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Follicular Lymphoma Can Be Distinguished From Benign Follicular Hyperplasia by Flow Cytometry Using Simultaneous Staining of Cytoplasmic bcl-2 and Cell Surface CD20

Dennis B. Cornfield MD, Debra M. Mitchell MD, Nidal M. Almasri MD, John B. Anderson MT, Kim P. Ahrens BS, Elaine O. Dooley MT, Raul C. Braylan MD
DOI: http://dx.doi.org/10.1309/VJTK-DJWA-X297-XF8Q 258-263 First published online: 1 August 2000


The distinction between benign follicular hyperplasia (FH) and follicular lymphoma (FL) is sometimes problematic. We wanted to determine whether the expression of bcl-2 of FH was quantitatively different from that of FL, using surface CD20 expression as a discriminator of the various lymphoid compartments. Lymph node cell suspensions from 12 cases of FH and 17 cases of FL were analyzed by flow cytometry using a combined surface CD20 and intracellular bcl-2 staining. CD20– T cells in FH demonstrated the same bcl-2 expression as the CD20+ mantle cells, but the bright CD20+ germinal center cells showed near absence of bcl-2 expression. In contrast, the neoplastic cells of FL showed greater bcl-2 expression than the T cells of the same tumors and all cell populations of FH. This difference was particularly significant between the neoplastic B cells of FL and the germinal center cells of FH. The combined analysis of CD20 and bcl-2 should be useful for the differential diagnosis between FH and FL and particularly applicable to limited samples or when B-cell clonality is in question. Whether the quantitation of bcl-2 expression can be of further discriminatory value in malignant lymphomas remains to be determined.

Key Words:
  • Flow cytometry
  • bcl-2
  • Follicular lymphoma
  • Follicular hyperplasia