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CD Markers

CD23


Reviewer: Nat Pernick, M.D. (see Reviewers page)
Revised: 18 January 2011, last major update January 2011
Copyright: (c) 2002-2011, PathologyOutlines.com, Inc.

General
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● Key molecule for B-cell activation and growth

Terminology
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● Also known as low affinity IgE receptor, Fc fragment of IgE receptor, FCER

Physiology
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● A type C lectin that can be secreted
● After physiologic germinal cell development, the follicular dendritic cell meshwork expands and follicular dendritic cells in the light zone of the germinal center become CD23 positive
● CD23 acts as a B cell growth and activation factor, promoting differentiation into plasma cells
● Regulates IgE synthesis through CD21 and IgE binding (J Exp Med 2005;202:751), and mediates IgE related immune responses (Clin Rev Allergy Immunol 2005;29:61)
● Shows variability in flow cytometry expression between specimens from same patient (Am J Clin Pathol 2002;117:615)
● CD21, CD23 and CD35 are dendritic cell markers

Clinical features
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● High expression on B cells in peripheral blood is associated with bullous pemphigoid (J Dermatol Sci 2004;35:53)
● CD23 antibodies may decrease adherence of Plasmodium falciparum-infected erythrocytes (Cell Microbiol 2004;6:839)
● CD23 mediates antimycobacterial activity of human macrophages (Infect Immun 2009;77:5537)
Mantle cell lymphoma: usually CD23 negative, but may have CD23 present with dim intensity by flow cytometry (Am J Clin Pathol 2003;120:760 , Am J Clin Pathol 2001;116:893); however, these cases have high cyclin D1 levels (Am J Clin Pathol 2002;117:237); CD23+ cases may have better prognosis (Am J Clin Pathol 2008;130:166)
● Mantle cell lymphoma rarely has CD23+ cells in peripheral blood (Am J Clin Pathol 2002;118:758)
● High soluble CD23 is associated with aggressive disease and poorer prognosis in CLL (Leuk Lymphoma 2002;43:549, Clin Lab Haematol 2006;28:30)

Uses
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● CD21, CD23 and CD35 are dendritic cell markers
● Differentiate SLL/CLL (CD23+) vs. mantle cell lymphoma or MALT lymphoma (CD23-)
● B cell marker, particularly for SLL/CLL, mediastinal large B cell lymphoma and lymphoplasmacytic lymphoma
● Distinguish nodal mantle cell lymphoma from follicular lymphoma by identifying a disrupted follicular dendritic cell pattern (Int J Surg Pathol 2005;13:73)

Micro images
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Normal tonsil-contributed by Leica Microsystems, Biosystems Division

   

Follicular dendritic cell tumor-lung (figure 3A) and spine (figure 3B)

Follicular lymphoma-contributed by Leica Microsystems, Biosystems Division

MALT lymphoma-lung

Various images

Positive staining - normal
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● Activated mature B cells expressing IgM or IgD (particularly mantle cells), activated monocytes / macrophages, T cell subsets, platelets, eosinophils, Langerhans cells, follicular dendritic cells, intestinal epithelium (encodes IgE receptor, Gastroenterology 2005;129:928)

Positive staining - disease
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● B-cell CLL/SLL (almost all cases; high levels, Leuk Res 2002;26:809, Hum Pathol 1999;30:648)
● Atypical cases of CLL/SLL may have higher levels (Am J Clin Pathol 2001;116:655)
● Follicular dendritic cell tumors (including inflammatory pseudotumor type - Am J Surg Pathol 2001;25:721)
● Mediastinal large B cell lymphoma (70%, Histopathology 2004;45:619)
● Lymphoplasmacytic lymphoma (61%, usually dim intensity by flow cytometry, Am J Clin Pathol 2005;124:414, Clin Lymphoma 2005;5:246)
● Hairy cell leukemia (17%, Am J Clin Path 2006;125:251)
● Diffuse large B cell lymphoma (16%)

Negative staining
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● Basophils, resting B cells
● Other B cell lymphomas including Burkitt’s lymphoma, Burkitt-like lymphoma (Am J Surg Pathol 2005;29:1652), follicular lymphoma, mantle cell lymphoma, marginal zone lymphoma (Am J Surg Pathol 1999;23:59, Mod Pathol 1998;11:967)
● Also most T cell lymphomas, inflammatory fibroid polyps of the gastrointestinal tract (although of dendritic cell origin, Am J Surg Pathol 2004;28:107), follicular dendritic cell tumor, interdigitating dendritic cell tumor

Additional references
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MIM 151445

End of CD Markers > CD23


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