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Cheng J, Toner K, Habeshian K, Cardis M, Cowen EW, Bollard CM, Wistinghausen B, Kirkorian AY. Pediatric cutaneous T-cell neoplasm and mimics with gamma-delta expression: Not always aggressive. Pediatr Blood Cancer 2024; 71:e30837. [PMID: 38177069 DOI: 10.1002/pbc.30837] [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: 09/26/2023] [Revised: 12/06/2023] [Accepted: 12/18/2023] [Indexed: 01/06/2024]
Abstract
Pediatric cutaneous T-cell lymphoma with γδ immunophenotype is extremely rare. Only a few cases of γδ T-cell neoplasm have been reported in the literature, and therefore little is known whether γδ T-cell neoplasms in children are distinct from their adult counterparts with respect to the clinicopathological presentation, behavior, and prognosis. In this study, we demonstrate three unique pediatric cutaneous T-cell neoplasm and mimics with increased γδ T cells. All cases showed an indolent clinical course.
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Affiliation(s)
- Jinjun Cheng
- Department of Pathology and Laboratory Medicine, Children's National Hospital, Washington, District of Columbia, USA
- Center for Cancer and Immunology Research, Children's National Hospital, Washington, District of Columbia, USA
- George Washington University School of Medicine and Health Sciences, Washington, District of Columbia, USA
| | - Keri Toner
- Center for Cancer and Immunology Research, Children's National Hospital, Washington, District of Columbia, USA
- George Washington University School of Medicine and Health Sciences, Washington, District of Columbia, USA
- Center for Cancer and Blood Disorders, Children's National Hospital, Washington, District of Columbia, USA
| | - Kaiane Habeshian
- George Washington University School of Medicine and Health Sciences, Washington, District of Columbia, USA
- Division of Dermatology, Children's National Hospital, Washington, District of Columbia, USA
| | - Michael Cardis
- Department of Dermatology, Medstar-Georgetown University School of Medicine, Washington, District of Columbia, USA
| | - Edward W Cowen
- Dermatology Branch, National Institute of Arthritis and Musculoskeletal and Skin Diseases, National Institute of Health, Bethesda, Maryland, USA
| | - Catherine M Bollard
- Center for Cancer and Immunology Research, Children's National Hospital, Washington, District of Columbia, USA
- George Washington University School of Medicine and Health Sciences, Washington, District of Columbia, USA
- Center for Cancer and Blood Disorders, Children's National Hospital, Washington, District of Columbia, USA
| | - Birte Wistinghausen
- Center for Cancer and Immunology Research, Children's National Hospital, Washington, District of Columbia, USA
- George Washington University School of Medicine and Health Sciences, Washington, District of Columbia, USA
- Center for Cancer and Blood Disorders, Children's National Hospital, Washington, District of Columbia, USA
| | - A Yasmine Kirkorian
- George Washington University School of Medicine and Health Sciences, Washington, District of Columbia, USA
- Division of Dermatology, Children's National Hospital, Washington, District of Columbia, USA
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2
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Magro CM, Kalomeris T, Dillard A. Panniculitic primary cutaneous gamma delta T-cell lymphoma with concomitant features of autoimmune disease emphasizing a pathophysiologic continuum of lupus profundus with the panniculitic T cell lymphomas. Clin Dermatol 2023; 41:680-691. [PMID: 37716581 DOI: 10.1016/j.clindermatol.2023.09.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/18/2023]
Abstract
Certain T-cell lymphomas exhibit unique homing properties of the neoplastic lymphocytes for the subcutaneous fat. There are two primary forms of subcutaneous panniculitic lymphomas of T-cell origin. One falls under the designation of primary cutaneous gamma-delta T-cell lymphomas (PGD-TCL) whereby there is dominant involvement of the fat defininng a panniculitic form of PGD-TCL. The neoplastic cells are of the gamma-delta subset and are either double negative for CD4 and CD8 and/or can express CD8. They often have an aggressive clinical course. The other form of panniculitic T-cell lymphoma falls under the designation of subcutaneous panniculitis-like T-cell lymphoma (SPTCL). It represents a subcutaneous lymphoma derived from CD8+ T cells of the alpha-beta subset and typically has an indolent course. These two forms of panniculitic T-cell lymphoma exhibit overlapping histologic features with lupus profundus (LP), a putative form of panniculitic T-cell dyscrasia. We present three cases of PGD-TCL of the fat in the setting of lupus erythematosus (LE) (two cases) and dermatomyositis (DM) (one case), respectively. There were concurrent features of LE and DM in their lymphoma biopsies in two cases while a prior biopsy in one was interpreted as LP. In this latter case, the LP diagnosis presaged the diagnosis of panniculitic PGD-TCL by three years. One patient diagnosed with panniculitic PGD-TCL had hemophagocytic syndrome after developing a lupus-like complex including certain supportive serologies such as antibodies to double-stranded DNA following initiation of statin therapy. The second patient presented with PGD-TCL and concomitant features of anti-nuclear matrix 2 (NXP2) DM. The third patient presented in 2003 with LP and overlying skin features of acute LE, initially responding to Plaquenil, and then four years later was diagnosed with PGD-TCL heralded by Plaquenil treatment resistance. Two of the patients died of their lymphoma. All biopsies showed a characteristic histopathology of PGD-TCL. In two cases, the PGD-TCL was associated with overlying LE-cutaneous findings; another case had skin changes of lymphocyte-rich DM. In two cases, the MXA stain was strikingly positive, the surrogate type I interferon marker that is typically upregulated in biopsies of LE and DM. There are eight prior reported cases describing SPTCL with concomitant cutaneous changes of LE. In six cases there was an established history of LE, including LP responding initially to Plaquenil, similar to one of our cases. In the context of SPTCL or panniculitic PGD-TCL, panniculitic T-cell lymphomas can be associated with concomitant clinical and histologic features of LE or DM, including an upregulated type I interferon signature. Identifying histologic features associated with either of these prototypic autoimmune conditions should not be considered exclusionary to diagnosing any panniculitic T-cell lymphoma. A clinical, histomorphologic, and pathophysiologic continuum exists with LP, SPTCL and panniculitic PGD-TCL.
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Affiliation(s)
- Cynthia M Magro
- Department of Pathology and Laboratory Medicine, Weill Cornell Medicine, New York, New York, USA.
| | - Taylor Kalomeris
- Department of Pathology and Laboratory Medicine, New York-Presbyterian/Weill Cornell Medicine, New York, New York, USA
| | - Alicia Dillard
- Department of Pathology and Laboratory Medicine, New York-Presbyterian/Weill Cornell Medicine, New York, New York, USA
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3
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Lim MS, Foley M, Mussolin L, Siebert R, Turner S. Biopathology of childhood, adolescent and young adult non-Hodgkin lymphoma. Best Pract Res Clin Haematol 2023; 36:101447. [PMID: 36907637 DOI: 10.1016/j.beha.2023.101447] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Accepted: 02/01/2023] [Indexed: 02/05/2023]
Abstract
Mature non-Hodgkin lymphomas (NHL) in the childhood, adolescent and young adult (CAYA) population are rare and exhibit unique clinical, immunophenotypic and genetic characteristics. Application of large-scale unbiased genomic and proteomic technologies such as gene expression profiling and next generation sequencing (NGS) have led to enhanced understanding of the genetic basis for many lymphomas in adults. However, studies to investigate the pathogenetic events in CAYA population are relatively sparse. Enhanced understanding of the pathobiologic mechanisms involved in non-Hodgkin lymphomas in this unique population will allow for improved recognition of these rare lymphomas. Elucidation of the pathobiologic differences between CAYA and adult lymphomas will also lead to the design of more rational and much needed, less toxic therapies for this population. In this review, we summarize recent insights gained from the proceedings of the recent 7th International CAYA NHL Symposium held in New York City, New York October 20-23, 2022.
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Affiliation(s)
- Megan S Lim
- Department of Pathology and Laboratory Medicine, Memorial Sloan Kettering Cancer Center,417 East 68th New York City, NY, USA.
| | - Michelle Foley
- Department of Pediatrics, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, Howard 14, New York City, NY, USA New York City, NY, USA.
| | - Lara Mussolin
- Pediatric Hematology, Oncology and Stem Cell Transplant Division, University Hospital of Padova, via Giustiniani 3, 35128 Padova, Italy.
| | - Reiner Siebert
- Institute of Human Genetics, Ulm University & Ulm University Medical Center, Albert-Einstein-Allee 11, D-89081 Ulm, Germany.
| | - Suzanne Turner
- Department of Pathology, University of Cambridge, Lab Block Level 3, Box 231, Addenbrookes Hospital, Hills Road, Cambridge CB20QQ, UK; CEITEC, Masaryk University, Brno, Czech Republic.
