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Amber KT, Bloom R, Nouri K. Second Primary Malignancies in CTCL Patients from 1992 to 2011: A SEER-Based, Population-Based Study Evaluating Time from CTCL Diagnosis, Age, Sex, Stage, and CD30+ Subtype. Am J Clin Dermatol 2016; 17:71-7. [PMID: 26386881 DOI: 10.1007/s40257-015-0155-3] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Cutaneous T-cell lymphoma (CTCL) is a diverse group of extranodal non-Hodgkin lymphomas with malignant T lymphocytes localizing in the skin. CTCL can mainly be classified as mycosis fungoides, Sézary syndrome, or primary cutaneous CD30+ lymphoma. Patients with CTCL have an increased risk of developing second primary malignancies. OBJECTIVE Our objective was to analyze the overall incidence of second primary malignancies in patients with CTCL by age, sex, stage, and the primary cutaneous CD30+ lymphoproliferative subtype of CTCL, as this group has usually been excluded from previous analyses. METHODS We used the Surveillance, Epidemiology, and End Results (SEER) database to evaluate CTCL cases diagnosed between 1992 and 2011. We calculated the multiple primary standardized incidence ratio, comparing the observed incidence of second primary malignant neoplasms in the CTCL patient population versus the general population. RESULTS CTCL is associated with an overall increased risk of cancers. This incidence is greatest within the first year of diagnosis. The risk of secondary Hodgkin disease is greatest in patients aged ≥60 years; the risk of secondary non-Hodgkin lymphoma is greatest in patients aged 20-39. Males demonstrated a significantly increased risk of developing Hodgkin lymphoma, while females showed a significantly increased risk of developing bronchopulmonary malignancy. Overall, secondary malignancy incidence was significantly elevated for stage I and IV CTCL. Patients with CD30+ CTCL had a significantly higher incidence of Hodgkin lymphoma, non-Hodgkin lymphoma, and urinary cancers than the general population. CONCLUSION Occult secondary malignancies, particularly lymphomas, should be considered in adult CTCL patients, including those with the CD30+ subtype.
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MESH Headings
- Adolescent
- Adult
- Age Factors
- Child
- Child, Preschool
- Female
- Humans
- Incidence
- Infant
- Infant, Newborn
- Ki-1 Antigen/analysis
- Lymphoma, T-Cell, Cutaneous/classification
- Lymphoma, T-Cell, Cutaneous/epidemiology
- Lymphoma, T-Cell, Cutaneous/pathology
- Male
- Middle Aged
- Neoplasm Staging
- Neoplasms, Second Primary/classification
- Neoplasms, Second Primary/epidemiology
- Neoplasms, Second Primary/pathology
- Risk
- SEER Program
- Sex Factors
- Skin Neoplasms/classification
- Skin Neoplasms/epidemiology
- Skin Neoplasms/pathology
- Time Factors
- Young Adult
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Moreau JF, Buchanich JM, Geskin JZ, Akilov OE, Geskin LJ. Non-random geographic distribution of patients with cutaneous T-cell lymphoma in the Greater Pittsburgh Area. Dermatol Online J 2014; 20:13030/qt4nw7592w. [PMID: 25046454] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2014] [Accepted: 07/15/2014] [Indexed: 06/03/2023] Open
Abstract
BACKGROUND Environmental hazards may play a role in the etiology of cutaneous T-cell lymphoma (CTCL). Some studies have found an increased incidence of CTCL among workers in chemical science, transportation, and manufacturing industries, but other studies have not. This discrepancy may be attributable to population migration, complicating accurate assessment of lifetime exposures. The Pittsburgh population has very low migration rates and most CTCL patients seen at the University of Pittsburgh Medical Center (UPMC) Cutaneous Lymphoma Center are life-long local residents. The Greater Pittsburgh Area used to be an industrial hub. There are residential communities positioned within close proximity to inactive industrial sites that continue to contain pollutants. OBJECTIVE To determine whether CTCL patients' residences cluster within specific Pittsburgh regions, in particular, those with high levels of environmental pollutants. METHODS Our study included patients diagnosed with CTCL at the UPMC Cutaneous Lymphoma Center between 2000 and 2012. We mapped the longitudinal and latitudinal coordinates of patients' residences at diagnosis, superfund sites, toxic release inventory sites, particular matter levels, and dermatologists' offices using ArcMap 10.1. We then performed a SaTScan analysis using zip codes to assess for geographic clustering of patients' residences in the Pittsburgh metropolitan statistical area. We assessed for a correlation between case distribution and both environmental hazards sites and dermatologist density in the area. RESULTS We identified 274 patients with CTCL in the Greater Pittsburgh area. We identified a statistically significant geographic cluster (p<.001) in zip code 15213, which is the most densely populated neighborhood in Pittsburgh and the site of the region's only CTCL clinic. We observed no relationship between the locations of superfund sites, toxic release inventory sites, or particular matter levels and CTCL case distribution. CONCLUSION Our findings do not support an association between exposure to environmental toxins and CTCL. CTCL cases clustered in areas with the highest population density, which also happen to include a regional CTCL center. To evaluate a possibility of urban pollutants playing a role in etiology of CTCL, dermatologist density and access to care need to be addressed as potential confounders in the future studies.
