1
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Shaker N, Phelps R, Niedt G, Gupta N, Sangueza OP, Pradhan D. Primary Cutaneous CD4+ Small or Medium T-Cell Lymphoproliferative Disorder With Persistent B-Cell Clone: Clinicopathologic Challenge. Am J Dermatopathol 2024; 46:626-628. [PMID: 39150185 DOI: 10.1097/dad.0000000000002707] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/17/2024]
Affiliation(s)
- Nada Shaker
- Department of Pathology, The Ohio State University Wexner Medical Center, Columbus, OH
| | - Robert Phelps
- Departments of Dermatology and Pathology, Icahn School of Medicine at Mount Sinai, New York, NY
| | - George Niedt
- Departments of Dermatology and Pathology, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Neha Gupta
- Department of Pathology & Microbiology, University of Nebraska Medical Center, Nebraska Medical Center, Omaha, NE; and
| | - Omar P Sangueza
- Department of Pathology and Dermatology, Wake Forest University, School of Medicine, Medical Center Boulevard, Winston-Salem, NC
| | - Dinesh Pradhan
- Department of Pathology & Microbiology, University of Nebraska Medical Center, Nebraska Medical Center, Omaha, NE; and
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2
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Miller S, Vandergriff T, Woodworth Goff H, Xu J, Oliver D. Comparison of 2 T-Cell Receptor-γ Clonality Assays on Skin Biopsies Suspicious for Mycosis Fungoides. Am J Dermatopathol 2024; 46:581-587. [PMID: 38457687 DOI: 10.1097/dad.0000000000002654] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/10/2024]
Abstract
ABSTRACT PCR-based fragment analysis of the T-cell receptor (TCR) gene is used extensively in diagnostic labs to assess clonality in T-cell populations in multiple tissue sites. Of the numerous TCR assays that have been reported, studies assessing use on biopsies suspicious for mycosis fungoides specifically are lacking. We compared clonality findings from a previously run 2-tube/2-fluorochrome dye assay to a redesigned 1-tube/1-fluorochrome dye assay on formalin-fixed skin biopsies. Overall, the accuracy of the 2-tube assay was marginally better (75.7% vs. 71.4%), when using clinical history combined with histologic diagnosis as the gold standard. The 2-tube assay had better sensitivity (73.7% vs. 65.8%), while the 1-tube assay had superior specificity (93.8% vs. 87.5%). Clonality results were easier to interpret with the 1-tube assay. In nearly 19% of cases, a change of assays on the same biopsy resulted in a change of clonality interpretation. For laboratories that change TCR-γ clonality assays, follow-up biopsies for mycosis fungoides assessment may result in a change of diagnosis.
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Affiliation(s)
- Stan Miller
- Department of Pathology, UT Southwestern Medical Center, Dallas, TX; and
| | - Travis Vandergriff
- Department of Pathology, UT Southwestern Medical Center, Dallas, TX; and
- Department of Dermatology, UT Southwestern Medical Center, Dallas, TX
| | | | - Jing Xu
- Department of Pathology, UT Southwestern Medical Center, Dallas, TX; and
| | - Dwight Oliver
- Department of Pathology, UT Southwestern Medical Center, Dallas, TX; and
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3
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Korbi M, Amor F, Youssef M, Bellalah A, Chaabane NB, Belhadjali H, Zili J. Crusted plaques on the face. Int J Dermatol 2024. [PMID: 39146347 DOI: 10.1111/ijd.17444] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2024] [Revised: 07/14/2024] [Accepted: 08/04/2024] [Indexed: 08/17/2024]
Abstract
Facial neutrophilic dermatosis is a relatively recent and rare entity. Herein, we report an original case with a clinical appearance of crusty pyoderma gangrenosum and limited face involvement, classifying it as neutrophilic dermatosis (ND) of the face. The latter is an infrequent entity and forms part of the ND spectrum. The few reported cases in the literature are characterized by a restricted distribution on the face, as in our case. Nevertheless, this entity remains controversial: some consider it a variant of Sweet's syndrome; others see it as a truly independent entity. Matthews et al. reported an association between ND of the face, as in the case of our patient with a crusty appearance, and ulcerative colitis. Our observation and that of Matthews et al. underline the wide and varied potential for the clinical presentation of this entity.
