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Stains

bcl6


Reviewer: Nat Pernick, M.D. (see Reviewers page)
Revised: 2 January 2012, last major update January 2012
Copyright: (c) 2002-2012, PathologyOutlines.com, Inc.

Definition
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● Transcription factor at 3q27 normally expressed in germinal centers and in 5-15% of intrafollicular CD4+ T cells
● Protects germinal center (GC) B cells against DNA damage-induced apoptosis during somatic hypermutation and class-switch recombination (J Exp Med 2010;207:1209)
● Translocations help define "double hit" lymphomas (Am J Clin Pathol 2010;134:258)

Interpretation
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● Nuclear staining

Uses by pathologists
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● Germinal center marker (also CD10)
● Marker for follicular lymphoma (30-80%) of cases, can distinguish from MALT (bcl6-)
● Double staining of CD3 and bcl6 is helpful in appreciating follicular T-helper cell immunophenotype of angioimmunoblastic T-cell lymphoma (Hum Pathol 2010;41:79)

Micro images
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Diffuse blastoid B cell lymphoma (fig c)

   
Diffuse large B cell lymphoma-leg type (left) versus primary cutaneous follicular center lymphoma (right)


Diffuse large B cell lymphoma (fig e)

   
Follicular lymphoma: left-spleen (fig C), right-site unspecified


Intestinal large B-cell lymphoma (fig 3)


Mantle cell lymphoma case is bcl6+ (uncommon)


Neuroblastoma


Nodal marginal zone lymphoma (top) is bcl6- versus bcl6+ diffuse follicular center lymphoma (bottom)

Positive staining - normal
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● Germinal center marker of lymph nodes (also CD10), follicular helper T cells (Science 2009;325:1001)

Positive staining - disease
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● Angioimmunoblastic T-cell lymphoma, Burkitt lymphoma (Mod Pathol 2010;23:909)
● Diffuse large B cell lymphoma (30-80%, not bone-see below), follicular lymphoma, particularly with plasmacytic differentiation (Mod Pathol 2010;23:71), Hodgkin lymphoma-nodular lymphocyte predominant, neuroblastoma (Transl Oncol 2009;2:128)
● Plasmablastic lymphoma of oral mucosa type, primary cutaneous CD4 small/medium-sized pleomorphic T-cell lymphoma (Am J Surg Pathol 2012;36:109-atypical large cells), primary cutaneous follicular lymphoma (almost all, Am J Surg Pathol 2001;25:732)

Negative staining
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● Late germinal center or post-germinal center cells
● Diffuse large B cell lymphoma-bone (Am J Clin Pathol 2008;129:723)
● MALT lymphoma / nodal marginal zone lymphoma (although colonized follicles have bcl6+ cells, Am J Clin Pathol 2009;132:39), mantle cell lymphoma (usually, Appl Immunohistochem Mol Morphol 2010;18:103)

Molecular
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● Frequently rearranged in nodal diffuse large B cell lymphoma (Hum Pathol 2009;40:645)

Molecular images
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Dual-color FISH analysis for BCL6

End of Stains > bcl6


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