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Tomasini D, Berti E. Subcutaneous panniculitis-like T-cell lymphoma. GIORN ITAL DERMAT V 2013; 148:395-411. [PMID: 23900161] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
Subcutaneous panniculitis like T-cell lymphoma derived from α/β T-cells (SPTCL-AB) belongs to the group of primary cutaneous T-cell lymphoma, and it represents less than the 1% of all primary cutaneous T-cell lymphomas. It affects patients in the 4th decade of life (median age of 36 years) with a female preference (male/female ratio 0.5) with 19% of patients being 20 years or younger. It can be sometime complicated by a hemophagocytic syndrome, and patients without hemophagocytic syndrome had a significantly better survival (5-year OS: 91% vs. 46%). Histopathologically, SPTCL-AB is characterized by a lobular lymphocytic panniculitis. Tumor cells distribute between individual adipose lobules, proliferating and forming "rim" and "capping" images, conferring a lace-like appearance at scanning magnification. This is not an entirely disease-specific feature, and can also be seen in other lobular lymphocytic panniculitis, either of inflammatory and neoplastic origin. Tumor cells are phenotypically CD45RO+, βF1+ (a monoclonal antibody able to identify the alpha/beta chain of TCR), CD3+, CD4-, CD8+, and express cytotoxic granules (TIA-1, granzyme and perforin), whereas they show variable deletion of T-cell restricted antigens like CD2, CD5 and CD7. The majority of cases show a monoclonal rearrangement for TCR beta and gamma genes and do not show genomic integration of EBV. The present review will focus on histopathologic, immunophenotypical and molecolare data useful to overcome to a specific diagnosis of SPTCL-AB and to differentiate SPTCL-AB from other lymphomas of T-cell or NK/T cell origin and with benign panniculitidis sharing with SPTCL-AB a predominant lobular lymphocytic pattern of involvement of subcutaneous tissue.
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MESH Headings
- Adult
- Age Distribution
- Antigens, CD/analysis
- Antineoplastic Combined Chemotherapy Protocols/therapeutic use
- Dermis/pathology
- Diagnosis, Differential
- Female
- Gene Rearrangement, beta-Chain T-Cell Antigen Receptor
- Gene Rearrangement, gamma-Chain T-Cell Antigen Receptor
- Humans
- Immunophenotyping
- Immunosuppressive Agents/therapeutic use
- Lymphohistiocytosis, Hemophagocytic/etiology
- Lymphoma, T-Cell, Cutaneous/diagnosis
- Lymphoma, T-Cell, Cutaneous/drug therapy
- Lymphoma, T-Cell, Cutaneous/epidemiology
- Lymphoma, T-Cell, Cutaneous/pathology
- Male
- Neoplasm Staging
- Panniculitis/classification
- Panniculitis/diagnosis
- Prognosis
- Sex Distribution
- Subcutaneous Tissue/pathology
- T-Lymphocytes, Cytotoxic/pathology
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Grassi S, Borroni RG, Brazzelli V. Panniculitis in children. GIORN ITAL DERMAT V 2013; 148:371-385. [PMID: 23900159] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
This paper will give a comprehensive view of the most frequent panniculitides seen in childhood, with emphasis on the types exclusively found in infancy, and for all other types of panniculitides also found in adults. Aim of this paper is also to analyze the clinical differences between panniculitis in childhood and in adulthood, and to give reliable histopathologic criteria for a specific diagnosis. A review of the literature is here integrated by authors' personal contribution. Panniculitides in children is a heterogeneous group of diseases, as well as in adult life, characterized by inflammation of the subcutaneous fat. Only very few types of panniculitis are exclusively found in childhood, such as Sclerema neonatorum and subcutaneous fat necrosis of the newborn, while the vast majority of the other types may be found both in paediatric age and in adults. Furthermore, this paper will consider in detail panniculitis according to their frequency, such as Erythema nodosum, Lupus panniculitis, Cold panniculitis, panniculitis in Behçet disease, and poststeroid panniculitis. It will also describe rare forms of panniculitis, such as Eosinophilic panniculitis (a pathological entity debated by many authors), Subcutaneous panniculitis T-cell lymphoma, and the different forms of the so call "Lipophagic panniculitis", encompassing respectively the febrile relapsing panniculitis of Weber-Christian disease and the non-relapsing form of Rothmann-Makai disease. For each type of panniculitis considered concise information will be given about epidemiology, etiology, clinical findings, laboratory data, prognosis and therapy, while histopathologic findings will be described in detail.
