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Stein T, Robak T, Biernat W, Robak E. Primary Cutaneous CD30-Positive Lymphoproliferative Disorders-Current Therapeutic Approaches with a Focus on Brentuximab Vedotin. J Clin Med 2024; 13:823. [PMID: 38337516 PMCID: PMC10856748 DOI: 10.3390/jcm13030823] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2023] [Revised: 01/16/2024] [Accepted: 01/28/2024] [Indexed: 02/12/2024] Open
Abstract
One of the most common subgroups of cutaneous T-cell lymphomas is that of primary cutaneous CD30-positive lymphoproliferative disorders. The group includes lymphomatoid papulosis (LyP) and primary cutaneous anaplastic large cell lymphoma (pcALCL), as well as some borderline cases. Recently, significant progress has been made in understanding the genetics and treatment of these disorders. This review article summarises the clinical evidence supporting the current treatment options for these diseases. Recent years have seen the introduction of novel agents into clinical practice; most of these target CD30, such as anti-CD30 monoclonal antibodies and conjugated antibodies (brentuximab vedotin), bispecific antibodies and cellular therapies, particularly anti-CD30 CAR-T cells. This paper briefly reviews the biology of CD30 that makes it a good therapeutic target and describes the anti-CD30 therapies that have emerged to date.
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Affiliation(s)
- Tomasz Stein
- Department of Dermatology, Medical University of Lodz, 90-647 Lodz, Poland;
| | - Tadeusz Robak
- Department of Hematology, Medical University of Lodz, 93-510 Lodz, Poland
- Department of General Hematology, Copernicus Memorial Hospital, 93-510 Lodz, Poland
| | - Wojciech Biernat
- Department of Pathomorphology, Medical University of Gdansk, 80-214 Gdansk, Poland;
| | - Ewa Robak
- Department of Dermatology, Medical University of Lodz, 90-647 Lodz, Poland;
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2
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Fattah YH, Crasto D, Liu SS, Linhares Y, Kerdel F, Hanly A, Karai LJ. DUSP22-IRF4 Rearranged CD30-Positive Primary Cutaneous Lymphoproliferative Disorder With Gamma/Delta Phenotype. Am J Dermatopathol 2023; 45:831-834. [PMID: 37883980 DOI: 10.1097/dad.0000000000002573] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2023]
Abstract
ABSTRACT CD30-positive primary cutaneous lymphoproliferative disorders (CD30 + PCLPD) are a heterogeneous group of cutaneous T-cell lymphoma (CTCL) that includes lymphomatoid papulosis (LyP) and primary cutaneous anaplastic large cell lymphoma. They exist as a clinical and pathological spectrum, which display significant overlap and variability. The diagnosis is made based on correlation between clinical and histopathologic findings. LyP with 6p25.3 rearrangement subtype represents <5% of LyP cases and is defined by DUSP22-IRF4 rearrangement on 6p25.3 locus. The reported cases express the alpha/beta T-cell receptor and follow an indolent clinical behavior typical of LyP. The same rearrangement is detected in 28% of anaplastic large cell lymphoma. We hereby present an extraordinary case of CD30 + PCLPD with DUSP22-IRF4 rearrangement and novel expression of gamma/delta T-cell immunophenotype in a young patient. Although the gamma/delta T-cell immunophenotype has been described in many other T-cell lymphomas, this is the first reported association with CD30 + PCLPD with DUSP22-IRF4 rearrangement.
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Affiliation(s)
- Yasmin H Fattah
- Department of Dermatology, Larkin Community Hospital, South Miami, FL
| | - David Crasto
- Department of Dermatology, Larkin Community Hospital, South Miami, FL
| | - Shuo S Liu
- Department of Dermatology, Larkin Community Hospital, South Miami, FL
| | | | - Franz Kerdel
- Skin Center of South Miami, South Miami, FL; and
| | - Andrew Hanly
- Global Pathology, Sonic Health Care USA, Miami Lakes, FL
| | - Laszlo J Karai
- Global Pathology, Sonic Health Care USA, Miami Lakes, FL
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3
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Saleh JS, Subtil A, Hristov AC. Primary cutaneous T-cell lymphoma: a review of the most common entities with focus on recent updates. Hum Pathol 2023; 140:75-100. [PMID: 37802757 DOI: 10.1016/j.humpath.2023.09.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Revised: 06/01/2023] [Accepted: 06/07/2023] [Indexed: 10/08/2023]
Abstract
Cutaneous T-cell lymphomas are an heterogeneous group of uncommon lymphoid neoplasms that are challenging to diagnose and require close collaboration between dermatologists, pathologists and hematologists/oncologists. This article reviews the most common cutaneous T-cell lymphomas: mycosis fungoides (both classic and variant forms) as well as its leukemic counterpart Sézary syndrome, CD30+ T-cell lymphoproliferative disorders including the ever-expanding group of lymphomatoid papulosis and primary cutaneous anaplastic large cell lymphoma, and primary cutaneous CD4+ small/medium lymphoproliferative disorder. We discuss the classic clinical and histopathologic features of these lymphomas and review how they can be distinguished from reactive entities. In particularly, updates to these diagnostic categories and current controversies in classification are highlighted. Moreover, we review the prognosis and treatment for each entity. These lymphomas exhibit variable prognosis, and therefore it is important to correctly classify atypical cutaneous T-cell infiltrates for appropriate patient treatment and prognosis. Cutaneous T-cell lymphomas are at the interface of several medical specialties; this review seeks to summarize key features of these lymphomas and highlight new and emerging insights into these lymphomas.
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Affiliation(s)
- Jasmine S Saleh
- Department of Pathology, University of Michigan, Ann Arbor, MI, 48109, USA; Department of Dermatology, University of Michigan, Ann Arbor, MI, 48109, USA
| | - Antonio Subtil
- Department of Pathology, Royal Jubilee Hospital, University of British Columbia, Victoria, British Columbia, V8R1J8, Canada
| | - Alexandra C Hristov
- Department of Pathology, University of Michigan, Ann Arbor, MI, 48109, USA; Department of Dermatology, University of Michigan, Ann Arbor, MI, 48109, USA.
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4
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Saleh JS, Subtil A, Hristov AC. Primary cutaneous T-cell lymphoma: a review of the most common entities with focus on recent updates. Hum Pathol 2023; 138:76-102. [PMID: 37307932 DOI: 10.1016/j.humpath.2023.06.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Revised: 06/01/2023] [Accepted: 06/07/2023] [Indexed: 06/14/2023]
Abstract
Cutaneous T-cell lymphomas are an heterogeneous group of uncommon lymphoid neoplasms that are challenging to diagnose and require close collaboration between dermatologists, pathologists and hematologists/oncologists. This article reviews the most common cutaneous T-cell lymphomas: mycosis fungoides (both classic and variant forms) as well as its leukemic counterpart Sézary syndrome, CD30+ T-cell lymphoproliferative disorders including the ever-expanding group of lymphomatoid papulosis and primary cutaneous anaplastic large cell lymphoma, and primary cutaneous CD4+ small/medium lymphoproliferative disorder. We discuss the classic clinical and histopathologic features of these lymphomas and review how they can be distinguished from reactive entities. In particularly, updates to these diagnostic categories and current controversies in classification are highlighted. Moreover, we review the prognosis and treatment for each entity. These lymphomas exhibit variable prognosis, and therefore it is important to correctly classify atypical cutaneous T-cell infiltrates for appropriate patient treatment and prognosis. Cutaneous T-cell lymphomas are at the interface of several medical specialties; this review seeks to summarize key features of these lymphomas and highlight new and emerging insights into these lymphomas.