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Affiliation(s)
- Mouna Korbi
- Dermatology Department, Fattouma Bourguiba University Hospital, University of Monastir, Monastir, Tunisia
| | - Fourat Amor
- Dermatology Department, Fattouma Bourguiba University Hospital, University of Monastir, Monastir, Tunisia
| | - Monia Youssef
- Dermatology Department, Fattouma Bourguiba University Hospital, University of Monastir, Monastir, Tunisia
| | - Ahlem Bellalah
- Anatomopathology Department, Fattouma Bourguiba University Hospital, University of Monastir, Monastir, Tunisia
| | - Nabil B Chaabane
- Gastro-Enterology Department, Fattouma Bourguiba University Hospital, University of Monastir, Monastir, Tunisia
| | - Hichem Belhadjali
- Dermatology Department, Fattouma Bourguiba University Hospital, University of Monastir, Monastir, Tunisia
| | - Jameleddine Zili
- Dermatology Department, Fattouma Bourguiba University Hospital, University of Monastir, Monastir, Tunisia
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4
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Hashida Y, Nakajima K, Higuchi T, Ujihara T, Nakai K, Daibata M. Cutavirus Infection in Large-Plaque Parapsoriasis, a Premalignant Condition of Mycosis Fungoides. J Infect Dis 2024; 230:109-119. [PMID: 39052700 DOI: 10.1093/infdis/jiad521] [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: 09/11/2023] [Revised: 11/12/2023] [Accepted: 11/21/2023] [Indexed: 11/25/2023] Open
Abstract
BACKGROUND Cutavirus (CuV) is associated with mycosis fungoides; however, the CuV status in parapsoriasis en plaques (PP), a premalignant inflammatory condition of mycosis fungoides, has not been fully delineated. METHODS Fifty-five Japanese patients with chronic inflammatory skin diseases, including 13 patients with PP, were studied. RESULTS CuV DNA was detected significantly more frequently in biopsies of the lesional skin from patients with PP (38%; 4 of 13) than in those from patients with other inflammatory skin diseases (2%; 1 of 42; P = .009). All CuV-positive PP cases were of the large-plaque parapsoriasis (LPP) subtype. The viral loads ranged from 83 450 to 2 164 170 copies/103 cells. We recovered near-full-length CuV sequences from the CuV-positive LPP biopsies, all of which were of the Japanese/Asian genotype. The CuV genome appeared to be present within lymphoid cells infiltrating the epidermis and dermis. CuV NS1 and VP1 gene transcripts were also detected in the affected tissues. CONCLUSIONS The detection of high levels of CuV DNA with the expression of viral mRNA suggests a potential role for CuV in the pathogenesis of LPP, making it necessary to study further the impact of CuV, especially regarding the viral genotype, on the outcomes of patients with CuV-positive LPP.