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MESH Headings
- Adrenal Cortex Hormones/adverse effects
- Age of Onset
- Behcet Syndrome/complications
- Cellulitis/blood
- Cellulitis/epidemiology
- Cellulitis/pathology
- Cellulitis/therapy
- Child
- Child, Preschool
- Cold Temperature/adverse effects
- Diagnosis, Differential
- Eosinophilia/blood
- Eosinophilia/epidemiology
- Eosinophilia/pathology
- Eosinophilia/therapy
- Erythema Nodosum/blood
- Erythema Nodosum/diagnosis
- Erythema Nodosum/epidemiology
- Erythema Nodosum/pathology
- Erythema Nodosum/therapy
- Fat Necrosis/blood
- Fat Necrosis/epidemiology
- Fat Necrosis/pathology
- Fat Necrosis/therapy
- Granuloma Annulare/blood
- Granuloma Annulare/epidemiology
- Granuloma Annulare/pathology
- Granuloma Annulare/therapy
- Humans
- Infant
- Infant, Newborn
- Lymphoma, T-Cell, Cutaneous/blood
- Lymphoma, T-Cell, Cutaneous/epidemiology
- Lymphoma, T-Cell, Cutaneous/pathology
- Lymphoma, T-Cell, Cutaneous/therapy
- Panniculitis/classification
- Panniculitis/diagnosis
- Panniculitis/epidemiology
- Panniculitis/etiology
- Panniculitis/pathology
- Panniculitis/therapy
- Panniculitis, Nodular Nonsuppurative/blood
- Panniculitis, Nodular Nonsuppurative/epidemiology
- Panniculitis, Nodular Nonsuppurative/pathology
- Panniculitis, Nodular Nonsuppurative/therapy
- Sclerema Neonatorum/blood
- Sclerema Neonatorum/epidemiology
- Sclerema Neonatorum/pathology
- Sclerema Neonatorum/therapy
- Subcutaneous Fat/pathology
- alpha 1-Antitrypsin Deficiency/complications
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Wright A, Wijeratne A, Hung T, Gao W, Whittaker S, Morris S, Scarisbrick J, Beynon T. Prevalence and severity of pruritus and quality of life in patients with cutaneous T-cell lymphoma. J Pain Symptom Manage 2013; 45:114-9. [PMID: 22917715 DOI: 10.1016/j.jpainsymman.2012.01.012] [Citation(s) in RCA: 59] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2011] [Revised: 12/30/2011] [Accepted: 02/08/2012] [Indexed: 11/26/2022]
Abstract
CONTEXT Cutaneous T-cell lymphoma (CTCL), although rare, is associated with a significant symptom burden. Pruritus appears to be one of the most prominent and disturbing symptoms. OBJECTIVES To describe the prevalence and severity of pruritus and quality of life (QOL) in patients with CTCL. METHODS Patients with CTCL able to complete two questionnaires were invited to complete a visual analogue scale for itch (VAS(itch)) and the Skindex-29. Prevalence of pruritus, mean score, and SD were estimated for the VAS(itch) and Skindex-29, and the Pearson's correlation coefficient was calculated to evaluate the relationship between severity of pruritus and QOL. RESULTS One hundred patients were recruited (mean [SD] age 57.9 [12.9] years, range 30-86 years). Eighty-eight percent reported pruritus in the preceding four weeks, 46% indicating that it was often or always a problem. The mean (SD) of VAS(itch) (n=92) was 3.2 (3.2), range zero to 10. The mean (SD) total Skindex-29 score was 43.3 (27.7). More advanced disease stage was associated with poorer QOL. The Skindex-29 correlated strongly with the VAS(itch) (Pearson's correlation coefficient=0.72, P<0.001). CONCLUSION All aspects of QOL are affected in CTCL. Pruritus is a common and troublesome symptom. A more advanced disease stage and more severe pruritus symptoms were associated with poorer QOL in this study.