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Affiliation(s)
- Jasmine S Saleh
- Department of Pathology, University of Michigan, Ann Arbor, MI, 48109, USA; Department of Dermatology, University of Michigan, Ann Arbor, MI, 48109, USA
| | - Antonio Subtil
- Department of Pathology, Royal Jubilee Hospital, University of British Columbia, Victoria, British Columbia, V8R1J8, Canada
| | - Alexandra C Hristov
- Department of Pathology, University of Michigan, Ann Arbor, MI, 48109, USA; Department of Dermatology, University of Michigan, Ann Arbor, MI, 48109, USA.
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5
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Michali MC, Tsikou AT, Tsafaras CE, Kastanioudaki PI, Komnos ID. Primary Cutaneous Anaplastic Large Cell Lymphoma of the Nasal Dorsum and Nasal Tip. Cureus 2022; 14:e23811. [PMID: 35530829 PMCID: PMC9067410 DOI: 10.7759/cureus.23811] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/03/2022] [Indexed: 11/12/2022] Open
Abstract
Primary cutaneous anaplastic large-cell lymphoma (C-ALCL) is described as a non-Hodgkin lymphoma that affects only the skin, with no evidence of an extracutaneous disease during the first six months following the diagnosis. We present an unusual case of a 53-year-old man with developed fever and a rapidly increasing ulcerated skin lesion located on the nasal dorsum and nasal tip. The nasal endoscopy revealed a reddish polypoid lesion over the anterior edge of the superior turbinate which had extended through the roof of the nasal cavity in the adjacent area of the nasal septum.
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6
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Abstract
Primary cutaneous T cell lymphomas (CTCLs) are a heterogeneous group of lymphomas that present in the skin with no evidence of extracutaneous disease at the time of diagnosis. CTCL subtypes demonstrate a variety of clinical, histological, and molecular features, and can follow an indolent or a very aggressive course. The underlying pathogenetic mechanisms are not yet entirely understood. The pathophysiology of CTCL is complex and a single initiating factor has not yet been identified. Diagnosis is based on clinicopathological correlation and requires an interdisciplinary team. Treatment decision is made based on short-term and long-term goals. Therapy options comprise skin-directed therapies, such as topical steroids or phototherapy, and systemic therapies, such as monoclonal antibodies or chemotherapy. So far, the only curative treatment approach is allogeneic haematopoietic stem cell transplantation. Novel therapies, such as chimeric antigen receptor T cells, monoclonal antibodies or small molecules, are being investigated in clinical trials. Patients with CTCL have reduced quality of life and a lack of effective treatment options. Further research is needed to better identify the underlying mechanisms of CTCL development and course as well as to better tailor treatment strategies to individual patients.
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Merlio JP, Kadin ME. Cytokines, Genetic Lesions and Signaling Pathways in Anaplastic Large Cell Lymphomas. Cancers (Basel) 2021; 13:4256. [PMID: 34503066 PMCID: PMC8428234 DOI: 10.3390/cancers13174256] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2021] [Revised: 08/18/2021] [Accepted: 08/18/2021] [Indexed: 12/20/2022] Open
Abstract
ALCL is a tumor of activated T cells and possibly innate lymphoid cells with several subtypes according to clinical presentation and genetic lesions. On one hand, the expression of transcription factors and cytokine receptors triggers signaling pathways. On the other hand, ALCL tumor cells also produce many proteins including chemokines, cytokines and growth factors that affect patient symptoms. Examples are accumulation of granulocytes stimulated by IL-8, IL-17, IL-9 and IL-13; epidermal hyperplasia and psoriasis-like skin lesions due to IL-22; and fever and weight loss in response to IL-6 and IFN-γ. In this review, we focus on the biology of the main ALCL subtypes as the identification of signaling pathways and ALCL-derived cytokines offers opportunities for targeted therapies.
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Affiliation(s)
- Jean-Philippe Merlio
- Tumor Biology and Tumor Bank Laboratory, Centre Hospitalier et Universitaire de Bordeaux, 33600 Pessac, France
- INSERM U1053, University Bordeaux, 33000 Bordeaux, France
| | - Marshall E. Kadin
- Department of Pathology and Laboratory Medicine, Brown University Alpert School of Medicine, Providence, RI 02903, USA
- Department of Dermatology, Boston University, Boston, MA 02215, USA
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8
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Chen SL, Chan KC. Anaplastic Lymphoma Kinase- and CD30-Positive Anaplastic Large-Cell Lymphoma of the External Auditory Canal. Diagnostics (Basel) 2021; 11:diagnostics11071220. [PMID: 34359303 PMCID: PMC8307750 DOI: 10.3390/diagnostics11071220] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Revised: 07/03/2021] [Accepted: 07/05/2021] [Indexed: 11/17/2022] Open
Abstract
Anaplastic large-cell lymphoma (ALCL), a form of non-Hodgkin’s lymphoma, is rare in the external auditory canal (EAC). ALCL in the EAC region is challenging for clinicians and pathologists. We report a 34-year-old male presented with the chief complaint of a painless mass in the left EAC for approximately 2 weeks. Anaplastic lymphoma kinase (ALK)- and CD30-positive ALCL were confirmed using computed tomography, positron emission tomography, histopathological examination and IHC staining. We compared the clinicopathological characteristics of our patient with those of previous cases. The biopsy and IHC findings confirmed the rare diagnosis of ALK- and CD30-positive ALCL of the EAC. Radiotherapy and concurrent chemoradiotherapy are indicated for lymphoma depending on the extent of the disease. Brentuximab vedotin as initial salvage therapy should be considered for recurrent or refractory ALK-positive ALCL.
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Affiliation(s)
- Shih-Lung Chen
- Department of Otolaryngology & Head and Neck Surgery, Chang Gung Memorial Hospital, Linkou 333, Taiwan;
- School of Medicine, Chang Gung University, Taoyuan 333, Taiwan
| | - Kai-Chieh Chan
- Department of Otolaryngology & Head and Neck Surgery, Chang Gung Memorial Hospital, Linkou 333, Taiwan;
- School of Medicine, Chang Gung University, Taoyuan 333, Taiwan
- Correspondence: ; Tel./Fax: +886-3-3979-361
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9
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Sarfraz H, Gentille C, Ensor J, Wang L, Wong S, Ketcham MS, Joshi J, Pingali SRK. Primary cutaneous anaplastic large-cell lymphoma: a review of the SEER database from 2005 to 2016. Clin Exp Dermatol 2021; 46:1420-1426. [PMID: 34081802 DOI: 10.1111/ced.14777] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2020] [Revised: 04/27/2021] [Accepted: 06/01/2021] [Indexed: 12/31/2022]
Abstract
INTRODUCTION Primary cutaneous anaplastic large-cell lymphoma (PC-ALCL) is a rare T-cell lymphoma. A prior analysis of the Surveillance, Epidemiology, and End Results (SEER) database reported only 157 cases of localized primary cutaneous CD30+ T-cell lymphoproliferative disorders (PC-ALCL and lymphomatoid papulosis) from 1973 to 2004. Our analysis of the SEER database since 2004 is the largest to date and our results improve our understanding of this disease and their potential prognostic factors. METHODS We used the SEER database to retrospectively identify patients. Survival was analysed using the Kaplan-Meier method, and log-rank tests were used to compare survival distributions. RESULTS There were 501 cases of PC-ALCL recorded from 2005 to 2016. Overall survival rates at 5 and 10 years were found to be 80.6% (95% CI 76.3%-84.3%) and 61.5% (95% CI 54.1%-68.1%) respectively. Age ≥ 60 years [hazard ratio (HR) = 1.09, P = 0.001 and use of chemotherapy (HR = 1.86, P = 0.01)] were associated with lower overall survival. In contrast to the 1973-2004 cohort, the head and neck site was not significantly associated with prognosis on multivariate analysis. CONCLUSION PC-ALCL has been increasingly recognized over the past decade. Age > 60 years and use of chemotherapy are associated with a worse outcome. Contrary to prior studies, location was not associated with poor survival.
