymphomas, version 4.2011,1 highlights the utility of CD30 in differential diagnosis.

The CD30 staining pattern deserves special recognition. In lesions resembling reactive paracortical hyperplasia, CD30 is used to screen for HL. In classical HL, the Hodgkin cells show a membrane and/or paranuclear/Golgi staining pattern of fairly uniform intensity. Unfortunately, some T-cell lymphomas may also express CD30. Other T-cell lymphomas and DLBCL may show patchy CD30 positivity of variable intensity, but ALCL shows sheets of strong intensity CD30-positive cells.2 CD30 is a highly useful marker and is included in the initial panel of immunostains for determining a hematopathology diagnosis for several broad morphologic categories.

Algorithm for differential diagnosis of NHL
Hematopathology Immunophenotype
Anaplastic CD30+ ALK+: ALK+ ALCL
ALK-: DLBCL, CHL, LPD, ALK- ALCL
CD30- PTCL-NOS
Nonanaplastic, localization
— Cutaneous CD30+ CD30+ cutaneous LPD
CD30- CD4+: MF, ATLL, BPDC, small/medium CTCL, PTCL-NOS
CD4-: AECTCL, cutaneous γδTCL, SCPTCL, PTCL-NOS, NK/T nasal type
— Extranodal/noncutaneous CD30+ ALK+: ALK+ ALCL, small cell/histiocyte-rich variant
ALK-: EATL, PTCL-NOS
CD30- HSTCL, PTCL-NOS
— Nodal CD30+ ALK+: ALK+ ALCL, small cell/histiocyte-rich variant
CD30+/- ALK-: ATLL, PTCL-NOS

AECTCL = aggressive epidermotropic cytotoxic T-cell lymphoma; ALCL = anaplastic large cell lymphoma; ALK = anaplastic lymphoma kinase; ATLL = adult T-cell leukemia/lymphoma; BPDC = blastic plasmacytoid dendritic cell neoplasm; CHL = classical Hodgkin lymphoma; CTCL = cutaneous T-cell lymphoma; DLBCL = diffuse large B-cell lymphoma; EATL = enteropathy-associated T-cell lymphoma; HSTCL = hepatosplenic T-cell lymphoma; LPD = lymphoproliferative disorder; MF = mycosis fungoides; NK = natural killer; PTCL-NOS = peripheral T-cell lymphoma, not otherwise specified; SCPTCL = subcutaneous panniculitis-like T-cell lymphoma; γδTCL = gamma-delta T-cell lymphoma

References

  1. National Comprehensive Cancer Network (NCCN). NCCN clinical practice guidelines in oncology: non-Hodgkin’s lymphomas (version 4.2011). Fort Washington, PA: NCCN; 2011.
  2. Lu J, Chang KL. Practical immunohistochemistry in hematopathology: a review of useful antibodies for diagnosis. Adv Anat Pathol. 2011;18(2):133-151.