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Fernandez-Peñas P. Potent topical steroids are one of the treatments for cutaneous T-cell lymphoma. J Allergy Clin Immunol 2010; 126:414; author reply 414-5. [PMID: 20621338 DOI: 10.1016/j.jaci.2010.04.043] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2010] [Accepted: 04/29/2010] [Indexed: 11/30/2022]
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Kuiper RV, Kimpfler S, Grinwis GCM. Case report: epitheliotropic lymphoma in a zebrafish (Danio rerio). TIJDSCHRIFT VOOR DIERGENEESKUNDE 2009; 134:1018-1020. [PMID: 20120336] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
A proliferative disorder of lymphocytes was observed in a macroscopically normal young adult wild-type zebrafish (Danio rerio) during routine histological screening in a two-generation toxicity study. Proliferating lymphocytes were observed to invade the gill arches, infiltrate the cranial skeletal muscle and inner ear, and accumulate at distant sites in the frontal epidermis. The test compound, tetrabromobisphenol A (TBBPA, a flame retardant), is not known as a carcinogen and no tumours were detected in any of the 53 other fish in the study, including tank mates. Although neoplastic lymphoid proliferation in the thymus region is occasionally observed, we have never seen epitheliotropism in zebrafish during other similar exposure studies or brood stock. Our findings indicate that epitheliotropic lymphoma can occur spontaneously in zebrafish but at a low incidence.
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33
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Bagot M. Cutaneous T-cell lymphoma. Preface. Dermatol Clin 2008; 26 Suppl 1:V. [PMID: 18405179] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
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34
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Criscione VD, Weinstock MA. Incidence of cutaneous T-cell lymphoma in the United States, 1973-2002. ACTA ACUST UNITED AC 2007; 143:854-9. [PMID: 17638728 DOI: 10.1001/archderm.143.7.854] [Citation(s) in RCA: 324] [Impact Index Per Article: 19.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
OBJECTIVE To describe incidence trends for cutaneous T-cell lymphoma (CTCL) in the United States. DESIGN Population-based study. SETTING Data were obtained from 13 population-based cancer registries of the Surveillance, Epidemiology, and End Results (SEER) Program of the National Cancer Institute from 1973 through 2002. PARTICIPANTS A total of 4783 cases of CTCL were identified for the period 1973 through 2002. MAIN OUTCOME MEASURE Diagnosis of CTCL. RESULTS The overall annual age-adjusted incidence of CTCL was 6.4 per million persons. Annual incidence increased by 2.9 x 10(-6) per decade over the study period. Incidence was higher among blacks (9.0 x 10(-6)) than among whites (6.1 x 10(-6)) and was higher among men (8.7 x 10(-6)) than among women (4.6 x 10(-6)). The racial differences in incidence decreased with age, while the sex differences increased with age and decreased over time. Substantial geographic variation in incidence was found. Incidence was correlated with high physician density, high family income, high percentage of population with a bachelor's degree or higher, and high home values. Changes in International Classification of Diseases for Oncology (ICD-O) morphologic definitions have resulted in the redistribution of the cases of CTCL among specific subclassifications. CONCLUSIONS The continued rise in incidence of CTCL is substantial, and the cause of this increase is unknown. The racial, ethnic, sex, and geographic differences in incidence may be of etiologic importance. Changes in ICD-O definitions have made it difficult to evaluate incidence trends for subclassifications of CTCL such as mycosis fungoides. In addition, these changes resulted in the creation of ambiguous histologic codes, which may have caused coding errors. These errors along with the lack of independent verification are limitations of our study. An epidemiological investigation using population-based data is important to better understand this disorder.
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35
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36
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Rosen ST. Advances in the treatment of primary cutaneous T-cell lymphoma. CLINICAL ADVANCES IN HEMATOLOGY & ONCOLOGY : H&O 2007; 5:347-8. [PMID: 17673888] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/16/2023]
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37
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Manuchehri HM, Rakhshan M. Characteristics of primary cutaneous lymphomas in Tehran, Iran (1998-2004). J Eur Acad Dermatol Venereol 2006; 20:758-60. [PMID: 16836523 DOI: 10.1111/j.1468-3083.2006.01536.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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38
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Yasukawa K, Kato N, Kodama K, Hamasaka A, Hata H. The spectrum of cutaneous lymphomas in Japan: a study of 62 cases based on the World Health Organization Classification. J Cutan Pathol 2006; 33:487-91. [PMID: 16872471 DOI: 10.1111/j.1600-0560.2006.00460.x] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND The relative incidence of malignant lymphoma subtypes differs according to geographic location. This study investigated the epidemiology of cutaneous lymphoma subtypes in Japan and compared it with other countries. METHODS Sixty-two patients with cutaneous lymphoma attending the Department of Dermatology, National Hospital Organization Hokkaido Cancer Center were reviewed. The World Health Organization classification of hematopoietic and lymphoid malignancies was adopted. RESULTS Of the 62 patients, 31 had primary cutaneous lymphoma (PCL) and 31 had secondary cutaneous lymphoma (SCL). T- and natural killer (NK)-cell lymphoma accounted for 80% of PCL, of which, mycosis fungoides accounted for almost 35%. Of the 31 patients with secondary cutaneous lymphoma, 17 patients (54%) had T- and NK-cell lymphoma, including nine adult T-cell leukemia/lymphoma patients, and 14 patients (46%) had B-cell lymphoma, including 11 diffuse large B-cell lymphoma patients. The majority of patients with SCL and NK-cell lymphoma with primary or secondary skin lesions had a poor outcome. CONCLUSIONS PCL in this study showed a similar incidence to that of other institutions in Japan, while also demonstrating different frequencies from that of other countries, suggesting that the relative frequency of different PCL subtypes differ according to geographical location, similar to previous reports of systemic malignant lymphoma.
