Surgical Pathology Criteria

Small Lymphocytic Lymphoma / Chronic Lymphocytic Leukemia

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%


Mantle Cell Lymphoma SLL/CLL
Irregular nuclear membranes Round nuclei
Residual germinal centers may be prominent Proliferation centers present
Expanded mantle zone around germinal centers variably present No mantle zone pattern
Scattered histiocytes Histiocytes not prominent
bcl1 85% bcl1 2%
CD23 2% CD23 85%
Blastic transformation Large cell transformation
Some mantle cell lymphomas have been reported to have proliferation centers; these are better considered as SLL/CLL


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%


Nodal, Extranodal and Splenic Marginal Zone Lymphoma SLL/CLL
Enlarged marginal zone Diffuse effacement
Pale monocytoid cells Small round lymphocytes
May have residual germinal centers Proliferation centers frequent
CD23 8% CD23 85%
CD5 negative CD5 80%
CD43 35% (Splenic 2%) CD43 80%
Both may involve the GI tract and other mucosal sites


Follicular Lymphoma SLL/CLL
Distinct nodular pattern Vague proliferation centers
Nodules composed of cleaved cells Nodules composed of prolymphocytes and paraimmunoblasts
Interfollicular cleaved cells common Background sheets of regular small lymphocytes
CD23 0-38% CD23 85%
CD5 negative CD5 80%
CD43 7% CD43 80%
CD10 85% CD10 0%
bcl2 stains over 90% of both


Lymphocyte Predominant Hodgkin Lymphoma SLL/CLL
Wide age range Rare under 30 years
Limited number of large nodules Scattered small proliferation centers
Large atypical cells scattered in and around nodules Large cells confined to proliferation centers
CD23 negative CD23 85%
CD5 negative on B cells CD5 80%
CD43 negative on B cells CD43 80%
Large cells may be EMA positive EMA negative
Light chains polytypic or negative Light chains monotypic or negative
CD57+ small cells surrounding large cells No CD57 ringing pattern


Sporadic Diffuse Large B Cell Lymphoma SLL/CLL with Large Cell Transformation
No history of SLL/CLL History or concurrent SLL/CLL
CD23 negative CD23 85%
CD5 negative CD5 80%
CD43 rare CD43 60-80%


Diffuse Large B Cell Lymphoma Paraimmunoblastic SLL/CLL
Nuclear shape variable Nuclei round, uniform
Nucleoli frequently multiple Nucleoli single
Cytoplasm may be basophilic Cytoplasm pale
Node capsule frequently destroyed Node capsule preserved even if overrun
CD5 rare CD5 80%


Immunoblastic Large B Cell Lymphoma Paraimmunoblastic SLL/CLL
Very large cell size Moderate to large cell size
Very vesicular nuclei Partially vesicular nuclei
Very large nucleoli Intermediate size nucleoli
Basophilic cytoplasm Pale cytoplasm
CD5 rare CD5 80%


Burkitt Lymphoma Prolymphocytic SLL/CLL
Starry sky macrophages present Starry sky macrophages variable
Uniform population Admixed prolymphocytes and small cells
Cytoplasm amphophilic or basophilic Cytoplasm pale
Multiple nucleoli Single nucleolus
Ki67 nearly 100% Ki67 moderately high
CD23 negative CD23 85%
Translocation involving myc gene No myc translocation

Nodal Involvement by Prolymphocytic Leukemia Paraimmunoblastic SLL/CLL
Many circulating prolymphocytes <10% circulating prolymphocytes
Pure prolymphocytic infiltrate Predominantly paraimmunoblasts
Splenomegaly present Splenomegaly variable
Lymphadenopathy minimal Lymphadenopathy prominent

Chronic Inflammation SLL/CLL
Germinal centers may be present Proliferation centers indistinct
Mixed population Uniform small cells (except proliferation centers)
CD23 negative (follicular dendritic cells positive) CD23 85% positive on lymphocytes
No coexpression Coexpression of CD5 or CD43 75-100%
B and T zones Sheets of B cells
No light chain monotypia Light chain monotypia variably demonstrable
Clonal immunoglobulin rearrangements absent Clonal immunoglobulin rearrangements present
Capsular fibrosis infrequent Capsular fibrosis frequent
Plasmacytosis infrequent Plasmacytosis frequent

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