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4
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Diagnosis and management of cutaneous lymphomas and lymphoid proliferations in children, adolescents and young adults (CAYA). Best Pract Res Clin Haematol 2023; 36:101448. [PMID: 36907638 DOI: 10.1016/j.beha.2023.101448] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Accepted: 02/06/2023] [Indexed: 02/12/2023]
Abstract
Cutaneous lymphomas and lymphoid proliferations (LPD) in children, adolescents, and young adults (CAYA) are a heterogeneous group of lymphoid neoplasms that present formidable diagnostic challenges to clinicians and pathologists alike. Although rare overall, cutaneous lymphomas/LPD occur in real-world settings and awareness of the differential diagnosis, potential complications, and various therapeutic approaches will help ensure the optimal diagnostic work-up and clinical management. Lymphomas/LPD involving the skin can occur as primary cutaneous disease in a patient that characteristically has lymphoma/LPD confined to the skin, or as secondary involvement in patients with systemic disease. This review will comprehensively summarize both primary cutaneous lymphomas/LPD that occur in the CAYA population as well as those CAYA systemic lymphomas/LPD with propensity for secondary cutaneous involvement. Focus on the most common primary entities occurring in CAYA will include lymphomatoid papulosis, primary cutaneous anaplastic large cell lymphoma, mycosis fungoides, subcutaneous panniculitis-like T-cell lymphoma, and hydroa vacciniforme lymphoproliferative disorder.
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5
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Zheng J, Shen D, Wang B, Fu F. CT imaging findings of a rare case of subcutaneous panniculitis-like T-cell lymphomatosis involving the bone marrow: A rare case report. Asian J Surg 2023:S1015-9584(23)00022-2. [PMID: 36635172 DOI: 10.1016/j.asjsur.2022.12.133] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Accepted: 12/29/2022] [Indexed: 01/11/2023] Open
Affiliation(s)
- Jingyi Zheng
- Graduate Collaborative Training Base of Yiyang Central Hospital,Hengyang Medical School, University of South China, Hengyang, Hunan, 421001, PR China
| | - Dan Shen
- Graduate Collaborative Training Base of Yiyang Central Hospital,Hengyang Medical School, University of South China, Hengyang, Hunan, 421001, PR China
| | - Bin Wang
- Department of Radiology, Second Affiliated Hospital of Kunming Medical University, Kunming, Yunnan, 650101, PR China
| | - Feixian Fu
- Department of Radiology, Yiyang Central Hospital, Yiyang, Hunan, 413000, PR China.
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6
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Duan Y, Gao H, Zhou C, Jin L, Yang J, Huang S, Zhang M, Zhang Y, Wang T. A retrospective study of 18 children with subcutaneous panniculitis-like T-cell lymphoma: multidrug combination chemotherapy or immunomodulatory therapy? Orphanet J Rare Dis 2022; 17:432. [PMID: 36503528 PMCID: PMC9743713 DOI: 10.1186/s13023-022-02575-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Accepted: 11/20/2022] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Subcutaneous panniculitis T-cell lymphoma (SPTCL) is a rare, cytotoxic T-cell lymphoma with which some patients have accompanying hemophagocytic syndrome (HPS). There is currently no standard treatment regimen. In the past, the most commonly used treatment was multidrug chemotherapy. In contrast, numerous case reports or small series suggest that immunosuppressive drugs could also be effective for some patients. Since this NHL subtype is extremely rare in children and adolescents, to improve the understanding of this disease and standardize its rational treatment, we retrospectively summarized the treatment regimens of 18 pathologically diagnosed children with SPTCL to compare the clinical efficacy of multidrug chemotherapy and immunomodulatory therapy. RESULTS The median age of onset was 11.1 years. Painless subcutaneous nodules or skin patchy lesions were found in all patients, most commonly involving the lower extremities and/or trunk. Before January 1, 2019, the treatment was mainly chemotherapy, and 10 patients were initially treated with chemotherapy, among whom was one patient who progressed during initial treatment, was voluntarily discharged and was subsequently lost to follow-up, one patient who died of disease progression, and the remaining 8 patients who all achieved sustained remission, with a complete remission (CR) rate of 80% (8/10). Corticosteroids combined with cyclosporine A or ruxolitinib were the most common initial immunosuppressive agents at our center after January 1, 2019 and had a CR rate of 71.4% (5/7). In addition, 1 patient achieved partial remission (PR) during follow-up, and one had autologous hematopoietic stem cell transplantation (AHSCT) after 4 months of drug withdrawal. There were 7 patients (38.9%, one case in chemotherapy group and six cases in immunotherapy group) with HPS and 4/5 screened patients (80%) with positive HAVCR2 gene mutations. The median follow-up was 17 months. CONCLUSION The prognosis of SPTCL is relatively good. Previous multi-drug and long-term chemotherapy treatment has clear efficacy, and recent immunomodulatory therapy as pre-chemotherapy therapy can also benefit patients.
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Affiliation(s)
- Yanlong Duan
- Medical Oncology Department, Pediatric Oncology Center, Beijing Children’s Hospital, National Center for Children’s Health, Beijing Key Laboratory of Pediatric Hematology Oncology, Key Laboratory of Major Diseases in Children, Ministry of Education, National Key Discipline of Pediatrics, Capital Medical University, Beijing, 100045 People’s Republic of China
| | - Huixia Gao
- Medical Oncology Department, Pediatric Oncology Center, Beijing Children’s Hospital, National Center for Children’s Health, Beijing Key Laboratory of Pediatric Hematology Oncology, Key Laboratory of Major Diseases in Children, Ministry of Education, National Key Discipline of Pediatrics, Capital Medical University, Beijing, 100045 People’s Republic of China
| | - Chunju Zhou
- grid.411609.b0000 0004 1758 4735Pathology Department, National Center for Children’s Health, Beijing Children’s Hospital, Capital Medical University, Beijing, 100045 People’s Republic of China
| | - Ling Jin
- Medical Oncology Department, Pediatric Oncology Center, Beijing Children’s Hospital, National Center for Children’s Health, Beijing Key Laboratory of Pediatric Hematology Oncology, Key Laboratory of Major Diseases in Children, Ministry of Education, National Key Discipline of Pediatrics, Capital Medical University, Beijing, 100045 People’s Republic of China
| | - Jing Yang
- Medical Oncology Department, Pediatric Oncology Center, Beijing Children’s Hospital, National Center for Children’s Health, Beijing Key Laboratory of Pediatric Hematology Oncology, Key Laboratory of Major Diseases in Children, Ministry of Education, National Key Discipline of Pediatrics, Capital Medical University, Beijing, 100045 People’s Republic of China
| | - Shuang Huang
- Medical Oncology Department, Pediatric Oncology Center, Beijing Children’s Hospital, National Center for Children’s Health, Beijing Key Laboratory of Pediatric Hematology Oncology, Key Laboratory of Major Diseases in Children, Ministry of Education, National Key Discipline of Pediatrics, Capital Medical University, Beijing, 100045 People’s Republic of China
| | - Meng Zhang
- Medical Oncology Department, Pediatric Oncology Center, Beijing Children’s Hospital, National Center for Children’s Health, Beijing Key Laboratory of Pediatric Hematology Oncology, Key Laboratory of Major Diseases in Children, Ministry of Education, National Key Discipline of Pediatrics, Capital Medical University, Beijing, 100045 People’s Republic of China
| | - Yonghong Zhang
- Medical Oncology Department, Pediatric Oncology Center, Beijing Children’s Hospital, National Center for Children’s Health, Beijing Key Laboratory of Pediatric Hematology Oncology, Key Laboratory of Major Diseases in Children, Ministry of Education, National Key Discipline of Pediatrics, Capital Medical University, Beijing, 100045 People’s Republic of China
| | - Tianyou Wang
- Medical Oncology Department, Pediatric Oncology Center, Beijing Children’s Hospital, National Center for Children’s Health, Beijing Key Laboratory of Pediatric Hematology Oncology, Key Laboratory of Major Diseases in Children, Ministry of Education, National Key Discipline of Pediatrics, Capital Medical University, Beijing, 100045 People’s Republic of China ,grid.411609.b0000 0004 1758 4735Hematology Center, Beijing Children’s Hospital, Capital Medical University, Nanlishi Road No. 56, Xicheng District, Beijing, 100045 People’s Republic of China
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7
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Frederiks AJ, Spagnolo DV, Ramachandran S, Brand R. Subcutaneous panniculitis-like T-cell lymphoma in a 14-year-old female homozygous for HAVCR2 mutation. Australas J Dermatol 2021; 62:e576-e579. [PMID: 34398459 DOI: 10.1111/ajd.13684] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Revised: 06/28/2021] [Accepted: 07/24/2021] [Indexed: 11/28/2022]
Abstract
Subcutaneous panniculitis-like T-cell lymphoma (SPTCL) is a rare cytotoxic T-cell lymphoma preferentially involving subcutis. A link between patients with SPTCL and HAVCR2 mutations has recently been discovered. We present a 14-year-old girl of Chinese heritage who was diagnosed with SPTCL in the context of homozygous HAVCR2 status for c.245A>G p. (Tyr82Cys) and achieved complete remission after treatment with cyclosporin and steroids. Dermatologists should be aware of the diagnostic, management and familial genetic counselling utility of HAVCR2 for investigating and managing patients with SPTCL.
