CD43 is a pan T-cell marker, which is also expressed in myeloid (granulocytic) sarcomas and some B-cell lymphomas.  CD43 is aberrantly expressed in a number of B-cell lymphomas (expression is highly correlated with CD5), but this marker is most helpful in cases of marginal zone lymphoma when flow cytometry is not performed (i.e. usually small mucosal biopsies).  These cases may be difficult to differentiate from lymphoid hyperplasia.  Approximately 50% of cases of marginal zone lymphoma will express CD43.  Negativity for CD43 does not exclude the diagnosis, and additional molecular testing may be helpful to identify these cases.

 

Lee et. al identified normal co-expression of CD43 (strong expression) in perifolliuclar B-cells within submucosal lymphoid tissue from terminal ileum biopsies.  Therefore, CD43 co-expression on terminal ileum biopsies should NOT be used as a criterion alone to favor a diagnosis of MALT lymphoma.

 

The main take home point is that CD43 is a good marker, which is helpful, but there is lack a specificty and one should understand the stain performance in the diagnostic setting.  In the workup of a mature B cell lymphoma, CD43 (like CD5) should be compared against CD3 and CD20 staining.

 

CD43 Expression in Non-Hodgkin Lymphoma (Lai R., et. al. N=742 cases)

 

In the skin CD43 marked >95% of cases of granulocytic sarcoma (leukemia cutis). Other non-T cell lesions which may stain with CD43 include:  AML, hemangioma, Langerhans cell histiocytosis, mast cell disease and plasmacytoma.

Lai, R., Weiss, L. M., Chang, K. L., & Arber, D. A. (1999). Frequency of CD43 expression in non-Hodgkin lymphoma. A survey of 742 cases and further characterization of rare CD43+ follicular lymphomas. American Journal of Clinical Pathology, 111(4), 488–494.

 

Treasure, J., Lane, A., Jones, D. B., & Wright, D. H. (1992). CD43 expression in B cell lymphoma. Journal of Clinical Pathology, 45(11), 1018–1022. 

 

Cronin, D. M. P., George, T. I., & Sundram, U. N. (2009). An updated approach to the diagnosis of myeloid leukemia cutis. American Journal of Clinical Pathology, 132(1), 101–110. doi:10.1309/AJCP6GR8BDEXPKHR 

 

Jung G, Eisenmann J-C, Thiébault S, Hénon P. Cell surface CD43 determination improves diagnostic precision in late B-cell diseases. Br J Haematol. 2003;120: 496–499.

 

Lee P-S, Beneck D, Weisberger J, Gorczyca W. Coexpression of CD43 by benign B cells in the terminal ileum. Appl Immunohistochem Mol Morphol. 2005;13: 138–141.

 

Diagnostic Immunohistochemistry:  Theranostic and Genomic Applications [edited by] David J. Dabbs. 3rd Edition.  pp. 165.