1 In 30-50% of cases, a chromosomal aberration such as the t(2;5)(p23;q35) translocation gives rise to expression of the anaplastic lymphoma kinase (ALK) protein, 2 identifying a subgroup of patients with systemic ALCL with excellent prognosis.3-6 ALK expression seems specific for systemic nodal ALCL; it is not found in classic Hodgkin's disease (HD) 7-11 or primary cutaneous ALCL.7 10 12 13 Morphologically, these lymphomas may closely resemble systemic ALCL, being also characterised by CD30 positive tumour cells with abundant cytoplasm, large irregular nuclei, and a prominent single nucleolus or multiple nucleoli.1 Clinically, however, classic HD and primary cutaneous ALCL have a more favourable prognosis than ALK negative systemic ALCL. 12 14-16 Because of the diVerences in clinical behaviour and subsequent therapeutic strategies, diVerentiating ALK negative systemic ALCL from classic HD or primary cutaneous ALCL is very important.Several markers can be used in the diVerential diagnosis of ALCL and other CD30 positive lymphomas. One such marker is MUC1 mucin, also known as epithelial membrane antigen (EMA).17 18 MUC1 is a high molecular weight transmembrane glycoprotein, usually expressed on the luminal surface of glandular epithelia. [18][19][20] It consists of protein core with a constant cytoplasmic domain of 69 amino acids, and an extracellular domain with a variable number of 20 amino acid tandem repeats, containing serine and threonine residues, to which multiple oligosaccharide side chains are O-linked [21][22][23][24] (fig 1). Since the first rabbit polyclonal antisera raised against human milk fat globule, 17 and the first monoclonal antibodies designated HMFG1 and HMFG2 25 were described, many anti-MUC1 monoclonal antibodies have been generated and characterised. 26 Most react with a dominant epitope within the variable number of tandem repeats of the protein core; namely, the hydrophilic sequence of PDTRPAP.
26-28The specificity of antibody binding to the protein core depends largely on the extent of MUC1 glycosylation; during the ISOBM TD-4 workshop, clusters of monoclonal antibodies were identified that distinguish between the various glycoforms of MUC1. 29 30 Although MUC1 is defined as an epithelial antigen, in 1984 Delsol et al reported that lymphoid cells and malignancies express EMA.
31Since then, EMA (or more appropriately, MUC1) has been found to be consistently J Clin Pathol 2001;54:933-939 933