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Affiliation(s)
- H Sarfraz
- Department of Internal Medicine, Houston Methodist Hospital, Houston, TX, USA
| | - C Gentille
- Department of Oncology, Houston Methodist Cancer Center, Houston, TX, USA
| | - J Ensor
- Houston Methodist Research Institute, Houston, TX, USA
| | - L Wang
- Houston Methodist Research Institute, Houston, TX, USA
| | - S Wong
- Houston Methodist Research Institute, Houston, TX, USA
| | - M S Ketcham
- Department of Pathology and Genomic Medicine, Houston Methodist Hospita, Houston, TX, USA
| | - J Joshi
- Department of Oncology, Houston Methodist Cancer Center, Houston, TX, USA
| | - S R K Pingali
- Department of Oncology, Houston Methodist Cancer Center, Houston, TX, USA
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10
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Gru AA, McHargue C, Salavaggione AL. A Systematic Approach to the Cutaneous Lymphoid Infiltrates: A Clinical, Morphologic, and Immunophenotypic Evaluation. Arch Pathol Lab Med 2020; 143:958-979. [PMID: 31339758 DOI: 10.5858/arpa.2018-0294-ra] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
CONTEXT.— The evaluation of cutaneous lymphoid infiltrates, both neoplastic and inflammatory, occurs very frequently in routine dermatopathologic examination and consultation practices. The "tough" cutaneous lymphoid infiltrate is feared by many pathologists; skin biopsies are relatively small, whereas diagnostic possibilities are relatively broad. It is true that cutaneous lymphomas can be difficult to diagnose and that in many circumstances multiple biopsies are required to establish a correct diagnostic interpretation. As a reminder, one should understand that low-grade cutaneous lymphomas are indolent disorders that usually linger for decades and that therapy does not result in disease cure. It is also important to remember that in most circumstances, those patients will die from another process that is completely unrelated to a diagnosis of skin lymphoma (even in the absence of specific therapy). OBJECTIVE.— To use a clinicopathologic, immunophenotypic, and molecular approach in the evaluation of common lymphocytic infiltrates. DATA SOURCES.— An in-depth analysis of updated literature in the field of cutaneous lymphomas was done, with particular emphasis on updated terminology from the most recent World Health Organization classification of skin and hematologic tumors. CONCLUSIONS.— A diagnosis of cutaneous lymphoid infiltrates can be adequately approached using a systematic scheme following the proposed ABCDE system. Overall, cutaneous T- and B-cell lymphomas are rare and "reactive" infiltrates are more common. Evaluation of lymphoid proliferations should start with a good sense of knowledge of the clinical presentation of the lesions, the clinical differential considerations, and a conscientious and appropriate use of immunohistochemistry and molecular tools.
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Affiliation(s)
- Alejandro A Gru
- From the Departments of Pathology (Drs Gru and Salavaggione) and Dermatology (Dr Gru), University of Virginia, Charlottesville; and the Department of Dermatology (Dr McHargue), Henry Ford Health System, Detroit, Michigan
| | - Chauncey McHargue
- From the Departments of Pathology (Drs Gru and Salavaggione) and Dermatology (Dr Gru), University of Virginia, Charlottesville; and the Department of Dermatology (Dr McHargue), Henry Ford Health System, Detroit, Michigan
| | - Andrea L Salavaggione
- From the Departments of Pathology (Drs Gru and Salavaggione) and Dermatology (Dr Gru), University of Virginia, Charlottesville; and the Department of Dermatology (Dr McHargue), Henry Ford Health System, Detroit, Michigan
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11
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Piccinno R, Damiani G, Rossi LC, Berti E. Radiotherapy of primary cutaneous anaplastic large cell lymphoma: our experience in 30 cases. Int J Dermatol 2020; 59:469-473. [PMID: 31916593 DOI: 10.1111/ijd.14754] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2019] [Revised: 10/16/2019] [Accepted: 11/25/2019] [Indexed: 11/30/2022]
Abstract
BACKGROUND Since the observation of new cases of primary cutaneous anaplastic large cell lymphoma (PCALCL) with a seemingly aggressive clinical presentation and a favorable response to radiation therapy (RT), a review of our series has been performed to evaluate the results of RT. MATERIALS AND METHODS The study is a retrospective analysis of 30 patients with PCALCL treated with conventional energy RT. RESULTS About 55 fields of irradiation were performed. Complete clinical response (CCR) was obtained in 29 cases and a partial clinical response (PCR) in one. Two lesions had a marginal relapse at 7 and 37 months, respectively. In eight cases, new lesions appeared in the same body district and in six cases, in body sites at distance from the field of treatment. Total radiation dose ranged from 15 to 35 Gy (median 25 Gy). Follow-up range was 2-218 months (median 38.5 months) with a local control rate of 85% and a relapse-free rate of 49% at 5 years from RT. Three cases developed a nodal involvement. CONCLUSIONS PCALCL belongs to the group of primary cutaneous CD30+ lymphoproliferative disorders, accounting for 25-30% of cutaneous T-cell lymphomas. RT is considered of choice as alternative to surgical excision of solitary lesions. Recent studies have focused on ideal dose to obtain local control indicating 30 Gy as adequate, but others have hypothesized that lower doses may suffice. Our study confirms the excellent role of RT in the local control of the disease with total doses ≤25 Gy.
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Affiliation(s)
- Roberta Piccinno
- Servizio di Fotoradioterapia, Università degli Studi di Milano, Milano, Italy.,UO Dermatologia, Università degli Studi di Milano, Milano, Italy.,Fondazione IRCCS Ca'Granda Ospedale Maggiore Policlinico di Milano, Università degli Studi di Milano, Milano, Italy
| | - Giovanni Damiani
- UO Dermatologia, Università degli Studi di Milano, Milano, Italy.,Fondazione IRCCS Ca'Granda Ospedale Maggiore Policlinico di Milano, Università degli Studi di Milano, Milano, Italy.,Dipartimento di Fisiopatologia Medico-Chirurgica e dei Trapianti, Università degli Studi di Milano, Milano, Italy
| | - Luisa C Rossi
- UO Dermatologia, Università degli Studi di Milano, Milano, Italy.,Fondazione IRCCS Ca'Granda Ospedale Maggiore Policlinico di Milano, Università degli Studi di Milano, Milano, Italy.,Dipartimento di Fisiopatologia Medico-Chirurgica e dei Trapianti, Università degli Studi di Milano, Milano, Italy
| | - Emilio Berti
- UO Dermatologia, Università degli Studi di Milano, Milano, Italy.,Fondazione IRCCS Ca'Granda Ospedale Maggiore Policlinico di Milano, Università degli Studi di Milano, Milano, Italy.,Dipartimento di Fisiopatologia Medico-Chirurgica e dei Trapianti, Università degli Studi di Milano, Milano, Italy
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12
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How I treat primary cutaneous CD30+ lymphoproliferative disorders. Blood 2019; 134:515-524. [DOI: 10.1182/blood.2019000785] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2019] [Accepted: 05/14/2019] [Indexed: 12/12/2022] Open
Abstract
Abstract
The primary cutaneous CD30+ lymphoproliferative disorders are a family of extranodal lymphoid neoplasms that arise from mature postthymic T cells and localize to the skin. Current classification systems recognize lymphomatoid papulosis (LyP), primary cutaneous anaplastic large cell lymphoma, and borderline cases. In the majority of patients, the prognosis of primary cutaneous CD30+ lymphoproliferative disorders is excellent; however, relapses are common, and complete cures are rare. Skin-directed and systemic therapies are used as monotherapy or in combination to achieve the best disease control and minimize overall toxicity. We discuss 3 distinct presentations of primary cutaneous CD30+ lymphoproliferative disorder and present recommendations for a multidisciplinary team approach to diagnosis, evaluation, and management of these conditions in keeping with existing consensus guidelines.