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Affiliation(s)
- Aaron J Frederiks
- Department of Dermatology, Perth Children's Hospital, Nedlands, Australia
| | - Dominic V Spagnolo
- PathWest Laboratory Medicine, Nedlands, Australia.,Division of Pathology and Laboratory Medicine, School of Medicine, University of Western Australia, Nedlands, Australia
| | - Shanti Ramachandran
- Department of Oncology, Haematology, Blood and Marrow Transplantation, Perth Children's Hospital, Nedlands, Australia.,School of Paediatrics and Child Health, University of Western Australia, Nedlands, Australia
| | - Roland Brand
- Department of Dermatology, Perth Children's Hospital, Nedlands, Australia
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8
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Smith GA, Levinson AL, Galvin RT, Lalor LE, McCalmont T, Wang L, Geis MC, Odegaard K, Hupp M, Maguiness S, Turcotte LM, Cordoro KM, Hermiston ML. Concurrent Subcutaneous Panniculitis-like T-Cell Lymphoma and B-Cell Acute Lymphoblastic Leukemia in 2 Pediatric Patients. J Pediatr Hematol Oncol 2021; 43:e791-e794. [PMID: 32852399 PMCID: PMC9433225 DOI: 10.1097/mph.0000000000001921] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Accepted: 07/16/2020] [Indexed: 11/25/2022]
Abstract
Subcutaneous panniculitis-like T-cell lymphoma is a cutaneous lymphoma characterized by CD8+ T-cell infiltrate in the subcutis that is rare in children. Acute lymphoblastic lymphoma is the most common pediatric malignancy and often presents with fevers and pancytopenia. Herein, we report 2 pediatric patients presenting with subcutaneous panniculitis-like T-cell lymphoma and B-cell acute lymphoblastic lymphoma, distinct hematologic malignancies arising from different lymphoid lineages, with no identifiable germline cancer predisposition.
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Affiliation(s)
- Geoffrey A Smith
- Division of Hematology/Oncology, University of California San Francisco Benioff Children's Hospital
| | - Anya L Levinson
- Division of Hematology/Oncology, University of California San Francisco Benioff Children's Hospital
| | | | | | | | - Linlin Wang
- Laboratory Medicine, University of California San Francisco, San Francisco, CA
| | - Michael C Geis
- Department of Pathology, Sanford Health Pathology Clinic, Sioux Falls, SD
| | - Karah Odegaard
- Department of Pathology, Sanford Health Pathology Clinic, Sioux Falls, SD
| | | | | | - Lucie M Turcotte
- Division of Hematology/Oncology, University of Minnesota, Minneapolis, MN
| | | | - Michelle L Hermiston
- Division of Hematology/Oncology, University of California San Francisco Benioff Children's Hospital
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9
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Li Z, Wang H, Dong R, Man J, Sun L, Qian X, Zhu X, Cao P, Yu Y, Le J, Fu Y, Wang P, Jiang W, Shen C, Ma Y, Chen L, Xu Y, Shi J, Zhang H, Qian M, Zhai X. Single-Cell RNA-seq Reveals Characteristics of Malignant Cells and Immune Microenvironment in Subcutaneous Panniculitis-Like T-Cell Lymphoma. Front Oncol 2021; 11:611580. [PMID: 33816243 PMCID: PMC8013729 DOI: 10.3389/fonc.2021.611580] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Accepted: 03/01/2021] [Indexed: 11/13/2022] Open
Abstract
Background Subcutaneous panniculitis-like T-cell lymphoma (SPTCL) is a malignant primary T-cell lymphoma that is challenging to distinguish from autoimmune disorders and reactive panniculitides. Delay in diagnosis and a high misdiagnosis rate affect the prognosis and survival of patients. The difficulty of diagnosis is mainly due to an incomplete understanding of disease pathogenesis. Methods We performed single-cell RNA sequencing of matched subcutaneous lesion tissue, peripheral blood, and bone marrow from a patient with SPTCL, as well as peripheral blood, bone marrow, lymph node, and lung tissue samples from healthy donors as normal controls. We conducted cell clustering, gene expression program identification, gene differential expression analysis, and cell-cell interaction analysis to investigate the ecosystem of SPTCL. Results Based on gene expression profiles in a single-cell resolution, we identified and characterized the malignant cells and immune subsets from a patient with SPTCL. Our analysis showed that SPTCL malignant cells expressed a distinct gene signature, including chemokines families, cytotoxic proteins, T cell immune checkpoint molecules, and the immunoglobulin family. By comparing with normal T cells, we identified potential novel markers for SPTCL (e.g., CYTOR, CXCL13, VCAM1, and TIMD4) specifically differentially expressed in the malignant cells. We also found that macrophages and fibroblasts dominated the cell-cell communication landscape with the SPTCL malignant cells. Conclusions This work offers insight into the heterogeneity of subcutaneous panniculitis-like T-cell lymphoma, providing a better understanding of the transcription characteristics and immune microenvironment of this rare tumor.
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Affiliation(s)
- Zifeng Li
- Department of Hematology and Oncology, Children's Hospital of Fudan University, National Children's Medical Center, Shanghai, China
| | - Hongsheng Wang
- Department of Hematology and Oncology, Children's Hospital of Fudan University, National Children's Medical Center, Shanghai, China
| | - Rui Dong
- Department of Pediatric Surgery, Children's Hospital of Fudan University, National Children's Medical Center, Shanghai, China
| | - Jie Man
- Department of Hematology and Oncology, Children's Hospital of Fudan University, National Children's Medical Center, Shanghai, China
| | - Li Sun
- Department of Rheumatism and Immunology, Children's Hospital of Fudan University, National Children's Medical Center, Shanghai, China
| | - Xiaowen Qian
- Department of Hematology and Oncology, Children's Hospital of Fudan University, National Children's Medical Center, Shanghai, China
| | - Xiaohua Zhu
- Department of Hematology and Oncology, Children's Hospital of Fudan University, National Children's Medical Center, Shanghai, China
| | - Ping Cao
- Department of Hematology and Oncology, Children's Hospital of Fudan University, National Children's Medical Center, Shanghai, China
| | - Yi Yu
- Department of Hematology and Oncology, Children's Hospital of Fudan University, National Children's Medical Center, Shanghai, China
| | - Jun Le
- Department of Hematology and Oncology, Children's Hospital of Fudan University, National Children's Medical Center, Shanghai, China
| | - Yang Fu
- Department of Hematology and Oncology, Children's Hospital of Fudan University, National Children's Medical Center, Shanghai, China
| | - Ping Wang
- Department of Hematology and Oncology, Children's Hospital of Fudan University, National Children's Medical Center, Shanghai, China
| | - Wenjin Jiang
- Department of Hematology and Oncology, Children's Hospital of Fudan University, National Children's Medical Center, Shanghai, China
| | - Chen Shen
- Department of Hematology and Oncology, Children's Hospital of Fudan University, National Children's Medical Center, Shanghai, China
| | - Yangyang Ma
- Department of Pathology, Children's Hospital of Fudan University, National Children's Medical Center, Shanghai, China
| | - Lian Chen
- Department of Pathology, Children's Hospital of Fudan University, National Children's Medical Center, Shanghai, China
| | - Yaochen Xu
- Shanghai Institute of Biochemistry and Cell Biology, Center for Excellence in Molecular Cell Science, Chinese Academy of Sciences, Shanghai, China
| | - Jiantao Shi
- Shanghai Institute of Biochemistry and Cell Biology, Center for Excellence in Molecular Cell Science, Chinese Academy of Sciences, Shanghai, China
| | - Hui Zhang
- Department of Hematology/Oncology, Guangzhou Women and Children's Medical Center, Guangzhou, China
| | - Maoxiang Qian
- Institute of Pediatrics, Children's Hospital of Fudan University, National Children's Medical Center, and the Shanghai Key Laboratory of Medical Epigenetics, Institutes of Biomedical Sciences, Fudan University, Shanghai, China
| | - Xiaowen Zhai
- Department of Hematology and Oncology, Children's Hospital of Fudan University, National Children's Medical Center, Shanghai, China
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10
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Kim S, Kim A, Hah JO. Subcutaneous Panniculitis-Like T-Cell Lymphoma with Hemophagocytic Syndrome in a Child: A Successful Treatment with the BFM-NHL-90 Protocol. CLINICAL PEDIATRIC HEMATOLOGY-ONCOLOGY 2020. [DOI: 10.15264/cpho.2020.27.2.129] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Affiliation(s)
- Sunjoo Kim
- Departments of Pediatrics, Daegu Fatima Hospital, Daegu, Korea
| | - Aeri Kim
- Departments of Pathology, Daegu Fatima Hospital, Daegu, Korea
| | - Jeong Ok Hah
- Departments of Pediatrics, Daegu Fatima Hospital, Daegu, Korea
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11
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Subcutaneous panniculitis-like T-Cell lymphoma in a child presenting as an abdominal wall mass. JOURNAL OF PEDIATRIC SURGERY CASE REPORTS 2020. [DOI: 10.1016/j.epsc.2020.101556] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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12
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Wegehaupt O, Groß M, Wehr C, Marks R, Schmitt-Graeff A, Uhl M, Lorenz M, Schwarz K, Kratz C, Niemeyer C, Ehl S. TIM-3 deficiency presenting with two clonally unrelated episodes of mesenteric and subcutaneous panniculitis-like T-cell lymphoma and hemophagocytic lymphohistiocytosis. Pediatr Blood Cancer 2020; 67:e28302. [PMID: 32285995 DOI: 10.1002/pbc.28302] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2020] [Revised: 03/16/2020] [Accepted: 03/17/2020] [Indexed: 01/21/2023]
Abstract
This report offers novel clinical and diagnostic aspects of the association between germline mutations in HAVCR2 and subcutaneous panniculitis-like T-cell lymphoma (SPTCL). The patient presented with panniculitis-like T-cell lymphoma involving mesenteric fatty tissue associated with hemophagocytic lymphohistiocytosis (HLH). Five years later, he developed a clonally unrelated SPTCL and underwent hematopoietic stem cell transplantation. Retrospectively, he was found to carry germline mutations in HAVCR2 associated with reduced T-cell immunoglobulin mucin-3 (TIM-3) expression. We show that mesenteric fatty tissue localization of SPTCL can be the presenting manifestation of TIM-3 deficiency, that this condition predisposes to recurrent lymphoma, and that flow cytometry is a possible screening tool.
