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Alsomali DY, Bakshi N, Kharfan-Dabaja M, El Fakih R, Aljurf M. Diagnosis and Treatment of Subcutaneous Panniculitis-like T-cell Lymphoma: A Systematic Literature Review. Hematol Oncol Stem Cell Ther 2023; 16:110-116. [PMID: 34015273 DOI: 10.1016/j.hemonc.2021.04.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Revised: 03/24/2021] [Accepted: 04/25/2021] [Indexed: 01/31/2023] Open
Abstract
OBJECTIVES The aim of this systematic review is to investigate different diagnostic methods and the available treatment options for subcutaneous panniculitis-like T-cell lymphoma (SPTCL). METHODS We searched PubMed, Web of Science, SCOPUS, EBSCO, and CINAHL Plus for published case reports of SPTCL. From each record, we extracted data of the diagnostic methods, immunohistochemical profile, clinical characteristics, and the treatment approaches provided. Data were summarized and narratively synthesized to highlight the various diagnostic methods and treatment options of SPTCL. RESULTS Our literature search yielded 1293 unique citations. Following screening, nine articles reporting a total of 15 cases were included in this systematic review. All patients presented with subcutaneous nodules. Three of the 15 cases were initially misdiagnosed. The atypical lymphoid cells were positive for CD2, CD3, granzyme B, and TIA-1 and negative for CD1a, EBER, and CD20 in all the reported cases. The atypical lymphoid cells were positive for CD45RO in four out of seven cases, positive for CD56 in three out of 12 cases tested, while positive for CD5 and CD8 in the majority of cases. Therapy ranged from topical agents to immunosuppressive agents all the way to multiagent chemotherapy. CONCLUSION SPTCL is a rare lymphoma. Diagnosis is highly dependent on the immunohistochemical stains added to histopathologic and radiologic findings. Therapy is dependent on the pace of the disease, with encouraging results obtained with single-agent cyclosporine.
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Affiliation(s)
| | - Nasir Bakshi
- King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | | | - Riad El Fakih
- King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | - Mahmoud Aljurf
- King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
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Haghayeghi K, Patel D, Rice SM, Davis MJ, Hayes CA, Kaur P, Lansigan F, Carter JB, LeBlanc RE. Primary cutaneous gamma-delta T-cell lymphoma masquerading as leukemia cutis in a patient recently diagnosed with small lymphocytic lymphoma: Clues to the diagnosis. J Cutan Pathol 2022; 49:1015-1020. [PMID: 35841268 DOI: 10.1111/cup.14293] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2022] [Revised: 06/28/2022] [Accepted: 07/10/2022] [Indexed: 11/30/2022]
Abstract
A 54-year-old man recently diagnosed with small lymphocytic lymphoma (SLL) had waxing and waning, indurated, erythematous plaques on his legs, with leukopenia and anemia disproportionate to the SLL burden in his marrow and pelvic lymph nodes. Punch biopsy of a plaque performed to evaluate for leukemia cutis revealed a lymphocytic lobular-panniculitis-like infiltrate resembling lupus panniculitis, but a preponderance of CD8+/Ki-67+ T-cells surrounding adipocytes raised concern for subcutaneous panniculitis-like T-cell lymphoma (SPTCL). Additional immunohistochemistry (IHC) studies showed that the adipotropic T-cells expressed TCR-gamma, supporting the rare, unexpected diagnosis of Primary cutaneous gamma-delta T-cell lymphoma (PCGDTCL). The patient subsequently met diagnostic criteria for hemophagocytic lymphohistiocytosis (HLH). PCGDTCL is an aggressive, HLH-associated lymphoma requiring different management than SPTCL and SLL. This case illustrates how PCGDTCL can co-exist with B-cell lymphoma and resemble panniculitis on biopsies. PCGDTCL and SPTCL should enter the differential diagnosis whenever patients present with the constellation of lobular panniculitis and unexplained cytopenias. In the present case, close clinicopathologic correlation and judicious use of IHC on a small sample allowed for a prompt diagnosis.
