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Background Both BL and DLBCL are prevalent in HIV/AIDS patients and the correct classification of these two subtypes of Non-Hodgkin's lymphomas (NHL) particularly between DLCBL with high proliferation and BL, is critical to chemotherapy choice. Transcriptional gene expression profiling of sporadic and endemic BL by Stein et al (Berlin) identified a molecular signature for BL that included a down regulation of CD44 expression in a group of lymphomas from Africa. Immunophenotyping of formalin-fixed paraffin-embedded (FFPE) BL tissues by this group demonstrated difficulties in correctly classifying BL using morphology, BCL-2 (immunohistochemistry – IHC) presence and MYC (fluorescent in situ hybridization – FISH) absence. The differential expression of CD44, albeit nonmembranous, suggests an intricate regulatory circuit that allows for low expression, supporting the possibility that CD44 plays a role in BL/BLL dissemination. CD44 (IHC) could be a valuable marker to aid classification of tumors whose morphologic and phenotypic overlap is among BL, BLL and DLBCL. CD44 absence clearly separates MYC+ BL/BLL and MYC-DLBCL. DLBCL, Hodgkin's lymphoma (HL) and normal lymphocytes from lymphoid mantle/ marginal cell and interfollicular T-cell-rich zones should be strongly CD44 positive. Materials and methods We evaluated 128 FFPE lymphoma tissue biopsy collected at St. Mary's Lacor Hospital, Gulu, Uganda, Africa, from 1994 to 2007 from tissue microarray (TMA) blocks constructed on site using the UNITMA Quick-Ray System (Seoul, South Korea). The completed TMA blocks were sectioned and stained for HE in situ hybridization (ISH) for EBV (EBER) and kappa and lambda light chains and FISH break apart assay for CMYC translocation.

infectious agents and cancer

Value of CD44 immunostaining (IHC) as a surrogate in the differentiation of MYC-positive Burkitt lymphoma (BL) and Burkitt lymphoma-like (BLL) from MYC-negative Diffuse Large B-Cell Lymphoma (DLBCL) in a resource constrained clinical setting