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Affiliation(s)
- Oliver Wegehaupt
- Center for Pediatrics and Adolescent Medicine, Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany.,Institute for Immunodeficiency, Center for Chronic Immunodeficiency (CCI), Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Miriam Groß
- Institute for Immunodeficiency, Center for Chronic Immunodeficiency (CCI), Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany.,Faculty of Biology, University of Freiburg, Freiburg, Germany
| | - Claudia Wehr
- Center for Chronic Immunodeficiency (CCI), Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany.,Department of Medicine I, Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Reinhard Marks
- Department of Medicine I, Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Annette Schmitt-Graeff
- Center for Chronic Immunodeficiency (CCI), Medical Center, University of Freiburg, Freiburg, Germany
| | - Markus Uhl
- Department of Diagnostic and Therapeutic Radiology, St. Josef's Hospital, Freiburg, Germany
| | - Myriam Lorenz
- Institute for Transfusion Medicine, University of Ulm, Ulm, Germany
| | - Klaus Schwarz
- Institute for Transfusion Medicine, University of Ulm, Ulm, Germany.,Institute for Transfusion Medicine and Immunogenetics Ulm, German Red Cross Blood Service Baden-Wuerttemberg-Hessen, Ulm, Germany
| | - Christian Kratz
- Department of Pediatric Hematology and Oncology, Hannover Medical School, Hannover, Germany
| | - Charlotte Niemeyer
- Center for Pediatrics and Adolescent Medicine, Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Stephan Ehl
- Institute for Immunodeficiency, Center for Chronic Immunodeficiency (CCI), Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany
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13
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Lévy R, Fusaro M, Guerin F, Chetouani A, Moshous D, Fischer A, de Saint Basile G, Sepulveda FE, Neven B. Efficacy of ruxolitinib in subcutaneous panniculitis-like T-cell lymphoma and hemophagocytic lymphohistiocytosis. Blood Adv 2020; 4:1383-1387. [PMID: 32271897 PMCID: PMC7160282 DOI: 10.1182/bloodadvances.2020001497] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2020] [Accepted: 02/26/2020] [Indexed: 12/17/2022] Open
Abstract
First evidence of ruxolitinib efficacy for subcutaneous panniculitis-like T-cell lymphoma with hemophagocytic lymphohistiocytosis. Supporting rationale for ruxolitinib use, not more aggressive treatment, in this context, questioning this condition’s neoplastic nature.
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Affiliation(s)
- Romain Lévy
- Imagine Institute, Université de Paris, INSERM U1163, Paris, France
- Unité d'Immuno-Hematologie et Rhumatologie, Département de Pédiatrie, and
| | - Mathieu Fusaro
- Imagine Institute, Université de Paris, INSERM U1163, Paris, France
- Centre d'Etude des Deficits Immunitaires, Hôpital Necker-Enfants Malades, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Frédéric Guerin
- Imagine Institute, Université de Paris, INSERM U1163, Paris, France
| | - Ahmed Chetouani
- Médecine Nucléaire, Groupe Hospitalier Nord-Essone, Orsay, France
| | - Despina Moshous
- Imagine Institute, Université de Paris, INSERM U1163, Paris, France
- Unité d'Immuno-Hematologie et Rhumatologie, Département de Pédiatrie, and
| | - Alain Fischer
- Imagine Institute, Université de Paris, INSERM U1163, Paris, France
- Unité d'Immuno-Hematologie et Rhumatologie, Département de Pédiatrie, and
- Collège de France, Paris, France; and
| | - Geneviève de Saint Basile
- Imagine Institute, Université de Paris, INSERM U1163, Paris, France
- Centre d'Etude des Deficits Immunitaires, Hôpital Necker-Enfants Malades, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Fernando E Sepulveda
- Imagine Institute, Université de Paris, INSERM U1163, Paris, France
- Centre National de la Recherche Scientifique, Paris, France
| | - Bénédicte Neven
- Imagine Institute, Université de Paris, INSERM U1163, Paris, France
- Unité d'Immuno-Hematologie et Rhumatologie, Département de Pédiatrie, and
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14
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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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15
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Frequent germline mutations of HAVCR2 in sporadic subcutaneous panniculitis-like T-cell lymphoma. Blood Adv 2020; 3:588-595. [PMID: 30792187 DOI: 10.1182/bloodadvances.2018028340] [Citation(s) in RCA: 63] [Impact Index Per Article: 15.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2018] [Accepted: 01/23/2019] [Indexed: 01/01/2023] Open
Abstract
Subcutaneous panniculitis-like T-cell lymphoma (SPTCL) is a rare subtype of peripheral T-cell lymphoma affecting younger patients and associated with hemophagocytic lymphohistiocytosis. To clarify the molecular pathogenesis of SPTCL, we analyzed paired tumor and germline DNAs from 13 patients by whole-exome sequencing. All cases were Asians and were phenotypically sporadic with no family history of SPTCL. Consistent with a recent report, germline mutations in HAVCR2, encoding T-cell immunoglobulin mucin 3 (TIM3), were identified in 11 of 13 (85%) cases. All mutated cases were primary SPTCL, whereas the 2 cases without mutation were secondary SPTCL associated with underlying diseases, including viral infection and autoimmune disease. Ten patients harbored homozygous p.Y82C mutations, and 1 showed compound heterozygous mutations (p.Y82C and p.T101I). Both missense mutations altered highly conserved residues located in the extracellular immunoglobulin variable-like domain. According to the Genome Aggregation Database of >138 500 general individuals, both mutations were documented with minor allele frequencies < 0.007, indicating remarkable enrichment of these HAVCR2 alleles in SPTCL. SPTCL cells also harbored somatic mutations (6.2 per patient) that are frequently identified in genes associated with epigenetic regulation and signal transduction. In conclusion, individuals harboring biallelic HAVCR2 (TIM3) germline mutations were highly susceptible to sporadic SPTCL, which was also associated with clonal somatic mutations.
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16
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Pediatric Subcutaneous Panniculitis-like T-Cell Lymphoma With Hemophagocytosis Showing Complete Resolution With the BFM90 Protocol: Case Report and Review of Literature. J Pediatr Hematol Oncol 2019; 41:478-481. [PMID: 30730380 DOI: 10.1097/mph.0000000000001434] [Citation(s) in RCA: 4] [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
Subcutaneous panniculitis-like T-cell lymphoma (SPTCL) is a distinct subtype of peripheral T-cell lymphoma associated with aggressive clinical behavior. Since its original description, it has continued to be a rare disease, and <200 cases have been reported in literature. We report an 11-year-old boy who presented with SPTCL and hemophagocytic lymphohistiocytosis (HLH) and responded to high-dose multiagent chemotherapy. He presented with steroid refractory erythematous, raised plaques over his face, trunk, and limbs over a period of 15 months treated elsewhere. Repeat evaluation in our center was consistent with SPTCL with features of HLH. He was initiated on therapy with the BFM90 protocol, which led to complete morphologic and biochemical remission. No single-best treatment regimen has been described for SPTCL with HLH in literature, and high-dose chemotherapy has shown good long-term remissions in the literature. The presence of SPTCL with HLH and systemic symptoms should prompt treatment with high-dose multiagent chemotherapy rather than Cyclophosphamide, Vincristine, Adriamycin, Prednisolone-like therapy. BFM90 is one such regimen that is well tolerated, and it can induce significant clinical and biochemical responses.
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17
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Xavier AC, Suzuki R. Treatment and prognosis of mature (non-anaplastic) T- and NK-cell lymphomas in childhood, adolescents, and young adults. Br J Haematol 2019; 185:1086-1098. [PMID: 30706440 DOI: 10.1111/bjh.15772] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Paediatric non-Hodgkin lymphomas (pNHL) are a diverse group of malignancies characterised by nodal and/or extranodal involvement. Less common pNHL forms include those derived from mature T- and natural killer (NK) cells. Much of our current understanding of paediatric mature (non-anaplastic) T/NK-cell lymphomas with respect to pathogenesis, diagnosis and treatment is extrapolated from adult literature. At the Sixth International Symposium on Childhood, Adolescent and Young Adult Non-Hodgkin Lymphoma, convened September 26-29, 2018 in Rotterdam, The Netherlands, some important aspects on diagnosis and outcomes of mature (non-anaplastic) T/NK-cell lymphoma in children and adolescents were discussed and will be reviewed in here.
