Surgical Pathology Criteria

Lymphoplasmacytic Lymphoma

Differential Diagnosis

Small B Cell Lymphomas
  SLL/CLL Mantle Marginal Zone Lymphoplasmacytic Follicular
CD23 85% 2% 8% 0-30% on immunohistology but up to 60% weak positive on flow 0-25%
CD5 80% 80% 0% 5% 0%
bcl1 2% 85% 0% 0% 0%
CD10 0% 2% 2% 3% 85%
CD43 80% 85% 35% 10-30% 7%
bcl2 95% 95% 65-90% >50% 90%

 

Lymphoplasmacytic Lymphoma / Immunocytoma SLL/CLL
Proliferation centers absent Proliferation centers frequent
Plasmacytoid differentiation marked Plasmacytoid differentiation variable
CD5 5% CD5 80%
CD23 0-30% on immunohistology but up to 60% weak positive on flow CD23 85%

 

Lymphoplasmacytic Lymphoma / Immunocytoma Mantle Cell Lymphoma
Round nuclear membranes Variably irregular nuclear membranes
bcl1 negative bcl1 85%
CD5 5% CD5 80%
Large cell transformation Blastic transformation
Plasmacytoid diffrentiation may be prominent in mantle cell lymphoma

 

Nodal, Extranodal and Splenic Marginal Zone Lymphoma Lymphoplasmacytic Lymphoma
Enlarged marginal zone Diffuse effacement
Pale monocytoid cells No monocytoid population

 

Plasmacytoma / Myeloma Lymphoplasmacytic Lymphoma and Nodal, Extranodal and Splenic Marginal Zone Lymphomas
Plasma cells may be pleomorphic or plasmablastic Plasma cell component usually not markedly atypical
Uniform plasma cell morphology Plasma cells mixed with small lymphocytes
IgG or IgA M component most common IgM or IgG M component most common
CD20 often negative CD20 80%
Uniformly CD138 positive Scattered CD138 positive cells
Often CD56+, CD19-, CD45- CD56-, CD19+, CD45+

 

Castleman disease Lymphoplasmacytic Lymphoma
Small burned out follicles Residual follicles infrequent
No intranuclear inclusions Intranuclear inclusions present
30% of cases monotypic 100% monotypic
IgG or IgA IgM or IgG

 

Reactive Plasmacytosis Lymphoplasmacytic Lymphoma
Polytypic Monotypic
No intranuclear inclusions Intranuclear inclusions present
Generally a problem only with small samples or LLI with an interfollicular pattern

Stanford Medicine Resources:

Footer Links: