[Durgical](https://durgical.com/en/) › [DurgiPedia](https://durgical.com/en/durgipedia/) › [General pathology](https://durgical.com/en/general-pathology/) › [White cells, lymph nodes, spleen and thymus](https://durgical.com/en/general-pathology/areas/hematolymphoid/) › White-cell neoplasms: classification

# White-cell neoplasms: classification

- Topic

Blood cancers are sorted by the cell they come from and where they live. Markers, genes and the normal cell they copy decide the name.

Updated Nov 12, 2026

## Key points

- About 85–90% of lymphoid neoplasms are B-cell tumours.
- Clonality: all tumour cells share one antigen-receptor rearrangement (and one light chain, κ or λ, in B-cell tumours).
- Key markers: TdT for lymphoblasts, CD19/CD20 for B cells, CD3 for T cells, CD34 for stem/progenitors, CD13/CD33/CD117 and myeloperoxidase for myeloid blasts, CD15/CD30 for Reed–Sternberg cells, CD138 for plasma cells.
- Germinal centre-derived lymphomas (follicular, Burkitt, many DLBCL, Hodgkin) carry the scars of somatic hypermutation.
- Acute leukaemia: blasts replace the marrow; chronic leukaemia: more mature cells accumulate slowly.

## What it is

White-cell neoplasms are classified (WHO and International Consensus systems) by lineage, maturity and genetics, not just by whether they sit in the blood or in a mass. Leukaemia means wide marrow and blood involvement; lymphoma means a mass in nodes or tissues, but many entities can present either way. Lymphoid neoplasms are B, T or NK; myeloid neoplasms include acute myeloid leukaemia, myelodysplastic and myeloproliferative neoplasms. Most lymphomas copy a stage of normal B-cell development, which explains their markers and genetics.

## Step by step

- Look at the cells: size, nuclear chromatin, nucleoli, granules and Auer rods.
- Look at the architecture in node or marrow biopsy: follicular, diffuse, sinusoidal or paratrabecular patterns.
- Immunophenotype by flow cytometry and immunohistochemistry: lineage and maturation stage.
- Genetics: karyotype, FISH and sequencing for defining translocations and mutations.
- Combine with the clinical picture: age, sites, tempo of disease.

## The four classic leukaemias compared

| Leukaemia | Typical age | Cell on the smear | Key markers or genetics | Classic clue |
| --- | --- | --- | --- | --- |
| [Acute lymphoblastic leukaemia (ALL)](https://durgical.com/en/conditions/acute-leukaemia/) | Children (peak early childhood) | Lymphoblasts, scant cytoplasm, fine chromatin | TdT, CD10, CD19 (B-ALL); CD3 (T-ALL) | Bone pain, mediastinal mass in T-ALL, CNS and testis relapse |
| [Acute myeloid leukaemia (AML)](https://durgical.com/en/conditions/acute-leukaemia/) | Adults, rising with age | Myeloblasts with nucleoli and granules | Myeloperoxidase, CD33, CD117, CD34 | Auer rods; DIC in promyelocytic type |
| [Chronic lymphocytic leukaemia (CLL)](https://durgical.com/en/conditions/chronic-lymphocytic-leukaemia/) | Older adults | Small round mature lymphocytes, smudge cells | CD5 and CD23 on B cells | Hypogammaglobulinaemia, autoimmune haemolysis |
| [Chronic myeloid leukaemia (CML)](https://durgical.com/en/conditions/chronic-myeloid-leukaemia/) | Middle age | Granulocytes at all stages, basophils | BCR::ABL1, t(9;22) | Huge spleen, blast crisis if untreated |

## Markers

- TdT
- CD19
- CD20
- CD3
- CD34
- CD33
- CD117
- MPO
- CD15
- CD30
- CD138

## Clinical notes

- Neoplasms of immune cells often cause immune disorders too: infections from lost immunity and autoimmune cytopenias from broken tolerance.
- Myeloid neoplasms almost always involve the marrow; lymphomas often start in nodes and spread to marrow later.

## Memory aid

Ask four questions of any blood cancer: which lineage, how mature, which gene, which normal cell does it copy.

## Test yourself

Think of the answer, then tap the question to see it.

## Which marker distinguishes lymphoblasts from mature lymphocytes?

Terminal deoxynucleotidyl transferase (TdT), expressed only in pre-B and pre-T lymphoblasts.

## How does light-chain restriction prove a B-cell population is clonal?

A reactive population mixes κ and λ cells; a clone expresses only one of them.

## What proportion of lymphoid neoplasms are B-cell tumours?

About 85 to 90 percent.

[Add to my cards (3)](https://durgical.app/estudiar/?add=/en/general-pathology/white-cell-neoplasms-classification/)

[More Pathology questions →](https://durgical.com/en/practice/?f=pathology)

## Elsewhere in DurgiPedia

- [Hematopoiesis and bone marrow](https://durgical.com/en/histology/hematopoiesis-and-bone-marrow/)
- [B-cell activation, class switching and affinity maturation](https://durgical.com/en/immunology/b-cell-activation-class-switching-and-affinity-maturation/)
- [Hematopoiesis](https://durgical.com/en/physiology/hematopoiesis/)
- [Bone marrow and hematopoiesis of immune cells](https://durgical.com/en/immunology/bone-marrow-and-hematopoiesis-of-immune-cells/)

## Connections

## Related 5

- [Immunohistochemistry: the principle and the markers to know](https://durgical.com/en/general-pathology/immunohistochemistry-the-principle-and-the-markers-to-know/)
- [Molecular pathology: PCR, FISH, sequencing and liquid biopsy](https://durgical.com/en/general-pathology/molecular-pathology-pcr-fish-sequencing-and-liquid-biopsy/)
- [Naming tumours: -oma, carcinoma, sarcoma, and the misleading names](https://durgical.com/en/general-pathology/naming-tumours-oma-carcinoma-sarcoma-and-the-misleading-names/)
- [White-cell neoplasms: causes and translocations](https://durgical.com/en/general-pathology/white-cell-neoplasms-causes-and-translocations/)
- [Myeloproliferative neoplasms: overview](https://durgical.com/en/general-pathology/myeloproliferative-neoplasms-overview/)

## Related conditions 7

- [Acute leukaemia (AML and ALL)](https://durgical.com/en/conditions/acute-leukaemia/)
- [Chronic lymphocytic leukaemia](https://durgical.com/en/conditions/chronic-lymphocytic-leukaemia/)
- [Chronic myeloid leukaemia](https://durgical.com/en/conditions/chronic-myeloid-leukaemia/)
- [Non-Hodgkin lymphoma](https://durgical.com/en/conditions/non-hodgkin-lymphoma/)
- [Hodgkin lymphoma](https://durgical.com/en/conditions/hodgkin-lymphoma/)
- [Multiple myeloma](https://durgical.com/en/conditions/multiple-myeloma/)
- [Myelodysplastic syndromes](https://durgical.com/en/conditions/myelodysplastic-syndromes/)

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Educational content on the mechanisms of disease; not a diagnostic or treatment guide and no substitute for a health professional's advice. No doses are given.

Sources: [Non-Hodgkin Lymphoma Treatment (PDQ®)–Patient Version](https://www.cancer.gov/types/lymphoma/patient/adult-nhl-treatment-pdq) (National Cancer Institute (NCI), 2026); [Acute Myeloid Leukemia Treatment (PDQ®)–Patient Version](https://www.cancer.gov/types/leukemia/patient/adult-aml-treatment-pdq) (National Cancer Institute (NCI), 2026).

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