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Affiliation(s)
- Ana C Xavier
- Division of Hematology/Oncology, Department of Pediatrics, Children's of Alabama/University of Alabama at Birmingham, Birmingham, AL, USA
| | - Ritsuro Suzuki
- Department of Haematology/Oncology, Shimane University Hospital, Izumo, Japan
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18
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Flower A, Xavier AC, Cairo MS. Mature (non‐anaplastic, non‐cutaneous) T‐/
NK
‐cell lymphomas in children, adolescents and young adults: state of the science. Br J Haematol 2019; 185:418-435. [DOI: 10.1111/bjh.15767] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Affiliation(s)
- Allyson Flower
- Department of Pediatrics New York Medical College Valhalla NY USA
- Department of Microbiology & Immunology New York Medical College Valhalla NY USA
| | - Ana C. Xavier
- Division of Hematology/Oncology Department of Pediatrics Children's of Alabama/University of Alabama at Birmingham Birmingham AL USA
| | - Mitchell S. Cairo
- Department of Pediatrics New York Medical College Valhalla NY USA
- Department of Microbiology & Immunology New York Medical College Valhalla NY USA
- Department of Medicine New York Medical College Valhalla NY USA
- Department of Pathology New York Medical CollegeValhalla NY USA
- Department of Cell Biology & Anatomy New York Medical College Valhalla NY USA
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19
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Hematopoietic stem cell transplantation for subcutaneous panniculitis-like T-cell lymphoma: single center experience in an Asian population. Int J Hematol 2018; 109:187-196. [PMID: 30547418 DOI: 10.1007/s12185-018-02568-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2018] [Revised: 11/27/2018] [Accepted: 11/29/2018] [Indexed: 10/27/2022]
Abstract
Subcutaneous panniculitis-like T-cell lymphoma (SPTL) is a rare form of cytotoxic T-cell lymphoma. It is believed that SPTL in patients without hemophagocytic syndrome (HPS) follows an indolent course; in contrast, SPTL in patients with HPS has been associated with unfavorable survival. To provide more clinical data on SPTL in Asian populations and to identify optimal therapeutic strategies for SPTL, we assessed the clinicopathological features and long-term follow-up data of 10 Taiwanese SPTL patients diagnosed at a single center. Our study demonstrates a group of patients with high incidence of HPS (50%), rather aggressive courses, and early progression. A total of eight patients underwent hematopoietic stem cell transplant (HSCT), including one autologous HSCT and seven allogeneic HSCT. Seven of eight patients receiving HSCT achieved durable remission and maintained in remission for over 30 months (range 30-132 months). There was no difference in 3-year survival of patients with HPS (80%) compared with patients without HPS (80%). Of long-term survivors in the HPS group, three of four received HSCT (autologous HSCT, n = 1; allogeneic HSCT, n = 2). Our study indicated that HSCT is a curative option for eligible SPTL patients with HPS.
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20
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Gayden T, Sepulveda FE, Khuong-Quang DA, Pratt J, Valera ET, Garrigue A, Kelso S, Sicheri F, Mikael LG, Hamel N, Bajic A, Dali R, Deshmukh S, Dervovic D, Schramek D, Guerin F, Taipale M, Nikbakht H, Majewski J, Moshous D, Charlebois J, Abish S, Bole-Feysot C, Nitschke P, Bader-Meunier B, Mitchell D, Thieblemont C, Battistella M, Gravel S, Nguyen VH, Conyers R, Diana JS, McCormack C, Prince HM, Besnard M, Blanche S, Ekert PG, Fraitag S, Foulkes WD, Fischer A, Neven B, Michonneau D, de Saint Basile G, Jabado N. Germline HAVCR2 mutations altering TIM-3 characterize subcutaneous panniculitis-like T cell lymphomas with hemophagocytic lymphohistiocytic syndrome. Nat Genet 2018; 50:1650-1657. [DOI: 10.1038/s41588-018-0251-4] [Citation(s) in RCA: 84] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2018] [Accepted: 09/05/2018] [Indexed: 12/14/2022]
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21
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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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22
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Gizewska-Kacprzak K, Karpinska-Kaczmarczyk K, Ociepa T. Subcutaneous Panniculitis-Like T-Cell Lymphoma Presenting as a Local Inflammation of a Thigh in an 8-Month-Old Child. European J Pediatr Surg Rep 2017; 5:e68-e70. [PMID: 29085769 PMCID: PMC5660631 DOI: 10.1055/s-0037-1607036] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2017] [Accepted: 07/25/2017] [Indexed: 11/13/2022] Open
Abstract
During infancy, skin inflammation is usually treated in basic pediatric care. In this study, we present a case of an 8-month-old girl with a 2-month history of an inflammation of the thigh treated locally by ointments and oral antibiotics in basic and dermatological care. The patient had a history of fever, sweating, and failure to thrive. The lactate dehydrogenase was elevated up to 869 U/L with low C-reactive protein (1.04 mg/L). Magnetic resonance imaging of the thigh reassured the diagnosis of local inflammation. Intravenous antibiotic caused mild local improvement, but the episodes of high fever sustained. The patient was transferred to our pediatric surgery department for treatment and surgical biopsy of the lesion. Histopathological examination confirmed a subcutaneous panniculitis-like T-cell lymphoma, which is a rare cytotoxic T-cell lymphoma representing less than 1% of non-Hodgkin lymphomas, uncommon in children. The patient was introduced to a chemotherapy protocol EURO-LB 2002 with good response. In a skin lesion that is associated with systemic symptoms and responding untypically to antibiotic treatment malignancy should be considered and biopsy not be postponed.
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Affiliation(s)
- Kaja Gizewska-Kacprzak
- Department of Pediatric and Oncological Surgery, Pomorski Uniwersytet Medyczny w Szczecinie, Szczecin, Poland
| | | | - Tomasz Ociepa
- Department of Pediatrics, Hematology and Oncology, Pomorski Uniwersytet Medyczny w Szczecinie, Szczecin, Poland
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23
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Useful Parameters for Distinguishing Subcutaneous Panniculitis-like T-Cell Lymphoma From Lupus Erythematosus Panniculitis. Am J Surg Pathol 2017; 40:745-54. [PMID: 26796503 DOI: 10.1097/pas.0000000000000596] [Citation(s) in RCA: 50] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Some cases of subcutaneous panniculitis-like T-cell lymphoma (SPTCL) and lupus erythematosus panniculitis (LEP) demonstrate clinical and histopathologic overlap, raising the possibility that they represent opposite ends of a disease spectrum. SPTCL, however, is typically associated with greater morbidity and risk for hemophagocytic lymphohistiocytosis (HLH); therefore, diagnostic distinction is clinically important. We present the histopathologic, immunophenotypic, and molecular findings with long-term clinical follow-up of 13 patients with SPTCL (median, 64 mo follow-up) and 7 with LEP (median, 50 mo follow-up) in our multidisciplinary cutaneous oncology clinic. Six SPTCL patients developed HLH, including 2 under the age of 21 years. In the SPTCL group, 2 of 13 patients died of disease. In contrast, we had no mortality or development of HLH in our LEP cohort. We demonstrate that a limited panel (Ki-67, CD3, CD4, and CD8 immunostains) reveals foci of "Ki-67 hotspots" enriched in cytotoxic atypical CD8+ T cells in SPTCL. Ki-67 hotspots were not identified in LEP, thus aiding the distinction of SPTCL from LEP. Lymphocyte atypia combined with adipocyte rimming of CD8+ T cells within Ki-67 hotspots was also highly specific for the diagnosis of SPTCL. Hyaline lipomembranous change, B-cell aggregates, plasmacytoid dendritic cell clusters, and plasma cell aggregates favored the diagnosis of LEP but were identified in some cases of SPTCL including patients with HLH. We confirm that SPTCL and LEP can show significant histologic overlap, suggest a role for high-throughput sequencing in confirming neoplastic clones, and introduce the concept of SPTCL "Ki-67 hotspots" in evolving disease.
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24
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Abstract
Primary cutaneous cytotoxic lymphomas are T-cell or natural killer-cell lymphomas that express 1 or more cytotoxic markers. These neoplasms constitute a spectrum of diseases. In this review, an overview of clinical, morphologic, and phenotypical features of each subtype is provided. Differential diagnosis is discussed with attention to scenarios in which diagnostic difficulties are most frequently encountered.
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Affiliation(s)
- Adriana García-Herrera
- Department of Pathology, Hospital Clínic de Barcelona, Villarroel, 170, Escalera 3, Planta 5, Barcelona 08036, Spain
| | - Eduardo Calonje
- Dermatopathology Laboratory, St John's Institute of Dermatology, St Thomas' Hospital, South Wing, Staircase C, Westminster Bridge Road, London SE1 7EH, UK.
