Stains & CD markers
HGAL
Copyright: 2002-2024, PathologyOutlines.com, Inc.
PubMed Search: HGAL
HGAL
Author: Nat Pernick, M.D.
Editorial Board Members: Christian M. Schürch, M.D., Ph.D., Brandon Umphress, M.D.
Last author update: 3 January 2024
Last staff update: 3 January 2024
Copyright: 2002-2024, PathologyOutlines.com, Inc.
PubMed Search: HGAL
Table of Contents
Definition / general | Essential features | Terminology | Pathophysiology | Interpretation | Uses by pathologists | Microscopic (histologic) images | Positive staining - normal | Positive staining - disease | Negative staining | Sample pathology report | Board review style question #1 | Board review style answer #1 | Board review style question #2 | Board review style answer #2Cite this page: Pernick N. HGAL. PathologyOutlines.com website. https://www.pathologyoutlines.com/topic/stainsHGAL.html. Accessed April 16th, 2024.
Definition / general
Essential features
- Germinal center marker
- Useful to diagnose diffuse large cell lymphoma, particularly if CD10-
- Marker of T follicular helper (TFH) cells - useful to diagnose TFH derived lymphomas including angioimmunoblastic T cell lymphoma
Terminology
- Also known as germinal center expressed transcript 2 (GCET2), germinal center associated signaling and motility (GCSAM) (Blood Adv 2021;5:5072)
Pathophysiology
- Regulates B cell receptor signaling and cell motility; may interact with tubulin and other cytoskeletal proteins to regulate lymphoma motility and spread (Blood 2010;116:5217, Blood Adv 2021;5:5072)
Interpretation
- Cytoplasmic staining
Uses by pathologists
- Can increase the accuracy of classification of diffuse large cell lymphoma cases, particularly CD10- cases (Turk J Haematol 2023;40:162)
- For follicular lymphoma, more sensitive than BCL6 and CD10
- Particularly helpful in detecting its interfollicular and diffuse components
- Useful to detect tumors at nodal and extranodal sites, although less sensitive in the bone marrow (Diagn Pathol 2011;6:97, Am J Surg Pathol 2010;34:1266, Am J Clin Pathol 2011;135:697)
- Helps classify cutaneous large B cell lymphomas (Mod Pathol 2008;21:653)
- Associated with prolonged survival in diffuse large B cell lymphoma and classical Hodgkin lymphoma (Blood 2003;101:433, Leuk Lymphoma 2009;50:1830, Blood 2007;109:298)
- Reliable marker of T follicular helper (TFH) cells; useful to diagnose TFH lymphomas, particularly early patterns of angioimmunoblastic T cell lymphoma (Am J Surg Pathol 2022;46:643)
Microscopic (histologic) images
Contributed by Yasodha Natkunam, M.D., Ph.D., Izidore S. Lossos, M.D., Jennifer Rose Chapman, M.D., Nat Pernick, M.D. and Neslihan Berker, M.D.
Tonsil (normal)
Tonsil (normal)
Lymph node (normal)
Lymph node, diffuse large B cell lymphoma
Lymph node, follicular lymphoma
Lymph node, marginal zone lymphoma
Positive staining - normal
- Germinal center lymphocytes
- T follicular helper cells (Am J Surg Pathol 2022;46:643)
Positive staining - disease
- Germinal center derived lymphomas, including follicular center cell lymphoma
- Diffuse large B cell lymphoma (54% of cases, 84% of germinal center B cell [GCB] derived cases and 35% of non-GCB cases) (Turk J Haematol 2023;40:162)
- Lymphomas of TFH derivation, particularly early patterns of angioimmunoblastic T cell lymphoma (Am J Surg Pathol 2022;46:643)
Negative staining
- Small lymphocytic lymphoma, plasmablastic lymphoma, marginal zone lymphoma, mantle cell lymphoma, peripheral T cell lymphoma, anaplastic large cell lymphoma (Turk J Haematol 2023;40:162)
Sample pathology report
- Axillary lymph node, excision:
- Diffuse large B cell lymphoma (see comment)
- Comment: Sections show partial or complete effacement of normal tissue architecture by a diffuse infiltrate of large atypical B lymphoid cells with vesicular chromatin and prominent nucleoli. The tumor cells are immunoreactive for B cell markers CD20 and CD79a. Although negative for the germinal center marker CD10, they are immunoreactive for HGAL and LMO2.
Board review style question #1
Which of the following statements about HGAL is true?
- HGAL does not stain follicular center cells
- HGAL does not stain T follicular helper cells
- HGAL expression is associated with improved survival in diffuse large B cell lymphoma
- HGAL is a non-germinal center cell marker
Board review style answer #1
C. HGAL expression is associated with improved survival in diffuse large B cell lymphoma and classical Hodgkin lymphoma. Answers A, B and D are incorrect because HGAL stains follicular center cells, stains T follicular helper cells and is a germinal center cell marker.
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Board review style question #2
HGAL is a useful marker in which of the following scenarios?
- Classification of cutaneous large B cell lymphomas
- Detection of follicular lymphoma involving the bone marrow
- Diagnosis of marginal zone lymphoma
- Helps classify CD10+ diffuse large cell lymphoma
Board review style answer #2
A. Classification of cutaneous large B cell lymphomas. HGAL marks germinal center B cells and can aid in the identification of tumors that arise from B lymphocytes such as primary cutaneous large B cell lymphoma. Answer B is incorrect because HGAL is less specific for follicular lymphomas involving the bone marrow and has shown downregulation in some studies. Answer C is incorrect because HGAL is a reliable marker for follicular lymphomas, not marginal zone lymphomas. Answer D is incorrect because HGAL helps classify CD10 negative diffuse large cell lymphomas, not CD positive ones.
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