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13
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Chen C, Gu YD, Geskin LJ. A Review of Primary Cutaneous CD30+ Lymphoproliferative Disorders. Hematol Oncol Clin North Am 2019; 33:121-134. [DOI: 10.1016/j.hoc.2018.08.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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14
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Abstract
Primary cutaneous CD30-positive lymphoproliferative disorders (CD30+ LPD) encompass lymphomatoid papulosis (LyP), primary cutaneous anaplastic large cell lymphoma (pcALCL), and borderline lesions [1]. CD30+ LPD are the second most common cutaneous T-cell lymphomas (CTCL) after mycosis fungoides (MF) and represent approximately 25% of all CTCL cases [2]. Their common phenotypic hallmark is an expression of the CD30 antigen, a cytokine receptor belonging to the tumor necrosis factor (TNF) receptor superfamily. Both LyP and pcALCL show numerous clinical, histological and immunophenotypic variants, and generally have an indolent course with a favorable prognosis. Overlapping features of LyP and pcALCL with other CD30+ T-cell lymphomas, inflammatory, and/or infectious conditions emphasize the importance of careful clinicopathologic correlation and staging.
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Affiliation(s)
- Liana Nikolaenko
- Department of Hematology and Hematopoietic Cell Transplantation, City of Hope National Medical Center, Duarte, CA, USA.
| | - Jasmine Zain
- Department of Hematology and Hematopoietic Cell Transplantation, City of Hope National Medical Center, Duarte, CA, USA
- Toni Stephenson Lymphoma Center, City of Hope National Medical Center, Duarte, CA, USA
| | - Steven T Rosen
- Department of Hematology and Hematopoietic Cell Transplantation, City of Hope National Medical Center, Duarte, CA, USA
- Toni Stephenson Lymphoma Center, City of Hope National Medical Center, Duarte, CA, USA
| | - Christiane Querfeld
- Division of Dermatology, City of Hope National Medical Center, Duarte, CA, USA
- Department of Pathology, City of Hope National Medical Center, Duarte, CA, USA
- Toni Stephenson Lymphoma Center, City of Hope National Medical Center, Duarte, CA, USA
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15
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Comparative Study of the Clinical Pathology, Immunophenotype, Epstein–Barr Virus Infection Status, and Gene Rearrangements in Adult and Child Patients With Hydroa Vacciniforme–Like Lymphoproliferative Disorder. Am J Dermatopathol 2019; 41:7-15. [DOI: 10.1097/dad.0000000000001229] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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16
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Su C, Nguyen KA, Bai HX, Zogg CK, Cao Y, Karakousis G, Zhang PJ, Zhang G, Xiao R. Ethnic disparity in primary cutaneous CD30 + T-cell lymphoproliferative disorders: an analysis of 1496 cases from the US National Cancer Database. Br J Haematol 2018; 181:752-759. [PMID: 29676444 DOI: 10.1111/bjh.15222] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2017] [Accepted: 12/28/2017] [Indexed: 11/30/2022]
Abstract
Primary cutaneous CD30+ T cell lymphoproliferative disorders (PCLPD), the second most common type of primary cutaneous T cell lymphomas, accounts for approximately 25-30% of cutaneous T-cell lymphoma cases. However, only small retrospective studies have been reported. We aimed to identify prognostic factors and evaluate the overall survival (OS) of patients with PCLPD stratified by ethnicity. We identified 1496 patients diagnosed with PCLPD between 2004 and 2014 in the US National Cancer Database. Chi-square test and anova were used to evaluate differences in demographic and disease characteristics, socioeconomic factors and treatments received. OS was evaluated with the log-rank test, Cox proportional hazard regression analysis, and propensity score matching. The study included 1267 Caucasians, 153 African Americans (AA), 43 Asians, and 33 of other/unknown ethnicity. Older age, higher Charlson-Deyo score, higher clinical stage and receipt of chemotherapy were predictors of shorter OS. Primary disease site on a lower extremity was associated with shorter OS, while a head and neck location was associated with longer OS. AA patients had shorter OS when compared to Caucasian patients on multivariate analysis. This ethnic disparity persisted on propensity-score matched analysis and after matching Caucasian and AA patients on demographic and disease characteristics, socioeconomic factors and treatments received, and age and gender-matched relative survival analyses.
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Affiliation(s)
- Chang Su
- The Second Xiangya Hospital, Central South University, Department of Dermatology, Changsha, Hunan, China.,Yale School of Medicine, New Haven, CT, USA
| | - Kevin A Nguyen
- Department of Molecular Biophysics and Biochemistry, Yale School of Medicine, New Haven, CT, USA
| | - Harrison X Bai
- Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
| | | | - Ya Cao
- Central South University, Cancer Research Institute, School of Basic Medicine, Changsha, Hunan, China
| | - Giorgos Karakousis
- Department of Surgery, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
| | - Paul J Zhang
- Department of Pathology and Laboratory Medicine, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
| | - Guiying Zhang
- The Second Xiangya Hospital, Central South University, Department of Dermatology, Changsha, Hunan, China
| | - Rong Xiao
- The Second Xiangya Hospital, Central South University, Department of Dermatology, Changsha, Hunan, China
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17
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Abstract
This article focuses on cutaneous hematopoietic neoplasms that are more likely to be encountered in the pediatric age-group and includes both lymphoproliferative and histiocytic disorders. The cutaneous hematologic disorders in children have a different epidemiologic profile to what is seen during adulthood. Although mycosis fungoides is the most frequent form of cutaneous lymphoma in adults, it is very rare in children. Because lymphoblastic leukemias and lymphomas are more frequent in the pediatric setting, cutaneous leukemic infiltrates are relatively common in this age-group. Similarly, histiocytic disorders are more common in children, particularly Langerhans cell histiocytosis and juvenile xanthogranuloma. Notably, the histiocytic disorders have undergone significant modifications on their nomenclature in the basis of the molecular characteristics that are present in them. A summary of the most frequent cutaneous hematopoietic disorders in children will be discussed further in this review.