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25
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26
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Ceppi F, Pope E, Ngan B, Abla O. Primary Cutaneous Lymphomas in Children and Adolescents. Pediatr Blood Cancer 2016; 63:1886-94. [PMID: 27229270 DOI: 10.1002/pbc.26076] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2016] [Revised: 04/28/2016] [Accepted: 04/28/2016] [Indexed: 12/22/2022]
Abstract
Primary cutaneous lymphomas are rare in children and mostly represented by mycosis fungoides and CD30(+) lymphoproliferative disorders. Most pediatric cutaneous lymphomas have similar clinical/pathological features as their adult counterparts, particularly the T-cell subtypes. With regard to outcome, adult cutaneous mature T-cell lymphomas have a tendency to progression, while this appears to be relatively infrequent in children. The outcome of cutaneous B-cell lymphomas depends on subtype, with the B-lymphoblastic entity being associated with similar outcomes to precursor B acute lymphoblastic leukemia, while there are insufficient data on other entities. The diagnosis and treatment of these patients require a close collaboration between experienced pediatric pathologists, dermatologists, and oncologists. Prospective collection of longitudinal clinical and biological data from children with these rare lymphomas is needed to better understand their biological and clinical behavior and to ultimately discover the best therapeutic strategies.
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Affiliation(s)
- Francesco Ceppi
- Division of Hematology/Oncology, Department of Pediatrics, Hospital for Sick Children, Ontario, Toronto, Canada
| | - Elena Pope
- Division of Dermatology, Department of Pediatrics, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Bo Ngan
- Division of Pathology, Department of Pediatric Laboratory Medicine, Hospital for Sick Children, Toronto, Ontario
| | - Oussama Abla
- Division of Hematology/Oncology, Department of Pediatrics, Hospital for Sick Children, Ontario, Toronto, Canada.
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27
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Shiau CJ, Abi Daoud MS, Wong SM, Crawford RI. Lymphocytic panniculitis: an algorithmic approach to lymphocytes in subcutaneous tissue. J Clin Pathol 2016; 68:954-62. [PMID: 26602413 DOI: 10.1136/jclinpath-2014-202849] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
The diagnosis of panniculitis is a relatively rare occurrence for many practising pathologists. The smaller subset of lymphocyte-predominant panniculitis is further complicated by the diagnostic consideration of T cell lymphoma involving the subcutaneous tissue, mimicking inflammatory causes of panniculitis. Accurate classification of the panniculitis is crucial to direct clinical management as treatment options may vary from non-medical therapy to immunosuppressive agents to aggressive chemotherapy. Many diseases show significant overlap in clinical and histological features, making the process of determining a specific diagnosis very challenging. However, with an adequate biopsy including skin and deep subcutaneous tissue, a collaborative effort between clinician and pathologist can often lead to a specific diagnosis. This review provides an algorithmic approach to the diagnosis of lymphocyte-predominant panniculitis, including entities of septal-predominant pattern panniculitis (erythema nodosum, deep necrobiosis lipoidica, morphea profunda and sclerosing panniculitis) and lobular-predominant pattern panniculitis (lupus erythematous panniculitis/lupus profundus, subcutaneous panniculitis-like T cell lymphoma, cutaneous γ-δ T cell lymphoma, Borrelia infection and cold panniculitis).
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Affiliation(s)
- Carolyn J Shiau
- Department of Pathology, Royal Columbian Hospital, New Westminster, British Columbia, Canada Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Marie S Abi Daoud
- Department of Pathology and Laboratory Medicine, University of Calgary and Calgary Laboratory Services, Calgary, Alberta, Canada
| | - Se Mang Wong
- Department of Dermatology and Skin Science, University of British Columbia, Vancouver, British Columbia, Canada
| | - Richard I Crawford
- Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, British Columbia, Canada Department of Dermatology and Skin Science, University of British Columbia, Vancouver, British Columbia, Canada Department of Pathology, Vancouver General Hospital, Vancouver, British Columbia, Canada
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28
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O'Suoji C, Welch JJG, Perkins SL, Smith LM, Weitzman S, Simko SJ, Galardy PJ, Bollard CM, Gross TG, Termuhlen AM. Rare Pediatric Non-Hodgkin Lymphomas: A Report From Children's Oncology Group Study ANHL 04B1. Pediatr Blood Cancer 2016; 63:794-800. [PMID: 26728447 DOI: 10.1002/pbc.25881] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2015] [Accepted: 12/02/2015] [Indexed: 12/21/2022]
Abstract
BACKGROUND Non-Hodgkin lymphoma (NHL) is a relatively common malignancy in pediatric patients; however, a small subgroup have unusual lymphoma subtypes for the pediatric population. PROCEDURE The Children's Oncology Group Rare and Cutaneous NHL registry's (protocol ANHL 04B1) main objectives were to determine the pathologic, biologic, and clinical features of rare and cutaneous pediatric NHL and establish a bank of centrally reviewed tissue specimens. We report the clinical data, treatment data, and outcome for rare pediatric NHL. RESULTS In 101 lymphomas, there is a 97.8% concordance between the reviewing study pathologists and an 87.6% concordance between the central and institutional pathology review. Samples in the specimen bank include primary tumor tissue that is snap frozen, in paraffin blocks, or H&E-stained and unstained paraffin slides as well as blood, serum, and bone marrow. This descriptive analysis shows that children with pediatric follicular lymphoma, mucosa-associated lymphoid tissue, nodal marginal zone lymphoma, primary cutaneous, primary central nervous system lymphoma, and subcutaneous panniculitis-like T-cell lymphomas have 100% survival at a median of 2 years from enrollment. There are early deaths, mostly from progressive disease, in subjects with peripheral T-cell (not otherwise specified), NKT, and hepatosplenic T-cell lymphomas. CONCLUSIONS This registry provides high-quality biologic specimens with clinical data to investigators working on the biology of these unusual pediatric diseases.
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Affiliation(s)
- Chibuzo O'Suoji
- Division of Pediatric Hematology/Oncology, West Virginia University, Charleston, West Virginia
| | - Jennifer J G Welch
- Division of Pediatric Hematology/Oncology, Hasbro Children's Hospital, Alpert Medical School Brown University, Providence, Rhode Island
| | - Sherrie L Perkins
- Department of Pathology, University of Utah Health Sciences, Salt Lake City, Utah
| | - Lynette M Smith
- Department of Biostatistics, University of Nebraska Medical Center, Omaha, Nebraska
| | - Sheila Weitzman
- Division of Pediatric Hematology/Oncology, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Stephen J Simko
- Texas Children's Cancer Center, Baylor College of Medicine, Houston, Texas
| | - Paul J Galardy
- Division of Pediatric Hematology/Oncology, Mayo Clinic, Rochester, Minnesota
| | - Catherine M Bollard
- Children's National Health System, The George Washington University, Washington, District of Columbia
| | | | - Amanda M Termuhlen
- Department of Pediatrics, Keck School of Medicine, University of Southern California, Los Angeles, California
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29
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Pillai V, Tallarico M, Bishop MR, Lim MS. Mature T- and NK-cell non-Hodgkin lymphoma in children and young adolescents. Br J Haematol 2016; 173:573-81. [PMID: 26992145 DOI: 10.1111/bjh.14044] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2015] [Accepted: 01/19/2016] [Indexed: 12/16/2022]
Abstract
Mature T/Natural killer (NK)-cell neoplasms of children and the young adolescent population exhibit higher prevalence in Central and South American and Asian populations and many are associated with Epstein-Barr virus (EBV). They are represented in large part by extranodal T/NK cell lymphomas- nasal-type or extra nasal-type, chronic lymphoproliferative disorders of T/NK cells or chronic active EBV disease, systemic EBV-positive lymphoproliferative disorders of childhood, hydroa vacciniforme-like lymphoma, hepatosplenic T-cell lymphoma and primary cutaneous gamma/delta T-cell lymphoma among others. Many T/NK cell neoplasms in this age group are derived from cells of the innate immune system, in contrast to adults where they are predominantly from the adaptive immune system. The genetic basis of T/NK cell lymphomas in children and young adolescents remains largely unknown. Anthracycline-based regimens and haematopoietic stem cell transplants (allogeneic and autologous) are current treatment modalities, however it is anticipated that novel targeted therapeutic agents will be available in the near future.
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Affiliation(s)
- Vinodh Pillai
- Department of Pathology and Laboratory Medicine, Hospital of the University of Pennsylvania, University of Pennsylvania, Philadelphia, PA, USA.,Department of Pathology and Laboratory Medicine, The Children's Hospital of Philadelphia, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Michael Tallarico
- Section of Hematology-Oncology, Department of Medicine, University of Chicago, Chicago, IL, USA
| | - Michael R Bishop
- Section of Hematology-Oncology, Department of Medicine, University of Chicago, Chicago, IL, USA
| | - Megan S Lim
- Department of Pathology and Laboratory Medicine, Hospital of the University of Pennsylvania, University of Pennsylvania, Philadelphia, PA, USA.,Department of Pathology and Laboratory Medicine, The Children's Hospital of Philadelphia, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
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30
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Gupta V, Arava S, Bakhshi S, Vashisht KR, Reddy R, Gupta S. Subcutaneous Panniculitis-Like T-Cell Lymphoma with Hemophagocytic Syndrome in a Child. Pediatr Dermatol 2016; 33:e72-6. [PMID: 26764131 DOI: 10.1111/pde.12776] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Subcutaneous panniculitis-like T-cell lymphoma (SPTCL) characterized by subcutaneous infiltration of pleomorphic T-cells of the α/β phenotype rarely affects children. Development of hemophagocytic syndrome (HPS) leads to a poor prognosis with this otherwise indolent lymphoma. We report a case of SPTCL in a 5-year-old child complicated by HPS treated successfully with combination chemotherapy. We discuss the potential pitfalls in reaching an early diagnosis and challenges in its management. Previously reported cases of SPTCL with HPS in children are briefly reviewed.
