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CD10, HLA-DR, Kappa, and Lambda

Continuing with this case, note that CD10 is 0% and HLA-DR is 10%. Kappa is 4% and Lambda is 3%. The breakdown thus far is:

CD19= 7%
CD20= 7%
HLA-DR= 10%
CD10= 0%

Given this information, follicular lymphoma can be ruled out because CD10 is not present. Referring to the decision tree, (above) the CD10 surface marker would be positive with follicular lymphoma.

Kappa and Lambda light chains are both expressed and in approximately equal amounts. This helps to rule out a B-cell neoplastic process. If the B lymphocytes expressed only one type of light chain (kappa or lambda), or one predominated significantly, a malignant, clonal population would be suspected.

It is important to also look at the T cells to determine whether or not there is normal representation of the expected antigens.