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Affiliation(s)
- Alejandro A Gru
- 1 Department of Pathology, University of Virginia, Charlottesville, Virginia
| | - Louis P Dehner
- 2 Lauren V. Ackerman Laboratory of Surgical Pathology, St. Louis Children's Hospital and Dermatopathology, Washington University Medical Center, St. Louis, Missouri
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18
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Hapgood G, Pickles T, Sehn LH, Villa D, Klasa R, Scott DW, Gerrie AS, Gascoyne RD, Slack GW, Parsons C, Morris JW, Connors JM, Savage KJ. Outcome of primary cutaneous anaplastic large cell lymphoma: a 20-year British Columbia Cancer Agency experience. Br J Haematol 2016; 176:234-240. [DOI: 10.1111/bjh.14404] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2016] [Accepted: 08/22/2016] [Indexed: 11/30/2022]
Affiliation(s)
- Greg Hapgood
- Department of Medical Oncology; Centre for Lymphoid Cancer; British Columbia Cancer Agency; Vancouver BC Canada
| | - Tom Pickles
- Department of Radiation Oncology; British Columbia Cancer Agency; Vancouver BC Canada
| | - Laurie H. Sehn
- Department of Medical Oncology; Centre for Lymphoid Cancer; British Columbia Cancer Agency; Vancouver BC Canada
| | - Diego Villa
- Department of Medical Oncology; Centre for Lymphoid Cancer; British Columbia Cancer Agency; Vancouver BC Canada
| | - Richard Klasa
- Department of Medical Oncology; Centre for Lymphoid Cancer; British Columbia Cancer Agency; Vancouver BC Canada
| | - David W. Scott
- Department of Medical Oncology; Centre for Lymphoid Cancer; British Columbia Cancer Agency; Vancouver BC Canada
| | - Alina S. Gerrie
- Department of Medical Oncology; Centre for Lymphoid Cancer; British Columbia Cancer Agency; Vancouver BC Canada
| | - Randy D. Gascoyne
- Department of Pathology; Centre for Lymphoid Cancer; British Columbia Cancer Agency; Vancouver BC Canada
| | - Graham W. Slack
- Department of Pathology; Centre for Lymphoid Cancer; British Columbia Cancer Agency; Vancouver BC Canada
| | - Christina Parsons
- Department of Radiation Oncology; British Columbia Cancer Agency; Vancouver BC Canada
| | - James W. Morris
- Department of Radiation Oncology; British Columbia Cancer Agency; Vancouver BC Canada
| | - Joseph M. Connors
- Department of Medical Oncology; Centre for Lymphoid Cancer; British Columbia Cancer Agency; Vancouver BC Canada
| | - Kerry J. Savage
- Department of Medical Oncology; Centre for Lymphoid Cancer; British Columbia Cancer Agency; Vancouver BC Canada
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19
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Graff Z, Mendoza G, Barche A, Turner C. Case 4: Two Black Eschars in a 6-year-old Girl. Pediatr Rev 2016; 37:399-401. [PMID: 27587644 DOI: 10.1542/pir.2016-0034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Affiliation(s)
- Zachary Graff
- Texas Tech University Health Sciences Center School of Medicine, Amarillo, TX
| | - Geronimo Mendoza
- Texas Tech University Health Sciences Center School of Medicine, Amarillo, TX
| | - Apurv Barche
- Texas Tech University Health Sciences Center School of Medicine, Amarillo, TX
| | - Curtis Turner
- Texas Tech University Health Sciences Center School of Medicine, Amarillo, TX
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20
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Lee WJ, Moon IJ, Lee SH, Won CH, Chang SE, Choi JH, Moon KC, Park CS, Huh J, Lee MW. Cutaneous anaplastic large-cell lymphoma (ALCL): A comparative clinical feature and survival outcome analysis of 52 cases according to primary tumor site. J Am Acad Dermatol 2016; 74:1135-43. [DOI: 10.1016/j.jaad.2015.12.053] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2015] [Revised: 12/04/2015] [Accepted: 12/31/2015] [Indexed: 10/22/2022]
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21
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Phenotypic variability in primary cutaneous anaplastic large T-cell lymphoma: a study on 35 patients. Am J Dermatopathol 2014; 36:153-7. [PMID: 24394302 DOI: 10.1097/dad.0b013e3182a5683a] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Primary cutaneous anaplastic large T-cell lymphoma (pcALCL) is a well-defined entity characterized by neoplastic cells expressing CD30, CD2, CD3, CD4, and CD5. Cases with different phenotype have been reported, including variable loss of CD2, CD3, and CD5, and expression of cytotoxic phenotype (CD8⁺) and/or of cytotoxic proteins. Aberrant phenotypes represent a diagnostic pitfall and may be the cause of misdiagnoses. We reviewed 35 cases of pcALCL (M:F = 19:16; mean age, 50.8 years; range, 14-92 years), to better characterize the immunophenotypic spectrum of the disease. Twelve cases (34%) had a T-helper phenotype (CD4⁺/CD8⁻), and TIA-1 was positive in 5 of 8 stained cases. Six cases (18%) had a T-cytotoxic phenotype (CD4⁻/CD8⁺) and were also positive for TIA-1. Positivity for both CD4 and CD8 was observed in 7 cases (20%), 4 of which were stained for TIA-1 and found to be positive, whereas both CD4 and CD8 were negative in 9 cases (26%, only 1/8 tested cases being TIA-1 positive). CD2 was positive in 21 of 27 tested cases (78%), CD3 in 21 of 34 cases (62%), and CD5 in 15 of 31 cases (48%). Interestingly, 11 cases (31%) showed a profoundly aberrant phenotype lacking simultaneously several T-cell markers. Our data allow a better characterization of pcALCL with aberrant phenotypes, showing the remarkable variability in expression of different markers.
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22
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Barbosa L, Brito MJ, Balaco I, Noruegas MJ. Anaplastic cutaneous lymphoma mimicking an infection. J Radiol Case Rep 2014; 8:39-47. [PMID: 24967027 DOI: 10.3941/jrcr.v8i3.1934] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
We present a case of a 17-year-old boy who presented with a skin lesion with extension to the soft tissues of the left thigh. On ultrasound, a homogeneous and hypoechoic expansile formation in the subcutaneous tissue was found, measuring 6.5 × 5 × 3.5 cm, with scarce vascularization. Computed tomography showed a low attenuating neoformation with surrounding edema. An inflammatory disorder was the first diagnosis, but the absence of improvement with antibiotics led us to perform magnetic resonance imaging that showed a high signal lesion on T2-weighted imaging and low intensity signal on T1-weighted imaging and surrounding contrast uptake. Positron emission tomography and computed tomography showed uptake of 18F-fluorodeoxyglucose by the lesion. The final diagnosis was anaplastic cutaneous lymphoma.
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Affiliation(s)
- Luciana Barbosa
- Radiology Department, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
| | - Manuel João Brito
- Pediatric Oncology Department, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
| | - Inês Balaco
- Pediatric Orthopedic Department, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
| | - Maria José Noruegas
- Radiology Department, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
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23
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Parajuli S, Gurung D, Paudel U, Pokhrel DB, Kempf W. Primary cutaneous CD30-positive anaplastic large cell lymphoma in an 80-year-old man: a case report from Nepal. Int J Dermatol 2014; 53:1498-500. [PMID: 24738699 DOI: 10.1111/j.1365-4632.2012.05802.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Sudip Parajuli
- Department of Dermatology, Tribhuvan University Teaching Hospital, Kathmandu, Nepal
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24
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Marçal N, Campelos S, Dias L, Gonçalves M, Pereira G, Godinho T. Primary cutaneous CD30-positive anaplastic large-cell lymphoma of the external auditory canal. EAR, NOSE & THROAT JOURNAL 2013; 91:E10-2. [PMID: 23288823 DOI: 10.1177/014556131209101214] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Primary cutaneous T-cell lymphoma is rare. Cutaneous lymphoma is defined as primary when there is an absence of nodal or systemic disease during the first 6 months following diagnosis. We report what we believe to be the first documented case of a primary cutaneous CD30-positive anaplastic large-cell lymphoma of the external auditory canal. The patient was an elderly woman who presented with progressively worsening right otalgia and hypoacusis. Otoscopy revealed an erythematic, ulcerative, nonbleeding, localized lesion in the anterosuperior area of the external auditory canal. The patient underwent an excisional biopsy, and after the diagnosis was established, she underwent 22 sessions of radiotherapy. During follow-up, she exhibited no evidence of recurrence.
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Affiliation(s)
- Nuno Marçal
- Department of Otorhinolaryngology, Hospital de São Marcos, Sete Fontes, Braga, Portugal.