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MESH Headings
- Adult
- Aged
- Aged, 80 and over
- Female
- Humans
- Incidence
- Japan/epidemiology
- Killer Cells, Natural/pathology
- Leukemia, T-Cell/classification
- Leukemia, T-Cell/epidemiology
- Leukemia, T-Cell/pathology
- Lymphoma/classification
- Lymphoma/epidemiology
- Lymphoma/pathology
- Lymphoma, B-Cell/classification
- Lymphoma, B-Cell/epidemiology
- Lymphoma, B-Cell/pathology
- Lymphoma, Large B-Cell, Diffuse/classification
- Lymphoma, Large B-Cell, Diffuse/epidemiology
- Lymphoma, Large B-Cell, Diffuse/pathology
- Lymphoma, T-Cell, Cutaneous/classification
- Lymphoma, T-Cell, Cutaneous/epidemiology
- Lymphoma, T-Cell, Cutaneous/pathology
- Male
- Middle Aged
- Mycosis Fungoides/classification
- Mycosis Fungoides/epidemiology
- Mycosis Fungoides/pathology
- Retrospective Studies
- Sezary Syndrome/classification
- Sezary Syndrome/epidemiology
- Sezary Syndrome/pathology
- Skin Neoplasms/classification
- Skin Neoplasms/epidemiology
- Skin Neoplasms/pathology
- World Health Organization
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Vargo N. Cutaneous malignancies: KA, CTCL, and KS. DERMATOLOGY NURSING 2006; 18:270, 277. [PMID: 16856684] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/10/2023]
MESH Headings
- Biopsy
- Diagnosis, Differential
- Disease Progression
- Humans
- Keratoacanthoma/epidemiology
- Keratoacanthoma/pathology
- Keratoacanthoma/therapy
- Lymphoma, T-Cell, Cutaneous/epidemiology
- Lymphoma, T-Cell, Cutaneous/pathology
- Lymphoma, T-Cell, Cutaneous/therapy
- Remission, Spontaneous
- Sarcoma, Kaposi/epidemiology
- Sarcoma, Kaposi/pathology
- Sarcoma, Kaposi/therapy
- Skin Neoplasms/epidemiology
- Skin Neoplasms/pathology
- Skin Neoplasms/therapy
- United States/epidemiology
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Wilkins K, Turner R, Dolev JC, LeBoit PE, Berger TG, Maurer TA. Cutaneous malignancy and human immunodeficiency virus disease. J Am Acad Dermatol 2006; 54:189-206; quiz 207-10. [PMID: 16443048 DOI: 10.1016/j.jaad.2004.11.060] [Citation(s) in RCA: 78] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2004] [Revised: 11/22/2004] [Accepted: 11/22/2004] [Indexed: 12/21/2022]
Abstract
UNLABELLED Certain skin cancers occur with increased frequency or altered course in patients infected with HIV. Malignant melanoma and squamous cell carcinoma are examples of cutaneous malignancies that have a more aggressive course in patients with HIV. Others, such as basal cell carcinoma, appear more frequently in this population but do not appear to be more aggressive. The incidence of HIV-associated Kapsosi's sarcoma has markedly decreased since the advent of HIV antiretroviral therapy. Our understanding of the pathogenesis of this malignancy and its unique management issues are fully reviewed. Cutaneous T-cell lymphoma (CTCL) is rare in this population. Other types of cutaneous lymphoma and HIV-associated pseudo-CTCL are discussed. This article addresses prevention, treatment, and follow-up strategies for this at-risk population. LEARNING OBJECTIVE At the completion of this learning activity, participants should be familiar with the unique epidemiology, clinical course, and management of cutaneous malignancy in patients infected with HIV.