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Affiliation(s)
- Vishal Gupta
- Department of Dermatology and Venereology, All India Institute of Medical Sciences, New Delhi, India
| | - Sudheer Arava
- Department of Pathology, All India Institute of Medical Sciences, New Delhi, India
| | - Sameer Bakhshi
- Department of Medical Oncology, All India Institute of Medical Sciences, New Delhi, India
| | - Kanya Rani Vashisht
- Department of Dermatology and Venereology, All India Institute of Medical Sciences, New Delhi, India
| | - Rakesh Reddy
- Department of Medical Oncology, All India Institute of Medical Sciences, New Delhi, India
| | - Somesh Gupta
- Department of Dermatology and Venereology, All India Institute of Medical Sciences, New Delhi, India
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31
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Wagner G, Rose C, Meyer V, Klemke CD, Back W, Sachse MM. [Subcutaneous panniculitis-like T-cell lymphoma : Two case reports]. DER HAUTARZT 2015; 67:397-402. [PMID: 26676418 DOI: 10.1007/s00105-015-3739-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Histopathology, immunohistochemical, and molecular genetic findings revealed the diagnosis of subcutaneous panniculitis-like T-cell-lymphoma in two patients, aged 44 and 70 years. The clinical morphology of the lymphoma manifestations showed varied significantly. One patient presented with a singular erythematous nodule in the chin region. The other patient suffered from extended plate-like resistances and atrophy of the face, upper arms and left breast. Hemophagocytic syndrome was not present in either patient. Prognosis of subcutaneous panniculitis-like T-cell lymphoma without associated hemophagocytic syndrome is reported to be favorable. Radiotherapy of the singular lesion on the chin and systemic corticosteroids of the extended plaques induced complete remission in both patients.
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Affiliation(s)
- G Wagner
- Klinik für Dermatologie, Allergologie und Phlebologie, Klinikum Bremerhaven Reinkenheide, Postbrookstr. 103, 27574, Bremerhaven, Deutschland.
| | - Ch Rose
- Dermatohistologisches Labor, Lübeck, Deutschland
| | - V Meyer
- Klinik für Dermatologie, Allergologie und Phlebologie, Klinikum Bremerhaven Reinkenheide, Postbrookstr. 103, 27574, Bremerhaven, Deutschland
| | - C-D Klemke
- Klinik für Dermatologie, Venerologie und Allergologie, Universitätsmedizin Mannheim, Medizinische Fakultät Mannheim, Ruprecht-Karls-Universität Heidelberg, Mannheim, Deutschland
- Hautklinik, Städtisches Klinikum Karlsruhe, Karlsruhe, Deutschland
| | - W Back
- Pathologisches Institut Bremerhaven, Bremerhaven, Deutschland
| | - M M Sachse
- Klinik für Dermatologie, Allergologie und Phlebologie, Klinikum Bremerhaven Reinkenheide, Postbrookstr. 103, 27574, Bremerhaven, Deutschland
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32
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Johnston EE, LeBlanc RE, Kim J, Chung J, Balagtas J, Kim YH, Link MP. Subcutaneous panniculitis-like T-cell lymphoma: Pediatric case series demonstrating heterogeneous presentation and option for watchful waiting. Pediatr Blood Cancer 2015; 62:2025-8. [PMID: 26146844 DOI: 10.1002/pbc.25626] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2015] [Accepted: 05/16/2015] [Indexed: 11/12/2022]
Abstract
Subcutaneous panniculitis-like T-cell lymphoma (SPTCL) and primary cutaneous gamma delta T-cell lymphoma (PCGD-TCL) were initially both classified as subcutaneous panniculitis-like T-cell lymphoma. In 2008, SPTCL with alpha-beta T-cell receptor subtype was separated from primary cutaneous gamma delta T-cell lymphomas (PCGD-TCL). We report four pediatric cases that demonstrate the heterogeneity of each disease and show that PCGD-TCL in children can have an indolent course, whereas SPTCL can behave aggressively. Three patients had spontaneous, durable remissions without treatment, whereas the one patient with disease progression was treated successfully. Watchful waiting may thus be appropriate for initial management of children.
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Affiliation(s)
- Emily E Johnston
- Department of Pediatrics, Stanford University School of Medicine, Stanford, California
| | - Robert E LeBlanc
- Department of Pathology, Stanford University School of Medicine, Stanford, California
| | - Jinah Kim
- Department of Pathology, Stanford University School of Medicine, Stanford, California.,Department of Dermatology, Stanford University School of Medicine, Stanford, California
| | - Jong Chung
- Department of Pediatrics, University of California Davis, Sacramento, California
| | - Jay Balagtas
- Department of Pediatrics, University of California Davis, Sacramento, California
| | - Youn H Kim
- Department of Dermatology, Stanford University School of Medicine, Stanford, California
| | - Michael P Link
- Department of Pediatrics, Stanford University School of Medicine, Stanford, California
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33
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Subcutaneous panniculitis-like T-cell lymphoma presenting with diffuse cutaneous edema in a 2-year-old child. J Pediatr Hematol Oncol 2015; 37:329-30. [PMID: 25739026 DOI: 10.1097/mph.0000000000000312] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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34
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Sandlund JT, Perkins SL. Uncommon non-Hodgkin lymphomas of childhood: pathological diagnosis, clinical features and treatment approaches. Br J Haematol 2015; 169:631-46. [PMID: 25851546 DOI: 10.1111/bjh.13359] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
We provide a review of the pathological and clinical features for uncommon B-cell and T-cell lymphomas of childhood with a specific focus on advances in treatment approaches and outcomes. There is clearly a need for prospective investigation of both the clinical and biological features of the uncommon non-Hodgkin lymphoma subtypes in childhood. These results should lead to more uniform and more effective treatment approaches.
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Affiliation(s)
- John T Sandlund
- Department of Oncology, St Jude Children's Research Hospital, Memphis, TN, USA
| | - Sherrie L Perkins
- Department of Pathology, University of Utah and ARUP Laboratories, Salt Lake City, UT, USA
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35
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Kempf W, Kazakov DV, Belousova IE, Mitteldorf C, Kerl K. Paediatric cutaneous lymphomas: a review and comparison with adult counterparts. J Eur Acad Dermatol Venereol 2015; 29:1696-709. [PMID: 25715748 DOI: 10.1111/jdv.13044] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2014] [Accepted: 01/16/2015] [Indexed: 11/30/2022]
Abstract
Primary cutaneous lymphomas (CL) in children is rare. Only a few studies focused specifically on paediatric CL and therefore little is known whether primary CL in children are similar to or different from their adult counterparts with respect to the clinicopathological presentation, behaviour and prognosis. An extensive literature search using PubMed/MEDLINE from January 1995 through July 2014 was undertaken for articles reporting cases of paediatric CL. In addition, we identified 31 children with CL in our institutions. Mycosis fungoides and lymphomatoid papulosis are the two most prevalent lymphoma forms in children. A few entities of cutaneous lymphomas such as cutaneous diffuse large B-cell lymphoma leg type, and Sézary syndrome have not been reported so far in children. Other lymphoma entities such as hydroa vacciniforme-like lymphoma are mostly seen in certain geographic areas (Asia, Central and South America). In the paediatric population, low-malignant indolent forms such as primary cutaneous marginal zone lymphoma and primary cutaneous follicle centre lymphoma are very rare, whereas the more aggressive forms of B-cell lymphomas, precursor lymphoblastic lymphomas, and blastic plasmacytoid dendritic cell neoplasm are the most common forms in children, mostly involving the skin secondarily. Most paediatric lymphomas have similar clinicopathological features and course as their adults counterparts, particularly in the group of cutaneous T-cell lymphomas. The spectrum of cutaneous B-cell lymphomas in children significantly differs from the one in adults. Diagnostic work-up and treatment of paediatric patients with lymphomas are best achieved in close collaboration with paediatric haematopathologists and oncologists.
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Affiliation(s)
- W Kempf
- Kempf und Pfaltz, Histologische Diagnostik, Zürich, Switzerland.,Department of Dermatology, University Hospital Zürich, Zürich, Switzerland
| | - D V Kazakov
- Kempf und Pfaltz, Histologische Diagnostik, Zürich, Switzerland.,Department of Pathology, Medical Faculty in Pilsen, Charles University in Prague, Prague, Czech Republic
| | - I E Belousova
- Department of Dermatology, Medical Military Academy, Saint-Petersburg, Russia
| | - C Mitteldorf
- Department of Dermatology, HELIOS-Klinikum, Hildesheim, Germany
| | - K Kerl
- Department of Dermatology, University Hospital Zürich, Zürich, Switzerland
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36
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Oschlies I, Simonitsch-Klupp I, Maldyk J, Konovalov D, Abramov D, Myakova N, Lisfeld J, Attarbaschi A, Kontny U, Woessmann W, Klapper W. Subcutaneous panniculitis-like T-cell lymphoma in children: a detailed clinicopathological description of 11 multifocal cases with a high frequency of haemophagocytic syndrome. Br J Dermatol 2015; 172:793-7. [PMID: 25456748 DOI: 10.1111/bjd.13440] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Affiliation(s)
- I Oschlies
- Department of Pathology, Hematopathology Section and Lymph Node Registry, Christian-Albrecht University Kiel and University Hospital Schleswig-Holstein, Campus Kiel, Michaelisstr. 11, 24105, Kiel, Germany.