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MESH Headings
- Male
- Humans
- Middle Aged
- Leukemia, Lymphocytic, Chronic, B-Cell/diagnosis
- Panniculitis/diagnosis
- Panniculitis/pathology
- Lymphoma, T-Cell/diagnosis
- Lymphoma, B-Cell/diagnosis
- Skin Neoplasms/diagnosis
- Skin Neoplasms/pathology
- Diagnosis, Differential
- Lymphohistiocytosis, Hemophagocytic/diagnosis
- Leukemia/diagnosis
- Lymphoma, T-Cell, Cutaneous/diagnosis
- Lymphoma, T-Cell, Cutaneous/pathology
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Affiliation(s)
- Koorosh Haghayeghi
- Department of Pathology and Laboratory Medicine, Dartmouth Hitchcock Medical Center, Lebanon, New Hampshire, USA
| | - Dhrumil Patel
- Department of Dermatology, Dartmouth Hitchcock Medical Center, Lebanon, New Hampshire, USA
| | - Shauna M Rice
- Chan Medical School, University of Massachusetts, Worcester, Massachusetts, USA
| | - Michael J Davis
- Department of Dermatology, Dartmouth Hitchcock Medical Center, Lebanon, New Hampshire, USA
| | - Christi Ann Hayes
- Department of Medicine, Dartmouth Hitchcock Medical Center, Lebanon, New Hampshire, USA
| | - Prabhjot Kaur
- Department of Pathology and Laboratory Medicine, Dartmouth Hitchcock Medical Center, Lebanon, New Hampshire, USA
| | - Frederick Lansigan
- Department of Medicine, Dartmouth Hitchcock Medical Center, Lebanon, New Hampshire, USA
| | - Joi B Carter
- Department of Dermatology, Dartmouth Hitchcock Medical Center, Lebanon, New Hampshire, USA
| | - Robert E LeBlanc
- Department of Pathology and Laboratory Medicine, Dartmouth Hitchcock Medical Center, Lebanon, New Hampshire, USA
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Subcutaneous Disseminated Nodules in a 13-Year-Old Girl: Answer. Am J Dermatopathol 2021; 43:997-998. [PMID: 34797795 DOI: 10.1097/dad.0000000000001989] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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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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Goto H, Hirano N, Kadowaki H, Suenobu S, Ihara K. Clinical features of infantile subcutaneous panniculitis-like T-cell lymphoma. Pediatr Int 2019; 61:1261-1262. [PMID: 31808238 DOI: 10.1111/ped.14017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2019] [Revised: 08/05/2019] [Accepted: 10/01/2019] [Indexed: 11/30/2022]
Affiliation(s)
- Hironori Goto
- Department of Pediatrics, Oita University Faculty of Medicine, Yufu, Japan
| | - Naoki Hirano
- Department of Pediatrics, Oita University Faculty of Medicine, Yufu, Japan
| | - Hiroko Kadowaki
- Department of Diagnostic Pathology, Oita University Faculty of Medicine, Yufu, Japan
| | - Souichi Suenobu
- Department of Pediatrics, Oita University Faculty of Medicine, Yufu, Japan.,Division of General Pediatrics and Emergency Medicine, Department of Pediatrics, Oita University Faculty of Medicine, Yufu, Japan
| | - Kenji Ihara
- Department of Pediatrics, Oita University Faculty of Medicine, Yufu, Japan
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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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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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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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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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Asati DP, Ingle V, Joshi D, Tiwari A. Subcutaneous panniculitis-like T-cell lymphoma with macrophage activation syndrome treated by cyclosporine and prednisolone. Indian Dermatol Online J 2016; 7:529-532. [PMID: 27990393 PMCID: PMC5134172 DOI: 10.4103/2229-5178.193909] [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] [Indexed: 11/22/2022] Open
Abstract
Subcutaneous panniculitis-like T-cell lymphoma (SPTCL; α/β T-cell subtype) is a distinct variantof cutaneous T-cell lymphomas, which presents as inflammatory subcutaneous nodules. A 17-year-old male presented with recurrent fever with concomitant facial swelling, pedal edema, hepatosplenomegaly, and mildly tender subcutaneous plaques in generalized distribution along with patches of scarring alopecia on scalp. There were features of macrophage activation syndrome in the form of hemophagocytosis in the bone marrow, pancytopenia, high serum lactate dehydrogenase levels, low fibrinogen clotting activity, prolonged activated prothrombine time (aPTT), increased serum ferritin, hypoalbuminemia, and hypertriglyceridemia. Histopathology showed lobular panniculitis-like infiltration by atypical lymphocytes rimming the adipocytes. Immunohistochemistry revealed positive CD3 and CD8 markers, whereas CD4, CD56, and CD20 were negative, consistent with the diagnosis of α/β type of SPTCL. Treatment with oral prednisolone (1mg/kg/day) and cyclosporine (2mg/kg/day; 100 mg) led to rapid subsidence of fever, plaques, and abnormal hematological parameters within a few weeks.
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Affiliation(s)
- Dinesh P Asati
- Department of Dermatology, All Institute of Medical Sciences, Bhopal, Madhya Pradesh, India
| | - Vaibhav Ingle
- Department of General Medicine, All Institute of Medical Sciences, Bhopal, Madhya Pradesh, India
| | - Deepti Joshi
- Department of Pathology, All India Institute of Medical Sciences, Bhopal, Madhya Pradesh, India
| | - Anurag Tiwari
- Consultant Dermatologist, Centre for Skin Diseases and Laser Treatment, Bhopal, Madhya Pradesh, India
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