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MESH Headings
- Algorithms
- Animals
- Anti-Retroviral Agents/administration & dosage
- Anus Neoplasms/epidemiology
- Anus Neoplasms/pathology
- Carcinoma, Basal Cell/epidemiology
- Carcinoma, Squamous Cell/epidemiology
- Carcinoma, Squamous Cell/pathology
- Carcinoma, Squamous Cell/therapy
- HIV Infections/drug therapy
- HIV Infections/epidemiology
- Herpesviridae Infections/epidemiology
- Herpesvirus 8, Human/isolation & purification
- Humans
- Immunity, Cellular
- Immunohistochemistry
- Lymphoma, Large-Cell, Anaplastic/epidemiology
- Lymphoma, T-Cell, Cutaneous/epidemiology
- Lymphoma, T-Cell, Cutaneous/immunology
- Lymphoma, T-Cell, Cutaneous/pathology
- Melanoma/epidemiology
- Melanoma/therapy
- Papillomaviridae
- Papillomavirus Infections/epidemiology
- Risk Factors
- Sarcoma, Kaposi/drug therapy
- Sarcoma, Kaposi/epidemiology
- Seroepidemiologic Studies
- Skin Neoplasms/epidemiology
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Demierre MF, Gan S, Jones J, Miller DR. Significant impact of cutaneous T-cell lymphoma on patients' quality of life. Cancer 2006; 107:2504-11. [PMID: 17048251 DOI: 10.1002/cncr.22252] [Citation(s) in RCA: 115] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Cutaneous T-cell lymphoma (CTCL) can have a profound impact on a patient's health-related quality of life; however, little is known about its actual impact. The authors evaluated patients' perspectives on the impact of CTCL on physical functioning, lifestyle, emotional well being, and satisfaction with treatment. METHODS A 4-page, self-administered questionnaire was mailed and made available online in March 2005 to the entire United States membership of the Mycosis Fungoides Foundation (n = 930 members). Outcome measures were patients' perspectives on the psychosocial impact of CTCL and the management of their disease. RESULTS The response rate was 68%, and 93.6% of respondents were white. The majority of respondents had mycosis fungoides (89%). Respondents were bothered by skin redness (94%) and by the extent of symptoms that affected their choice of clothing (63%). For most patients, the disease had a functional impact, rendering them tired or affecting their sleep. Health distress was reported by almost all respondents, with 94% reporting that they worried about the seriousness of their disease and 80% worrying about dying from the disease. Sixty-two percent of respondents reported that their disease made them feel unattractive, 85% reported that their treatment made their disease seem more manageable, but 61% reported that they felt burdened financially by their disease. CONCLUSIONS The high response rate and patients' responses to the survey provided compelling evidence that patients believed CTCL had a profound and severe impact on their functioning, emotional, and social well being. A striking health distress was prevalent in almost all respondents. Although the majority of patients reported that treatments made their disease more manageable, a significant proportion reported that they felt burdened financially by their disease.
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Tani M, Fina M, Alinari L, Stefoni V, Baccarani M, Zinzani PL. Phase II trial of temozolomide in patients with pretreated cutaneous T-cell lymphoma. Haematologica 2005; 90:1283-4. [PMID: 16154858] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/04/2023] Open
Abstract
Between July 2003 and March 2004, nine patients with pretreated mycosis fungoides were enrolled into a phase II trial and were treated with temozolomide. The overall response rate was 33%. Further studies are needed to test the efficacy of temozolomide, alone or in combination in earlier stages of this disease.
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Willemze R. Cutaneous T-cell lymphoma: epidemiology, etiology, and classification. Leuk Lymphoma 2004; 44 Suppl 3:S49-54. [PMID: 15202525 DOI: 10.1080/10428190310001623766] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
The term cutaneous T-cell lymphoma (CTCL) describes a heterogeneous group of neoplasms of skin-homing T-cells that vary considerably in clinical presentation, histologic appearance, immunophenotype, and prognosis. CTCL represent approximately 75-80% of all primary cutaneous lymphomas, whereas primary cutaneous B cell lymphomas account for approximately 20-25%. For many years mycosis fungoides and Sézary's syndrome were the only known types of CTCL. In the last decade, based on a combination of clinical, histological, and immunophenotypical criteria, new types of CTCL have been defined and new classifications for this group of primary cutaneous lymphomas have been formulated. In this overview, characteristic features of the different types of CTCL recognized in the European Organization for Research and Treatment of Cancer (EORTC) classification for primary cutaneous lymphomas and the World Health Organization (WHO) classification will be reviewed. Key conclusions from this brief overview are: (1) that the term CTCL does not refer to a single disease entity, but to a group of diseases with different clinical behaviors, therapeutic requirements, and prognoses; (2) that diagnosis and classification should always be based on a combination of clinical, histologic, and immunologic criteria; and (3) that the WHO and EORTC classification schemes are broadly equivalent for almost 90% of CTCL patients. Key research priorities are to develop effective therapies for peripheral T-cell lymphoma, extranodal NK (natural killer) T-cell lymphoma and so-called blastic NK cell lymphoma, and to determine molecular profiles for all forms of CTCL.