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37
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Jiang Q, Xu Y, Li X, Peng Q, Cai H, Wang J. Progressive and painful wound as a feature of subcutaneous panniculitis-like T-cell lymphoma (SPTCL): report of a case and review of literature. INTERNATIONAL JOURNAL OF CLINICAL AND EXPERIMENTAL PATHOLOGY 2015; 8:735-742. [PMID: 25755768 PMCID: PMC4348917] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 11/18/2014] [Accepted: 12/24/2014] [Indexed: 06/04/2023]
Abstract
Subcutaneous panniculitis-like T-cell lymphoma (SPTCL) is an uncommon extranodal non-Hodgkin lymphoma, with an aggressive course with no well-defined treatment. This article describes a 56-year-old man, treated surgically 7 months earlier for a subcutaneous nodosity near the left axilla, presenting with a progressive inflamed wound, pain, and high fever (39 °C). Treatment with systemic antibiotics and topical anti-inflammatory dressings failed. After 7 months, the patient was diagnosed with SPTCL based on biopsy results and a multidisciplinary consultation. While undergoing systemic chemotherapy with corticosteroid therapy, his wound become more painful, larger, and covered with necrotic tissue. Fifty days after chemotherapy with corticosteroid therapy, his wound became seriously painful and increasingly necrotic. He developed a serious stomachache and abdominal distension, rapidly became comatose, and died. The aim of this case report is to present our experience of the different clinical signs of SPTCL to expedite its early diagnosis in future. We summarize the main clinical characteristics of SPTCL as a rapidly progressing and increasingly painful wound with necrotic tissue, involving a multisystem disorder, which is easily misdiagnosed, responds poorly to corticosteroid and chemotherapy treatments, and has a high mortality rate. The pathological characteristics are early inflammation, advancing to profuse infiltration of the subcutaneous adipose tissues by CD3(+) and/or CD8(+) T-cell lymphoma cells. Clinicians must cooperate with pathologists and oncologists to diagnose this disease as soon as possible and to avoid a misdiagnosis. The use of antibiotic and painkillers should minimize the patient's discomfort and control rapid wound development. Future studies are required to investigate the optimal wound treatment and whether the necrotic tissue should be removed.
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Affiliation(s)
- Qixia Jiang
- Department of Outpatient, Jinling HospitalNanjing 210002, China
| | - Yuanling Xu
- Nanjing University of Chinese MedicineNanjing, China
| | - Xiaohua Li
- Department of Outpatient, Jinling HospitalNanjing 210002, China
| | - Qing Peng
- Department of Outpatient, Jinling HospitalNanjing 210002, China
| | - Hui Cai
- Department of Integrated Traditional and Western Medicine, Jinling HospitalNanjing 210002, China
| | - Jiandong Wang
- Department of Pathology, Jinling HospitalNanjing 210002, China
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38
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Nagai K, Nakano N, Iwai T, Iwai A, Tauchi H, Ohshima K, Ishii E. Pediatric subcutaneous panniculitis-like T-cell lymphoma with favorable result by immunosuppressive therapy: a report of two cases. Pediatr Hematol Oncol 2014; 31:528-33. [PMID: 24684413 DOI: 10.3109/08880018.2014.896062] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Subcutaneous panniculitis-like T-cell lymphoma (SPTL) is a rare type of skin lymphoma. Histopathology mimicking a lobular panniculitis makes it difficult to distinguish SPTL from benign autoimmune disease. We present cases of a 10-year-old female and an 11-year-old male with SPTL showing recurrent panniculitis and systemic manifestations. Initially, antibiotics and steroids were administered to treat infectious disease and benign panniculitis. However, they experienced recurrent fever and erythema nodosum. Additional immunohistochemistry and T-cell receptor (TCR) gene rearrangement analyses were performed, enabling the establishment of an SPTL diagnosis. The affected patients were given immunosuppressive therapy with favorable results.
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Affiliation(s)
- Kozo Nagai
- Department of Hematology and Oncology, Shikoku Medical Center for Children and Adults , Kagawa , Japan
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39
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Pasqualini C, Jorini M, Carloni I, Giangiacomi M, Cetica V, Aricò M, de Benedictis FM. Cytophagic histiocytic panniculitis, hemophagocytic lymphohistiocytosis and undetermined autoimmune disorder: reconciling the puzzle. Ital J Pediatr 2014; 40:17. [PMID: 24524345 PMCID: PMC3974103 DOI: 10.1186/1824-7288-40-17] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2013] [Accepted: 02/05/2014] [Indexed: 11/19/2022] Open
Abstract
Cytophagic histiocytic panniculitis is a rare disease, associated with either nonmalignant conditions or subcutaneous panniculitis-like T-cell lymphoma, and often also associated with hemophagocytic lymphohistiocytosis (HLH). We report the case of a 11-year-old boy with a history of secondary HLH who, after a local trauma, developed a painful, indurated plaque over the right thigh associated with relapsing HLH. Histopathologic findings from skin biopsy specimens revealed significant lobular panniculitis with benign histiocytes showing hemophagocytosis. High-dose intravenous methylprednisolone and cyclosporine A treatment was highly effective. A genetic study after a new, relapsing episode of HLH revealed an heterozygous missense mutation on STX 11 gene inherited from the mother.
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40
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Merritt BY, Curry JL, Duvic M, Vega F, Sheehan AM, Curry CV. Pediatric subcutaneous panniculitis-like T-cell lymphoma with features of hemophagocytic syndrome. Pediatr Blood Cancer 2013; 60:1916-7. [PMID: 23868752 PMCID: PMC4094035 DOI: 10.1002/pbc.24638] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2013] [Accepted: 05/13/2013] [Indexed: 11/07/2022]
Affiliation(s)
- Brian Y. Merritt
- Department of Pathology & Immunology, Baylor College of
Medicine, Houston, Texas
| | - Jonathan L. Curry
- Department of Pathology, The University of Texas MD Anderson Cancer
Center, Houston, Texas,Department of Dermatology, The University of Texas MD Anderson
Cancer Center, Houston, Texas
| | - Madeleine Duvic
- Department of Dermatology, The University of Texas MD Anderson
Cancer Center, Houston, Texas
| | - Francisco Vega
- Department of Hematopathology, The University of Texas MD Anderson
Cancer Center, Houston, Texas
| | - Andrea M. Sheehan
- Department of Pathology & Immunology, Baylor College of
Medicine, Houston, Texas,Department of Pathology, Texas Children’s Hospital,
Houston, Texas
| | - Choladda V. Curry
- Department of Pathology & Immunology, Baylor College of
Medicine, Houston, Texas,Department of Pathology, Texas Children’s Hospital,
Houston, Texas
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41
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Abstract
T-cell and NK-cell lymphomas are uncommon lymphomas with an aggressive clinical course. The causes and precise cellular origins of most T-cell lymphomas are still not well defined. The WHO classification utilizes morphologic and immunophenotypic features in conjunction with clinical aspects and in some instances genetics to delineate a prognostically and therapeutically meaningful categorization. The anatomic localization of neoplastic T-cells and NK-cells parallels in part their proposed normal cellular counterparts and functions. T-cells of the adaptive immune system are mainly based in lymph nodes and peripheral blood, whereas lymphomas derived from T-cells and NK-cells of the innate immune system are mainly extranodal. This approach allows for better understanding of some of the manifestations of the T-cell and NK-cell lymphomas, including their cellular distribution, some aspects of morphology and even associated clinical findings.
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MESH Headings
- Adaptive Immunity
- Humans
- Immunity, Innate
- Killer Cells, Natural/pathology
- Lymph Nodes/immunology
- Lymph Nodes/pathology
- Lymphoma, Extranodal NK-T-Cell/classification
- Lymphoma, Extranodal NK-T-Cell/immunology
- Lymphoma, Extranodal NK-T-Cell/pathology
- Lymphoma, T-Cell, Peripheral/classification
- Lymphoma, T-Cell, Peripheral/immunology
- Lymphoma, T-Cell, Peripheral/pathology
- Natural Killer T-Cells/immunology
- Natural Killer T-Cells/pathology
- T-Lymphocytes, Cytotoxic/immunology
- T-Lymphocytes, Cytotoxic/pathology
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Affiliation(s)
- Ewa B. Bajor-Dattilo
- Laboratory of Pathology, National Cancer Institute, Building 10, Room 2N113, Bethesda, MD 20892, USA, Tel: +1-301-402-2457, Fax: +1-301-402-2415,
| | - Stefania Pittaluga
- Laboratory of Pathology, National Cancer Institute, Building 10, Room 2N109, Bethesda, MD 20892, USA, Tel: +1-301-402-0297, Fax: +1-301-402-2415,
| | - Elaine S. Jaffe
- Laboratory of Pathology, National Cancer, Institute, Building 10, Room 2B42, Bethesda, MD 20892, USA, Tel: +1-301-496-0183, Fax: +1-301-402-2415,
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