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25
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Ting DSJ, Mansoor Q, Mathew S, Wride NK. Caruncular Tumor as the First Sign of T-Cell Lymphoma Relapse. Semin Ophthalmol 2013; 30:139-41. [DOI: 10.3109/08820538.2013.833260] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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26
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Sen S, Gangopadhyay A, Chatterjee U, Ray AC. Primary Cutaneous CD30+ Anaplastic Lymphoma: A Case Report and Reappraisal. Indian J Dermatol 2013; 58:165. [PMID: 23716862 PMCID: PMC3657272 DOI: 10.4103/0019-5154.108117] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Affiliation(s)
- Sumit Sen
- Department of Dermatology, IPGMER and SSKM Hospitals, West Bengal, India
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27
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Radiographically negative, asymptomatic, sentinel lymph node positive cutaneous T-cell lymphoma in a 3-year-old male: a case report. Case Rep Pediatr 2012; 2012:791602. [PMID: 23150841 PMCID: PMC3488386 DOI: 10.1155/2012/791602] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2012] [Accepted: 10/02/2012] [Indexed: 12/03/2022] Open
Abstract
We present a case of a 3-year-old male originally diagnosed with a CD30+ anaplastic cutaneous T-cell lymphoma with no evidence of systemic disease after CT scan, PET scan, and bone marrow aspiration. Sentinel lymph node biopsy (SLNB) was performed as an additional step in the workup and showed microscopic disease. Current management/recommendations for cutaneous T-cell lymphoma do not include SLNB. Medical and surgical management of cutaneous malignancies is dramatically different for local versus advanced disease. Therefore adequate evaluation is necessary to properly stage patients for specific treatment. Such distinction in extent of disease suggests more extensive therapy including locoregional radiation and systemic chemotherapy versus local excision only. Two international case reports have described SLNB in cutaneous T-cell lymphoma with one demonstrating evidence of node positive microscopic disease despite a negative metastatic disease workup. This case is being presented as a novel case in a child with implications including lymphoscintigraphy and SLNB as a routine procedure for evaluation and staging of cutaneous T-cell lymphoma if the patient does not demonstrate evidence of metastatic disease on routine workup.
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28
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Ju E, Adigun C, Dunphy C, Gold S, Morrell DS. Anaplastic large cell lymphoma: an unusual presentation in a 7-year-old girl. Pediatr Dermatol 2012; 29:498-503. [PMID: 21967522 DOI: 10.1111/j.1525-1470.2011.01465.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Anaplastic large cell lymphoma (ALCL) accounts for 10% to 30% of all childhood lymphomas and approximately 5% of all non-Hodgkin's lymphoma. ALCL is considered to be a T-cell non-Hodgkin's lymphoma that can be divided into two major groups with distinct genetic, immunophenotypic, and clinical behaviors. The first group consists of a spectrum of CD30+ T-cell lymphoproliferative disorders that include primary cutaneous ALCL (C-ALCL) and lymphomatoid papulosis. The second group is systemic ALCL (S-ALCL), which is further divided into two subgroups: anaplastic lymphoma kinase positive (ALK+) and ALK-negative. Between 30% and 60% of S-ALCL express ALK, which is usually the result of a t(2;5) translocation that correlates with onset in the first three decades of life, male predominance, and good prognosis. Although morphologically similar, ALK- ALCL shows varied clinical behaviors and immunophenotypes; is commonly seen in older age groups, with a peak incidence in the sixth decade of life with no preference as to sex; and has an overall poorer prognosis. We present a case of CD30+, ALK- S-ALCL in a 7-year-old girl.
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Affiliation(s)
- Elizabeth Ju
- North Carolina University School of Medicine, Chapel Hill, North Carolina 27516, USA
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29
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Fuertes I, Mascaró JM, Martínez A, García-Herrera A, Estrach TE. Primary cutaneous anaplastic large cell lymphoma simulating an aggressive angiocentric T-cell lymphoma. Int J Dermatol 2012; 52:1241-4. [PMID: 22458926 DOI: 10.1111/j.1365-4632.2011.05161.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Irene Fuertes
- Departments of DermatologyPathology, Hospital Clínic, University of Barcelona, Barcelona, Spain
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30
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Hagiwara M, Tomita A, Takata K, Shimoyama Y, Yoshino T, Tomita Y, Nakamura S. Primary cutaneous CD30 positive T-cell lymphoproliferative disorders with aberrant expression of PAX5: Report of three cases. Pathol Int 2012; 62:264-70. [DOI: 10.1111/j.1440-1827.2011.02784.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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31
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Santiago-et-Sánchez-Mateos D, Hernández-Martín A, Colmenero I, Mediero IG, León A, Torrelo A. Primary cutaneous anaplastic large cell lymphoma of the nasal tip in a child. Pediatr Dermatol 2011; 28:570-5. [PMID: 20825571 DOI: 10.1111/j.1525-1470.2010.01245.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
A 4-year-old boy with primary cutaneous anaplastic large cell lymphoma located on the nasal tip is presented. The lesion healed spontaneously in 4 months without any evidence of residual disease. Cutaneous anaplastic large cell lymphoma, though rare in children, may occur, and should be considered when a rapidly growing ulcerating skin lesion appears.
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32
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EORTC, ISCL, and USCLC consensus recommendations for the treatment of primary cutaneous CD30-positive lymphoproliferative disorders: lymphomatoid papulosis and primary cutaneous anaplastic large-cell lymphoma. Blood 2011; 118:4024-35. [PMID: 21841159 DOI: 10.1182/blood-2011-05-351346] [Citation(s) in RCA: 260] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
Primary cutaneous CD30(+) lymphoproliferative disorders (CD30(+) LPDs) are the second most common form of cutaneous T-cell lymphomas and include lymphomatoid papulosis and primary cutaneous anaplastic large-cell lymphoma. Despite the anaplastic cytomorphology of tumor cells that suggest an aggressive course, CD30(+) LPDs are characterized by an excellent prognosis. Although a broad spectrum of therapeutic strategies has been reported, these have been limited mostly to small retrospective cohort series or case reports, and only very few prospective controlled or multicenter studies have been performed, which results in a low level of evidence for most therapies. The response rates to treatment, recurrence rates, and outcome have not been analyzed in a systematic review. Moreover, international guidelines for staging and treatment of CD30(+) LPDs have not yet been presented. Based on a literature analysis and discussions, recommendations were elaborated by a multidisciplinary expert panel of the Cutaneous Lymphoma Task Force of the European Organization for Research and Treatment of Cancer, the International Society for Cutaneous Lymphomas, and the United States Cutaneous Lymphoma Consortium. The recommendations represent the state-of-the-art management of CD30(+) LPDs and include definitions for clinical endpoints as well as response criteria for future clinical trials in CD30(+) LPDs.
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33
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Abstract
BACKGROUND In recent years, there have been growing concerns about a possible association of non-Hodgkin's lymphoma--in particular, anaplastic large cell lymphoma (ALCL)--and breast implants. The purpose of this study was to identify and analyze all reported cases of non-Hodgkin's lymphoma occurring in patients with breast implants. METHODS The authors conducted a systematic literature review of reported cases of non-Hodgkin's lymphoma in patients with breast implants. Publications were identified with a search algorithm, forward searches, and expert nominations. After references were reviewed and assessed for inclusion or exclusion, case-based data were independently abstracted, reconciled, and adjudicated by multiple investigators. The data were then synthesized and analyzed. RESULTS Of 884 identified articles, only 83 were relevant to non-Hodgkin's lymphoma involving the breast, and 34 were included in our study. Thirty-six cases of non-Hodgkin's lymphoma in patients with implants were found, of which 29 (81 percent) were ALCLs. Although detailed clinical information was lacking in many cases, ALCL often involved the capsule and/or presented as an unexplained seroma or mass, was negative for anaplastic lymphoma kinase (ALK) expression, and had a relatively indolent clinical course when it developed adjacent to a breast implant. CONCLUSIONS A form of ALCL, which clinically behaves more like the less aggressive primary cutaneous form of ALK-negative ALCL rather than the more aggressive systemic form, may be associated with breast implants. Future research on the epidemiology and biology of this rare disease is clearly needed to better understand its nature.