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Fink-Puches R, Chott A, Ardigó M, Simonitsch I, Ferrara G, Kerl H, Cerroni L. The spectrum of cutaneous lymphomas in patients less than 20 years of age. Pediatr Dermatol 2004; 21:525-33. [PMID: 15461755 DOI: 10.1111/j.0736-8046.2004.21500.x] [Citation(s) in RCA: 141] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Cutaneous lymphomas are rare in young patients and are mostly represented by mycosis fungoides and its variants and CD30+ lymphoproliferative disorders (lymphomatoid papulosis [LYP] and anaplastic large T-cell lymphoma). We report our observations in a series of 69 patients less than 20 years of age who presented either with primary cutaneous lymphoma (n = 62) or with secondary manifestations of extracutaneous disease (n = 7). Clinicopathologic features permitted classification of the cases into the following diagnostic categories: mycosis fungoides (n = 24, all primary cutaneous), anaplastic large T-cell lymphoma (n = 13, all primary cutaneous), LYP (n = 11, all primary cutaneous), subcutaneous "panniculitis-like" T-cell lymphoma (n = 1, primary cutaneous), small-medium pleomorphic T-cell lymphoma (n = 2, all primary cutaneous), natural killer (NK)/T-cell lymphoma, nasal-type (n = 1, secondary cutaneous), follicle center cell lymphoma (n = 1, primary cutaneous), marginal zone B-cell lymphoma (n = 7, all primary cutaneous), B-lymphoblastic lymphomas (n = 6, 3 primary and 3 secondary cutaneous), specific cutaneous manifestations of Hodgkin disease (n = 1, secondary cutaneous), and acute myeloid leukemia (n = 2, both secondary cutaneous). Cutaneous lymphoma in children should be differentiated from benign skin disorders that may simulate them. In particular, mycosis fungoides and LYP in this age group may present with clinicopathologic features reminiscent of inflammatory disorders such as pityriasis alba, vitiligo, pityriasis rosea, and pityriasis lichenoides et varioliformis acuta. Even in secondary cutaneous lymphomas, skin manifestations may be the first sign of the systemic disease, and a diagnosis may be achieved on examination of histopathologic specimens of a cutaneous lesion. Our study illustrates the wide spectrum of cutaneous lymphomas and leukemias in patients less than 20 years of age and underlines the need for proper interpretation of these lesions by dermatologists and dermatopathologists.
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Abstract
The clinicopathologic characteristics of malignant lymphomas vary according to geography. The aim of this study was to determine the relative frequency of cutaneous lymphomas and to examine the clinical relevance of the WHO classification in Korean cases of cutaneous lymphoma. The Korean Dermatopathology Research Group conducted a clinicopathologic review of a nationwide collection of 80 cutaneous lymphomas, diagnosed at 23 institutes over a recent 3-year period. The clinical records, haematoxylin & eosin-stained slides and immunohistochemical stains from 80 patients with malignant lymphomas of the skin were reviewed. In our study, the most frequent cutaneous lymphoma was mycosis fungoides. Compared with Western countries, Korea had higher rates of NK/T cell lymphoma and subcutaneous panniculitis-like T-cell lymphoma and a much lower rate of B-cell lymphoma. The occurrence rates for various subtypes of malignant lymphoma in Korea are distinct from those in Western countries. The EORTC classification is not fully appropriate in dealing with Korean cases of cutaneous lymphoma, because NK/T cell lymphoma is not included in the EORTC classification for cutaneous lymphoma.
