VAI TRÒ CỦA DẤU ẤN MIỄN DỊCH TRONG CHẨN ĐOÁN LƠ-XÊ-MI KINH DÒNG LYMPHO KHÔNG ĐIỂN HÌNH: TỪ LÝ THUYẾT ĐẾN THỰC TIỄN LÂM SÀNG

Abstract

Chronic lymphocytic leukemia (CLL) is diagnosed through the integration of cellular morphology, the number of clonal B cells, and a characteristic immunophenotype. Typical CLL cells co-express CD19, CD5, and CD23, with weak expression of CD20, CD79b, and surface immunoglobulin (sIg). Because several mature B-cell lymphoproliferative disorders share overlapping morphological features, immunophenotyping is central to the diagnosis and differential diagnosis of CLL. However, typical markers may be weakly expressed or absent, resulting in atypical CLL (aCLL) and creating diagnostic challenges, particularly in settings with limited access to advanced laboratory testing. This article reviews the immunophenotypic features of CLL, the iwCLL diagnostic criteria, selected immunophenotypic scoring systems, and the role of additional tests in distinguishing aCLL from mantle cell lymphoma and other mature B-cell lymphoproliferative disorders. A clinical case is presented to illustrate the risk of misdiagnosing mantle cell lymphoma as aCLL.