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34
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Hussain R, Bajoghli A. Primary Cutaneous CD30-Positive Large T-Cell Lymphoma in an 80-Year-Old Man: A Case Report. ISRN DERMATOLOGY 2011; 2011:634042. [PMID: 22363854 PMCID: PMC3262543 DOI: 10.5402/2011/634042] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/19/2011] [Accepted: 02/15/2011] [Indexed: 11/23/2022]
Abstract
Primary cutaneous CD30-positive large cell lymphoma (CD30+ PCLCL) is a rare subtype of cutaneous T-cell lymphoma (CTCL) that can present in a variety of ways. We report a patient with a three-month history of an enlarging, exophytic mass with two smaller satellite lesions on the left forearm. Biopsy of the skin stained positive for CD30, and, after thorough systemic evaluation, a diagnosis of CD30+ PCLCL was made. When PCLCL is suspected, it is important to perform immunohistological studies for CD30 types and conduct a thorough workup to rule out systemic LCL. These measures will reduce the use of unnecessarily aggressive chemotherapy regimens for CD30+ PCLCL, an indolent disease with a favorable prognosis.
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Affiliation(s)
- Rehan Hussain
- School of Medicine, The George Washington University, Washington, DC 20037, USA
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35
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Kinney MC, Higgins RA, Medina EA. Anaplastic large cell lymphoma: twenty-five years of discovery. Arch Pathol Lab Med 2011; 135:19-43. [PMID: 21204709 DOI: 10.5858/2010-0507-rar.1] [Citation(s) in RCA: 91] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
CONTEXT The year 2010 commemorates the 25th year since the seminal publication by Karl Lennert and Harald Stein and others in Kiel, West Germany, describing an unusual large cell lymphoma now known as anaplastic large cell lymphoma (ALCL). Investigators at many universities and hospitals worldwide have contributed to our current in-depth understanding of this unique peripheral T-cell lymphoma, which in its systemic form, principally occurs in children and young adults. OBJECTIVE To summarize our current knowledge of the clinical and pathologic features of systemic and primary cutaneous ALCL. Particular emphasis is given to the biology and pathogenesis of ALCL. DATA SOURCES Search of the medical literature (Ovid MEDLINE In-Process & Other Non-Indexed Citations and Ovid MEDLINE: 1950 to Present [National Library of Medicine]) and more than 20 years of diagnostic experience were used as the source of data for review. CONCLUSIONS Based on immunostaining for activation antigen CD30 and the presence of dysregulation of the anaplastic lymphoma kinase gene (2p23), the diagnosis of ALCL has become relatively straightforward for most patients. Major strides have been made during the last decade in our understanding of the complex pathogenesis of ALCL. Constitutive NPM-ALK signaling has been shown to drive oncogenesis via an intricate network of redundant and interacting pathways that regulate cell proliferation, cell fate, and cytoskeletal modeling. Nevertheless, pathomechanistic, therapeutic, and diagnostic challenges remain that should be resolved as we embark on the next generation of discovery.
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Affiliation(s)
- Marsha C Kinney
- Department of Pathology, The University of Texas Health Science Center at San Antonio, 7703 Floyd Curl Dr., San Antonio, TX 78229-3900, USA.
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36
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Gencoglan G, Ozturk F, Inanir I, Miskioglu M, Temiz P, Gunduz K. Primary cutaneous anaplastic CD30 + large-cell lymphoma that completely regressed after incisional skin biopsy. Cutan Ocul Toxicol 2010; 30:163-6. [PMID: 21083511 DOI: 10.3109/15569527.2010.534749] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
We describe a 48-year-old woman with three erythematous nodules localized on the left forearm, with 2 months evolution. Histological and immunohistochemical examination revealed a CD30(+) large-cell lymphoma. Systemic involvement was not detected. The tumor regressed spontaneously within a week, after the incisional skin biopsy. In control skin biopsy, there was not any histological feature of lymphoma. No reactivation or any symptom of systemic disease was observed during the 10-month follow-up period.
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Affiliation(s)
- Gulsum Gencoglan
- Department of Dermatology, Celal Bayar University, Manisa, Turkey
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37
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Anaplastic Large Cell Lymphoma: Case Report and Literature Review. J Oral Maxillofac Surg 2010; 68:884-8. [DOI: 10.1016/j.joms.2009.04.084] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2008] [Revised: 03/05/2009] [Accepted: 04/19/2009] [Indexed: 11/18/2022]
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38
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Shimizu Y, Tanae K, Takahashi N, Kohri M, Arai E, Bessho M, Niitsu N. Primary cutaneous anaplastic large-cell lymphoma presenting with hemophagocytic syndrome: A case report and review of the literature. Leuk Res 2010; 34:263-6. [DOI: 10.1016/j.leukres.2009.07.001] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2009] [Revised: 06/30/2009] [Accepted: 07/02/2009] [Indexed: 10/20/2022]
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39
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Salama S, Todd S, Cina DP, Margetts P. Cutaneous presentation of post-renal transplant lymphoproliferative disorder: a series of four cases. J Cutan Pathol 2009; 37:641-53. [PMID: 19903218 DOI: 10.1111/j.1600-0560.2009.01449.x] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
We report detailed histological and molecular characteristics of four post transplant lymphoproliferative disorders (PTLD) presenting in the skin of renal transplant patients, and their clinical outcome. Three had B-cell lymphomas (cases 1-3), and one had a T-cell lymphoma (case 4). All B-cell lymphomas showed Epstein-Barr virus (EBV) by immunohistochemistry (IHC) or in situ hybridization (ISH). Cases 1 and 2 were large cell lymphomas, and case 3 a plasmacytoma. Case 1 showed light chain restriction and heavy chain gene rearrangement by polymerase chain reaction (PCR). The patient was then diagnosed with an abdominal lymphoma and died of sepsis. Case 2 had no recoverable DNA. Case 3 had a plasmacytoma that showed monoclonal light chain restriction on IHC and an oligoclonal heavy chain rearrangement by PCR. In cases 2 and 3, the lesions regressed following reduction of immunosuppression, and died 1.5 and 8 years later from unrelated medical causes. Case 4 was a CD 30+ anaplastic large T-cell lymphoma with no EBV detected by IHC, ISH and PCR, and died of heart failure 2 years later. Cutaneous manifestations of PTLD are rare, show wide array of clinical and pathological features, and generally have a favorable prognosis. EBV appears to be associated only with B-cell cutaneous lymphomas.
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Affiliation(s)
- Samih Salama
- Department of Pathology and Molecular Medicine, St. Joseph's Hospital, McMaster University, Hamilton, ON, Canada L8N 4A6.
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40
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Piccinno R, Caccialanza M, Berti E, Beretta M, Gnecchi L. Radiotherapy of primary cutaneous CD30+large cell lymphoma. A preliminary study of eight patients. J DERMATOL TREAT 2009. [DOI: 10.3109/09546639609086884] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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41
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Hampton PJ, Wood K, Lawrence CM. Painless unilateral ulceration of the lower leg. Clin Exp Dermatol 2009; 34:545-6. [PMID: 19522987 DOI: 10.1111/j.1365-2230.2008.02726.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- P J Hampton
- Department of Dermatology, Victoria Wing, Royal Victoria Infirmary, Newcastle Upon Tyne, UK.
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42
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Yamane N, Kato N, Nishimura M, Ito M, Yanagi T, Osawa R. Primary cutaneous CD30+ anaplastic large-cell lymphoma with generalized skin involvement and involvement of one peripheral lymph node, successfully treated with low-dose oral etoposide. Clin Exp Dermatol 2009; 34:e56-9. [PMID: 19438576 DOI: 10.1111/j.1365-2230.2008.03182.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Primary cutaneous CD30+ anaplastic large-cell lymphoma (PCALCL) in adults is rare, and the prognosis is generally excellent. Multifocal PCALCL tends to relapse after multiagent chemotherapy and is generally considered more prone to progress to extracutaneous involvement than is the localized disease. We report a 43-year-old woman with PCALCL who had generalized skin involvement accompanied by involvement of one peripheral draining lymph-node region. Although the disease relapsed after multiagent chemotherapy regimens, the disease was successfully treated with low-dose etoposide. We reviewed the previously reported cases of PCALCL treated with low-dose etoposide. We suggest that oral etoposide might be a useful effective treatment for treatment of relapsed multifocal PCALCL.