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Affiliation(s)
- Yumiko Hashida
- Department of Microbiology and Infection, Kochi Medical School, Kochi University, Nankoku, Kochi, Japan
| | - Kimiko Nakajima
- Department of Dermatology, Kochi Medical School, Kochi University, Nankoku, Kochi, Japan
| | - Tomonori Higuchi
- Department of Microbiology and Infection, Kochi Medical School, Kochi University, Nankoku, Kochi, Japan
| | - Takako Ujihara
- Department of Microbiology and Infection, Kochi Medical School, Kochi University, Nankoku, Kochi, Japan
- Science Research Center, Kochi University, Nankoku, Kochi, Japan
| | - Kozo Nakai
- Department of Dermatology, Kochi Medical School, Kochi University, Nankoku, Kochi, Japan
| | - Masanori Daibata
- Department of Microbiology and Infection, Kochi Medical School, Kochi University, Nankoku, Kochi, Japan
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5
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Isola S, Gammeri L, Furci F, Gangemi S, Pioggia G, Allegra A. Vitamin C Supplementation in the Treatment of Autoimmune and Onco-Hematological Diseases: From Prophylaxis to Adjuvant Therapy. Int J Mol Sci 2024; 25:7284. [PMID: 39000393 PMCID: PMC11241675 DOI: 10.3390/ijms25137284] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2024] [Revised: 06/29/2024] [Accepted: 07/01/2024] [Indexed: 07/16/2024] Open
Abstract
Vitamin C is a water-soluble vitamin introduced through the diet with anti-inflammatory, immunoregulatory, and antioxidant activities. Today, this vitamin is integrated into the treatment of many inflammatory pathologies. However, there is increasing evidence of possible use in treating autoimmune and neoplastic diseases. We reviewed the literature to delve deeper into the rationale for using vitamin C in treating this type of pathology. There is much evidence in the literature regarding the beneficial effects of vitamin C supplementation for treating autoimmune diseases such as Systemic Lupus Erythematosus (SLE) and Rheumatoid Arthritis (RA) and neoplasms, particularly hematological neoplastic diseases. Vitamin C integration regulates the cytokines microenvironment, modulates immune response to autoantigens and cancer cells, and regulates oxidative stress. Moreover, integration therapy has an enhanced effect on chemotherapies, ionizing radiation, and target therapy used in treating hematological neoplasm. In the future, integrative therapy will have an increasingly important role in preventing pathologies and as an adjuvant to standard treatments.
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Affiliation(s)
- Stefania Isola
- School and Operative Unit of Allergy and Clinical Immunology, Policlinico “G. Martino”, Department of Clinical and Experimental Medicine, University of Messina, 98125 Messina, Italy; (S.I.); (S.G.)
| | - Luca Gammeri
- School and Operative Unit of Allergy and Clinical Immunology, Policlinico “G. Martino”, Department of Clinical and Experimental Medicine, University of Messina, 98125 Messina, Italy; (S.I.); (S.G.)
| | - Fabiana Furci
- Provincial Healthcare Unit, Section of Allergy, 89900 Vibo Valentia, Italy;
| | - Sebastiano Gangemi
- School and Operative Unit of Allergy and Clinical Immunology, Policlinico “G. Martino”, Department of Clinical and Experimental Medicine, University of Messina, 98125 Messina, Italy; (S.I.); (S.G.)
| | - Giovanni Pioggia
- Institute for Biomedical Research and Innovation (IRIB), National Research Council of Italy (CNR), 98125 Messina, Italy;
| | - Alessandro Allegra
- Division of Hematology, Department of Human Pathology in Adulthood and Childhood “Gaetano Barresi”, University of Messina, 98100 Messina, Italy;
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6
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Qin Y, Lin Y, Chen Z, Zhang Q, Li Y, Wen Y, Tu P, Gao P, Wang Y. Effectiveness of narrowband ultraviolet B monotherapy versus combination therapy with systemic agents in patients with early-stage mycosis fungoides and the association with plaque lesions. J Evid Based Med 2024; 17:390-398. [PMID: 38898743 DOI: 10.1111/jebm.12623] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2024] [Accepted: 06/04/2024] [Indexed: 06/21/2024]
Abstract
