Myeloid cell nuclear differentiation antigen (MNDA) expression distinguishes extramedullary presentations of myeloid leukemia from blastic plasmacytoid dendritic cell neoplasm

Ryan C. Johnson, Jinah Kim, Yasodha Natkunam, Uma Sundram, Aharon G. Freud, Bryan Gammon, Michael J. Cascio

Research output: Contribution to journalArticle

7 Scopus citations

Abstract

Myeloid neoplasms constitute one of the most common malignancies in adults. In most cases these proliferations initially manifest in the blood and marrow; however, extramedullary involvement may precede blood or marrow involvement in a subset of cases, making a definitive diagnosis challenging by morphologic and immunohistochemical assessment alone. Blastic plasmacytoid dendritic cell neoplasm (BPDCN) is a rare, aggressive entity that frequently presents in extramedullary sites and can show morphologic and immunophenotypic overlap with myeloid neoplasms. Given that BPDCN and myeloid neoplasms may both initially present in extramedullary sites and that novel targeted therapies may be developed that exploit the unique molecular signature of BPDCN, new immunophenotypic markers that can reliably separate myeloid neoplasms from BPDCN are desirable. We evaluated the utility of myeloid cell nuclear differentiation antigen (MNDA) expression in a series of extramedullary myeloid leukemias (EMLs) and BPDCN. Forty biopsies containing EML and 19 biopsies containing BPDCN were studied by MNDA immunohistochemistry. The majority of myeloid neoplasms showed nuclear expression of MNDA (65%). In contrast, all cases of BPDCN lacked MNDA expression. These findings show that MNDA is expressed in the majority of EMLs and support the inclusion of MNDA immunohistochemistry in the diagnostic evaluation of blastic hematopoietic infiltrates, particularly when the differential diagnosis is between myeloid leukemia and BPDCN.

Original languageEnglish (US)
Pages (from-to)502-509
Number of pages8
JournalAmerican Journal of Surgical Pathology
Volume40
Issue number4
DOIs
StatePublished - Jan 1 2016

Keywords

  • Blastic plasmacytoid dendritic cell neoplasm
  • Leukemia cutis
  • MNDA
  • Myeloid neoplasia
  • Myeloid sarcoma

ASJC Scopus subject areas

  • Anatomy
  • Surgery
  • Pathology and Forensic Medicine

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