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Affiliation(s)
- N Yamane
- Department of Dermatology, National Hospital Organization Hokkaido Cancer Center, Sapporo, Japan
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Humme D, Lukowsky A, Steinhoff M, Beyer M, Walden P, Sterry W, Assaf C. Dominance of Nonmalignant T-Cell Clones and Distortion of the TCR Repertoire in the Peripheral Blood of Patients with Cutaneous CD30+ Lymphoproliferative Disorders. J Invest Dermatol 2009; 129:89-98. [DOI: 10.1038/jid.2008.204] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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44
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Hagiwara M, Takata K, Shimoyama Y, Yamamoto K, Takahashi E, Asano N, Iwase Y, Okazaki Y, Tamada Y, Yoshino T, Tomita Y, Nakamura S. Primary cutaneous T-cell lymphoma of unspecified type with cytotoxic phenotype: clinicopathological analysis of 27 patients. Cancer Sci 2009; 100:33-41. [PMID: 19018763 PMCID: PMC11158474 DOI: 10.1111/j.1349-7006.2008.01000.x] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2008] [Revised: 08/31/2008] [Accepted: 09/01/2008] [Indexed: 11/27/2022] Open
Abstract
The objective of our study was to investigate the clinicopathological features of the currently ill-defined subtype of primary cutaneous T-cell lymphoma of unspecified type (CTCLU) with a cytotoxic phenotype and no Epstein-Barr virus (EBV) association. A series of 27 patients with CTCLU (median age 49 years; range 25-87 years; 18 men) was reviewed. Performance status scores above 1 (7%), clinical stages above 2 (15%), B symptoms (26%), extracutaneous involvement (30%), and a fatal course within 1 year of diagnosis (19%) were observed infrequently. The International Prognostic Index was high or high to intermediate in 11%, and the Prognostic Index for Peripheral T-cell Lymphoma unspecified was above group 2 in 22%. Notably, the rates of spontaneous regression and T-cell receptor gene rearrangements by polymerase chain reaction analysis were seen in 26 and 17% of our cases, respectively. Histologically, 22 patients had subcutaneous involvement of whom eight showed a lethal clinical course, and five patients without subcutaneous involvement were all survivors. Immunophenotypical and morphological features allowed us to subclassify our cases according to the following four categories: (1) epidermotropic CD8+ T-cell lymphoma (n=5); (2) cutaneous gamma/delta T-cell lymphoma (n=8); (3) cutaneous alpha/beta pleomorphic T-cell lymphoma (n=8); and (4) cutaneous medium/large pleomorphic T-cell lymphoma, not otherwise specified (n=6). All four of these groups of lymphomas exhibited a relatively favorable clinical course compared to previous reports. However, epidermotropic CD8+ T-cell lymphoma appeared to be unique with a higher ratio (80%) of spontaneous regression, a lower ratio (40%) of subcutaneous involvement, and a more favorable clinical course than the other three subcategories.
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Affiliation(s)
- Masahiro Hagiwara
- Department of Dermatology, Nagoya Graduate School of Medicine, and Department of Pathology and Clinical Laboratories, Nagoya University Hospital, Showa-ku, Nagoya 466-8550, Japan.
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45
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Primary Cutaneous Anaplastic Large Cell Lymphoma of the Face Presenting as Posttraumatic Maxillary Sinusitis. J Craniofac Surg 2008; 19:1597-9. [DOI: 10.1097/scs.0b013e31818b2d24] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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46
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CHO K, KIM C, LEE D, SOHN S, KIM D, CHUNG J. An Epstein-Barr virus-associated lymphoproliferative lesion of the skin presenting as recurrent necrotic papulovesicles of the face. Br J Dermatol 2008. [DOI: 10.1046/j.1365-2133.1996.99812.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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47
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HERBST H, SANDER C, TRONNIEK M, KUTZNER H, HÜGEL H, KAUDEWITZ P. Absence of anaplastic lymphoma kinase (ALK) and Epstein-Barr virus gene products in primary cutaneous anaplastic large cell lymphoma and lymphomatoid papulosis. Br J Dermatol 2008. [DOI: 10.1046/j.1365-2133.1997.19352050.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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48
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Kempf W, Kutzner H, Cozzio A, Sander CA, Pfaltz M, Müller B, Pfaltz M. MUM1 expression in cutaneous CD30+ lymphoproliferative disorders: a valuable tool for the distinction between lymphomatoid papulosis and primary cutaneous anaplastic large-cell lymphoma. Br J Dermatol 2008; 158:1280-7. [DOI: 10.1111/j.1365-2133.2008.08566.x] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
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49
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Rannan-Eliya YF, Pulford K, Johnson R, Peart I, Kokai G, Baillie C, Ait-Tahar K, Pizer B. Isolated cutaneous anaplastic large cell lymphoma progressing to severe systemic disease with myocardial involvement and central nervous system infiltration. Pediatr Blood Cancer 2008; 50:879-81. [PMID: 17914741 DOI: 10.1002/pbc.21357] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Anaplastic large cell lymphoma (ALCL) is a rare tumor comprising around 10-15% of childhood lymphomas. We describe the case of a female who initially presented with localized skin disease associated with an insect bite. However, she subsequently relapsed with widespread systemic ALK-positive ALCL that included lymphoma deposits in the myocardium, a very rare manifestation. Her disease responded well to chemotherapy but she later developed a fatal relapse in the CNS. We also present data on an immune response to ALK, demonstrating a fluctuation in the levels of circulating antibodies to ALK corresponding to the different phases of her illness.
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MESH Headings
- Adolescent
- Anaplastic Lymphoma Kinase
- Antineoplastic Combined Chemotherapy Protocols/therapeutic use
- Central Nervous System Neoplasms/drug therapy
- Central Nervous System Neoplasms/genetics
- Central Nervous System Neoplasms/pathology
- Disease Progression
- Echocardiography, Transesophageal
- Fatal Outcome
- Female
- Heart Neoplasms/drug therapy
- Heart Neoplasms/genetics
- Heart Neoplasms/pathology
- Humans
- Lymphoma, Large-Cell, Anaplastic/genetics
- Lymphoma, Large-Cell, Anaplastic/pathology
- Lymphoma, Large-Cell, Anaplastic/therapy
- Myocardium
- Oncogene Proteins, Fusion/biosynthesis
- Oncogene Proteins, Fusion/genetics
- Oncogene Proteins, Fusion/immunology
- Protein-Tyrosine Kinases/biosynthesis
- Protein-Tyrosine Kinases/genetics
- Protein-Tyrosine Kinases/immunology
- Receptor Protein-Tyrosine Kinases
- Skin Neoplasms/genetics
- Skin Neoplasms/pathology
- Skin Neoplasms/surgery
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Affiliation(s)
- Yi Fan Rannan-Eliya
- Department of Paediatric Oncology, Royal Liverpool Children's NHS Trust, Liverpool, UK
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Treatment of Primary Cutaneous CD30+ Anaplastic Large-Cell Lymphoma With Radiation Therapy. Int J Radiat Oncol Biol Phys 2008; 70:1542-5. [DOI: 10.1016/j.ijrobp.2007.08.077] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2007] [Revised: 08/22/2007] [Accepted: 08/24/2007] [Indexed: 11/22/2022]
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