OBJECTIVE Narrowband ultraviolet B (NB-UVB) has been recommended as first-line therapy for early-stage mycosis fungoides (MF) in international guidelines. NB-UVB can be used as monotherapy or part of a multimodality treatment regimen. There is limited evidence on the effectiveness and optimal patients of NB-UVB in combination with systemic therapies in MF. We aimed to assess the effectiveness of the combination versus NB-UVB monotherapy in early-stage MF and if plaque lesion status was related to these effects. METHODS This observational cohort study included 247 early-stage MF patients who had received NB-UVB combined with systemic therapies vs. NB-UVB monotherapy from 2009 to 2021. The primary outcome was partial or complete response. Overall response rate and median time to response were calculated. Hazard ratios (HRs) were estimated using the Cox model. RESULTS In 139 plaque-stage patients, the response rate for combination therapy group was higher than that of monotherapy group (79.0% vs. 54.3%, p = 0.006). The adjusted HR for combination therapy compared with NB-UVB monotherapy was 3.11 (95% CI 1.72-5.63). The combination therapy group also showed shorter time to response (4 vs. 6 months, p = 0.002). In 108 patch-stage patients, the response rate and time to response in two treatment groups showed no significant difference. There was therefore an observed interaction with patients' plaque lesion status for the effect size of NB-UVB combination therapy. No serious adverse events were observed. CONCLUSIONS Adding systemic treatments to NB-UVB did not improve the treatment outcome of patch-stage patients, but it surpassed NB-UVB monotherapy for early-stage patients with plaques.
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Affiliation(s)
- Yao Qin
- Department of Dermatology and Venereology, Peking University First Hospital, Beijing, China
- Beijing Key Laboratory of Molecular Diagnosis on Dermatoses, Beijing, China
- National Clinical Research Center for Skin and Immune Diseases, Beijing, China
- NMPA Key Laboratory for Quality Control and Evaluation of Cosmetics, Beijing, China
| | - Yuwei Lin
- Clinical Research Institute, Institute of Advanced Clinical Medicine, Peking University, Beijing, China
| | - Zhuojing Chen
- Department of Dermatology and Venereology, Peking University First Hospital, Beijing, China
- Beijing Key Laboratory of Molecular Diagnosis on Dermatoses, Beijing, China
- National Clinical Research Center for Skin and Immune Diseases, Beijing, China
- NMPA Key Laboratory for Quality Control and Evaluation of Cosmetics, Beijing, China
| | - Qiuli Zhang
- Department of Dermatology, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, China
| | - Yingyi Li
- Department of Dermatology, Beijing Tsinghua Changgung Hospital, Beijing, China
| | - Yujie Wen
- Department of Dermatology and Venereology, Peking University First Hospital, Beijing, China
- Beijing Key Laboratory of Molecular Diagnosis on Dermatoses, Beijing, China
- National Clinical Research Center for Skin and Immune Diseases, Beijing, China
- NMPA Key Laboratory for Quality Control and Evaluation of Cosmetics, Beijing, China
| | - Ping Tu
- Department of Dermatology and Venereology, Peking University First Hospital, Beijing, China
- Beijing Key Laboratory of Molecular Diagnosis on Dermatoses, Beijing, China
- National Clinical Research Center for Skin and Immune Diseases, Beijing, China
- NMPA Key Laboratory for Quality Control and Evaluation of Cosmetics, Beijing, China
| | - Pei Gao
- Clinical Research Institute, Institute of Advanced Clinical Medicine, Peking University, Beijing, China
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing, China
- Key Laboratory of Epidemiology of Major Diseases (Peking University), Ministry of Education, Beijing, China
| | - Yang Wang
- Department of Dermatology and Venereology, Peking University First Hospital, Beijing, China
- Beijing Key Laboratory of Molecular Diagnosis on Dermatoses, Beijing, China
- National Clinical Research Center for Skin and Immune Diseases, Beijing, China
- NMPA Key Laboratory for Quality Control and Evaluation of Cosmetics, Beijing, China
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7
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Magazzino F, Aristei C, Passarelli A, Pierini A, De Giorgi U, Martinello R, Domenici L, Pignata S, Mangili G, Cormio G. Lymphomas of the Vulva: A Review of the MITO Rare Cancer Group. Cancers (Basel) 2024; 16:2102. [PMID: 38893221 PMCID: PMC11171216 DOI: 10.3390/cancers16112102] [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: 04/23/2024] [Revised: 05/26/2024] [Accepted: 05/29/2024] [Indexed: 06/21/2024] Open
Abstract
Since they are very rare tumors, lymphomas of the vulva are often not properly recognized. Patients with vulvar lymphoma are generally elderly and the classical manifestation of the disease is a vulvar mass. No significant age differences have been found between primary and secondary lymphoma. To make a correct diagnosis, it is therefore necessary to use not only histological examination but also the genetic and molecular profile in order to establish optimal therapeutic management. Literature analysis confirm the good prognosis of this disease.
