B-cell lymphoma highlights vs T-cell lymphoma highlights
How to tell B-cell lymphoma highlights and T-cell lymphoma highlights apart when a board question makes them look alike.
B-cell lymphoma is usually CD19/CD20 or surface-Ig driven; T-cell lymphoma is CD3-driven with subtype clues such as skin, HTLV-1, flower cells, hypercalcemia, or ALK-positive ALCL.
Side by side
B-cell lymphomas often express CD19/CD20 and include follicular, mantle, Burkitt, DLBCL, marginal zone, CLL/SLL, and plasma-cell related disorders.
T-cell lymphomas often express CD3 and include adult T-cell leukemia/lymphoma, mycosis fungoides/Sezary syndrome, and anaplastic large-cell lymphoma.
Clonal B cells arise at different maturation stages and may carry hallmark translocations such as BCL2, cyclin D1, or MYC.
Clonal T cells can involve skin, blood, nodes, or extranodal sites and are classified by T-cell phenotype and molecular features.
CD20, surface immunoglobulin, light-chain restriction, and B-cell translocations support B-cell lymphoma.
CD3, CD4 or CD8 phenotype, HTLV-1 association with flower cells/hypercalcemia, cerebriform lymphocytes, or ALK positivity in anaplastic large-cell lymphoma support T-cell lymphoma.
The trap
Lymphoma location alone is not enough; immunophenotype determines B-cell versus T-cell lineage.
Watch it explained
The repair move
For lymphoma lineage, look at immunophenotype before memorizing morphology: (1) CD20-positive plus surface immunoglobulin (kappa or lambda light-chain restriction proves clonality) plus B-cell translocation equals B-cell lymphoma (t(14;18) BCL2 in follicular lymphoma, t(8;14) MYC in Burkitt with starry-sky pattern, t(11;14) cyclin D1 in mantle cell, t(11;18) in MALToma); (2) CD3-positive plus subtype-specific clues equals T-cell lymphoma (cerebriform Sezary cells in blood plus Pautrier microabscesses in skin equals mycosis fungoides / Sezary syndrome; HTLV-1 from Japan or Caribbean plus hypercalcemia plus lytic bone lesions plus flower cells equals adult T-cell leukemia-lymphoma; ALK-positive plus sinusoidal pattern equals anaplastic large-cell lymphoma); (3) confirm with flow cytometry or biopsy with immunohistochemistry before counseling treatment.
Try a free question
CoreA lymphoma biopsy shows clonal CD20-positive cells with light-chain restriction and t(14;18) causing BCL2 overexpression. Which lineage is most likely?
Show answer and explanation
Answer: A. B-cell lymphoma. CD20, light-chain restriction, and BCL2 translocation support B-cell lymphoma.
Why the other choices are tempting
- B. T-cell lymphoma should express T-cell markers such as CD3.
- C. Myeloid leukemia uses myeloid markers and marrow/blood blast patterns.
- D. Histiocytic neoplasms use macrophage/dendritic markers rather than CD20 light-chain restriction.
- E. Metastatic carcinoma uses epithelial markers rather than lymphoid immunophenotype.
Flashcards
Tap a card to flip it.
What marker supports B-cell lymphoma?
CD20 or other B-cell markers such as CD19 support B-cell lymphoma.
What marker supports T-cell lymphoma?
CD3 supports T-cell lymphoma because CD3 is part of the T-cell receptor signaling complex.
Quick answers
What is the fastest way to tell B-cell lymphoma highlights from T-cell lymphoma highlights?
B-cell lymphoma is usually CD19/CD20 or surface-Ig driven; T-cell lymphoma is CD3-driven with subtype clues such as skin, HTLV-1, flower cells, hypercalcemia, or ALK-positive ALCL.
What is the key clue for B-cell lymphoma highlights?
B-cell lymphomas often express CD19/CD20 and include follicular, mantle, Burkitt, DLBCL, marginal zone, CLL/SLL, and plasma-cell related disorders.
What is the key clue for T-cell lymphoma highlights?
T-cell lymphomas often express CD3 and include adult T-cell leukemia/lymphoma, mycosis fungoides/Sezary syndrome, and anaplastic large-cell lymphoma.
What is the common trap with B-cell lymphoma highlights vs T-cell lymphoma highlights?
Lymphoma location alone is not enough; immunophenotype determines B-cell versus T-cell lineage.