金秋獻禮，共慶雙節｜一份實用的血液腫瘤免疫表型參考圖表，請收好！

點擊次數：235 更新時間：2025-09-26

免疫表型（Immunophenotype）是指細胞表面、細胞內或分泌的蛋白質（主要是抗原）的表達模式。不同的細胞系列（如淋巴細胞、髓系細胞）和細胞發育的不同階段，都會表達獨特的CD抗原組合。

免疫表型檢測，在臨床實踐中通常通過流式細胞術（Flow Cytometry）或免疫組化（Immunohistochemistry）來實現，是現代血液腫瘤診療中不可或缺的核心技術之一。它被譽為血液病醫生的“火眼金睛"，其作用貫穿于血液腫瘤的診斷、分型、預后判斷和治療監測的全過程。

上周我們更新了一篇非淋系的WHO-HAEM5（第5版造血與淋巴組織腫瘤分類）的疾病名稱中英文對照。

第5版WHO造血淋巴腫瘤疾病名稱中英文對照—非淋系篇

這周我們來看一下，根據WHO-HAEM5（第5版造血與淋巴組織腫瘤分類），而制作的免疫表型的表達圖譜，供血液從業者日常使用參考。

免疫表型的表達圖譜

（點擊圖片查看高清大圖）

說明

（上下滑動閱覽）

Waldenstr?m macroglobulinema (ICD-O code=9761/3) is found in a significant subset of patients with lymphoplasmacytic lymphoma with BM involvement and an IgM monoclonal gammopathy of any concentration.
In Heavy Chain Diseases, intracellular Ig heavy chains are not always IgMs.
Typically IgM+, and less often IgA+ or IgG+.
IgD is positive in a minority of the cases.
IgM+/-, IgD, IgG or rarely IgA.
More frequently with Lambda than Kappa restriction.
The membrane expression of CD3 may be weak.
25% of patients coexpress CD8 with CD4, a feature almost unique to T-PLL. 15% are CD4-neg, CD8-pos.
Expression of CD94/NKG2 and KIR families of receptors can be detected in 50% or more of cases.
Uncommon variants include CD4 TCRα/β-pos cases and TCRγ/δ-pos cases. Approximately 60% of the latter express CD8, the remainder are CD4/CD8-neg.
Abnormal uniform expression of CD8 can be seen.
KIR-pos cases preferentially express activating receptor isoforms.
If TCRα/β-positive, expect dierent immunophenotype for the rest of the markers.
A CD4-pos/CD8-neg phenotype predominates in nodal cases. CD4/CD8 double positivity or double negativity is at times seen.
CD13 with heterogeneous expression.
Co-expression of CD15 and strong CD64 is characteristic of monocytic dierentiation.
CD25 is highly associated with t(9;22) B-ALL, at least in adults.
NG2 is characteristically expressed and is relatively, though not absolutely, specific.
The cortical T stage shows a double positive (CD4-pos/CD8-pos) phenotype. The medullary T stage expresses only either CD4 or CD8.
IgM+/IgD+ as for B-CLL/SLL
When t(14;18) IGH/BCL2 is present, bcl2 expression is bright
>90% of cases also express Sox-11 by IHC
MYC protein is strongly expressed due to translocation of the MYC gene to the IGH, IGK, or IGL genes.
All immunophenotypes for T-ALL/T-LBL are based on IHC and NOT flow cytometry
In AML with inv(16), CD14 and CD64 are mainly expressed by the monocytic component of this AML with myelomonocytic dierentiation, and CD16 is mainly expressed by the granulocytic component
In AML with t(15;17), CD2, CD34, and CD123 are most commonly expressed by the microgranular variant
In AML with NPM1 mutation, the immunophenotype diers between cases with prominent monocytic dierentiation and cases with prominent myeloblastic morphology (the latter often has cuplike nuclear invagination if a concurrent FLT3-ITD mutation is present)
AML with RAM phenotype, a subset of megakaryoblastic AML, expresses high-level CD56 without CD7

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參考文獻（上下滑動閱覽）

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