Normal B-cell subsets and reactive changes:

Blood and bone marrow specimen:

  • The normal range for kappa:lambda ratio is between 1-3 (range 0.8-4)
  • Small subsets of CD5+CD23+ B-cells with normal CD20 expression and polytypic kappa:lambda expression are frequently observed
  • CD10+ B-cell precursors can be observed in the blood at low frequency in infants/children or in the context of regenerating bone marrows or infections
  • CD19+CD20-CD38intermediate subsets suggesting plasmacytoid differentiation can sometimes be observed in regenerating marrows or infection

Normal blood sample:

Normal_blood_sample_1 Normal_blood_sample_2 Normal_blood_sample_3 Normal_blood_sample_4 Normal_blood_sample_5 Normal_blood_sample_6

Peripheral blood sample post-bone marrow transplant:

Peripheral_blood_sample_1 Peripheral_blood_sample_2 Peripheral_blood_sample_3 Peripheral_blood_sample_4 Peripheral_blood_sample_5 Peripheral_blood_sample_6

Lymph nodes and tonsils:

  • The kappa:lambda ratio can show a wider range of 0.4-4.7
    • Note that cases of reactive follicular hyperplasia with light chain restriction have been described; therefore monotypic populations are not always malignant and correlation with histology is required to assess for architectural/cytologic atypia.
  • CD10+ CD20 bright CD38 bright are characteristic of follicular hyperplasia
  • CD5+ B-cells can reach up to 1/3 of B-cells in activated follicles

Reactive lymphoid hyperplasia in a lymph node:

Reactive_lymphoid_hyperplasia_1 Reactive_lymphoid_hyperplasia_2 Reactive_lymphoid_hyperplasia_3 Reactive_lymphoid_hyperplasia_4 Reactive_lymphoid_hyperplasia_5

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