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Tan SH, Sim CS, Ong BH. Cutaneous lymphomas other than mycosis fungoides in Singapore: a clinicopathological analysis using recent classification systems. Br J Dermatol 2003; 149:542-53. [PMID: 14510987 DOI: 10.1046/j.1365-2133.2003.05476.x] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND Cutaneous lymphomas other than mycosis fungoides (MF) are a heterogeneous group with wide variations in clinical presentation, biological behaviour and prognosis. New classification systems have been designed or proposed in recent years, with well-defined disease entities and emphasis on the importance of site. OBJECTIVES This study aims to analyse a series of non-MF lymphomas in an institution-based dermatological setting in Singapore, based on the European Organization for Research and Treatment of Cancer (EORTC) classification and the World Health Organization (WHO) classification. A secondary objective is to highlight the clinical utility of both classification systems. PATIENTS AND METHODS Forty cases diagnosed over a 12-year period were examined by immunohistochemistry with antibodies targeting CD3, CD4, CD5, CD8, CD20, CD30, CD43, CD45RO, CD56 and CD68 in paraffin-embedded specimens. The immunohistological diagnosis was correlated with the clinical presentation and staging investigations for the final diagnosis and the course of disease recorded. RESULTS Non-MF T-cell lymphomas presenting in the skin comprised 31 cases (78%) and were 3(1/2) times more common than B-cell lymphomas, which comprised nine cases (22%). The common subtypes were lymphomatoid papulosis, CD30+ large cell cutaneous T-cell lymphoma and subcutaneous panniculitis-like T-cell lymphoma. The commonly ascribed B-cell pattern with infiltrates in the mid and deep dermis and perivascular spaces was seen in 60% of T-cell lymphomas. Overall, there were equal numbers of primary cutaneous T-cell lymphomas and those due to concurrent or secondary cutaneous lymphoma. Five of six cases of subcutaneous panniculitis-like T-cell lymphoma had concurrent cutaneous and systemic involvement and their median survival was 7 months. CONCLUSIONS The predominance of cutaneous T-cell lymphomas in this case series closely matched that reported from east Asia; cutaneous B-cell lymphomas are much less common than in Europe. The EORTC classification, which is designed only for primary cutaneous lymphomas, should be used in conjunction with the WHO classification because of the high prevalence of cutaneous lymphomas as the secondary site of disease from systemic lymphoma. In addition, subcutaneous panniculitis-like T-cell lymphoma is a primary cutaneous lymphoma where systemic involvement is common at initial presentation. We propose full immunophenotyping and complete clinical evaluation with staging investigations for all patients presenting with cutaneous lymphomas other than MF.
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MESH Headings
- Adolescent
- Adult
- Aged
- Aged, 80 and over
- Child
- Female
- Humans
- Lymphoma, B-Cell/epidemiology
- Lymphoma, B-Cell/pathology
- Lymphoma, Large B-Cell, Diffuse/epidemiology
- Lymphoma, Large B-Cell, Diffuse/pathology
- Lymphoma, T-Cell, Cutaneous/epidemiology
- Lymphoma, T-Cell, Cutaneous/pathology
- Male
- Middle Aged
- Singapore/epidemiology
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Abstract
Male gender is interpreted as a risk factor for developing mycosis fungoides and perhaps other cutaneous and extracutaneous lymphomas. In this review the authors examine epidemiologic, clinical, pathologic, and molecular data in an effort to understand whether and to what extent gender or sex hormones are involved in the pathogenesis of lymphoproliferative disorders.
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MESH Headings
- Adolescent
- Adult
- Aged
- Aged, 80 and over
- Diagnosis, Differential
- Female
- Germany/epidemiology
- Humans
- Lymphoma, T-Cell, Cutaneous/diagnosis
- Lymphoma, T-Cell, Cutaneous/drug therapy
- Lymphoma, T-Cell, Cutaneous/epidemiology
- Lymphoma, T-Cell, Cutaneous/genetics
- Lymphoma, T-Cell, Cutaneous/immunology
- Lymphoma, T-Cell, Cutaneous/mortality
- Lymphoma, T-Cell, Cutaneous/pathology
- Lymphoma, T-Cell, Cutaneous/therapy
- Male
- Middle Aged
- Multicenter Studies as Topic
- Mycosis Fungoides/diagnosis
- Mycosis Fungoides/pathology
- Mycosis Fungoides/therapy
- Neoplasm Staging
- PUVA Therapy
- Photopheresis
- Randomized Controlled Trials as Topic
- Registries
- Sezary Syndrome/diagnosis
- Sezary Syndrome/therapy
- Skin/pathology
- Skin Neoplasms/diagnosis
- Skin Neoplasms/drug therapy
- Skin Neoplasms/epidemiology
- Skin Neoplasms/genetics
- Skin Neoplasms/immunology
- Skin Neoplasms/mortality
- Skin Neoplasms/pathology
- Skin Neoplasms/therapy
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Abstract
Effective long-term management of cutaneous T-cell lymphoma (CTCL) requires administration of skin-directed therapies such as topically applied nitrogen mustard or photochemotherapy to achieve a complete response in clinically early disease (patch and thin-plaque-phase mycosis fungoides, MF) and often the concomitant administration of well-tolerated drugs with systemic effects such as interferon alfa, bexarotene, methotrexate or extracorporeal photopheresis in more advanced, but not highly aggressive/nontransformed disease (thick plaque or tumor phase MF or erythrodermic CTCL). The author's approach is provided as a guide for dermatologists in private practice.
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