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Affiliation(s)
- Francescapaola Magazzino
- Complex Operating Unit Obstetrics and Gynaecology, Ospedale Civile di San Donà di Piave-Venezia, AULSS4 Veneto Orientale, 30027 San Donà di Piave, Italy
| | - Cynthia Aristei
- Radiation Oncology Section, Department of Medicine and Surgery, Perugia General Hospital Sant’Andrea delle Fratte, University of Perugia, 06156 Perugia, Italy;
| | - Anna Passarelli
- Department of Urology and Gynecology, Istituto Nazionale Tumori IRCCS “Fondazione G. Pascale”, 80144 Napoli, Italy; (A.P.); (S.P.)
| | - Antonio Pierini
- Division of Hematolgy and Clinical Immunolgy, Department of Medicine and Surgery, University of Perugia, 06156 Perugia, Italy;
| | - Ugo De Giorgi
- Department of Medical Oncology, IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) “Dino Amadori”, 47014 Meldola, Italy;
| | - Ruby Martinello
- Department of Medical Sciences, Institute of Obstetrics and Gynecology, University of Ferrara, 44121 Ferrara, Italy;
| | - Lavinia Domenici
- 2nd Division of Obstetrics and Gynaecology, Azienda Ospedaliera Universitaria Pisana, University of Pisa, 56126 Pisa, Italy;
| | - Sandro Pignata
- Department of Urology and Gynecology, Istituto Nazionale Tumori IRCCS “Fondazione G. Pascale”, 80144 Napoli, Italy; (A.P.); (S.P.)
| | - Giorgia Mangili
- Department of Obstetrics and Gynaecology, San Raffaele Scientific Institute, 20132 Milano, Italy;
| | - Gennaro Cormio
- Gynecologic Oncoly Unit, IRCCS Istituto Tumori “Giovanni Paolo II”, 70124 Bari, Italy;
- Department of Interdisciplinary Medicine, University of Bari, 70124 Bari, Italy
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Díaz-Calvillo P, Vílchez-Márquez F, Ramos-Pleguezuelos FM, Arias-Santiago S. Poikilodermatous Plaque-like Hemangioma: Case Presentation and Literature Review. Dermatopathology (Basel) 2024; 11:147-153. [PMID: 38804360 PMCID: PMC11130884 DOI: 10.3390/dermatopathology11020015] [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: 04/18/2024] [Revised: 05/15/2024] [Accepted: 05/16/2024] [Indexed: 05/29/2024] Open
Abstract
Poikilodermatous plaque-like hemangioma (PPH) is a recently described clinical and pathological entity, with only 18 cases reported in the literature. Although uncommon, this benign condition presents consistent clinical and histological findings. We present a new case of PPH in an 81-year-old male and review the existing literature. The persistence over time and the need to distinguish PPH from more significant lesions underscore the importance of its clinical and pathological recognition.
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Affiliation(s)
- Pablo Díaz-Calvillo
- Department of Dermatology, Hospital Universitario Virgen de las Nieves, Avenida de Madrid 15, 18012 Granada, Spain; (F.V.-M.); (S.A.-S.)
- Instituto de Investigación Biosanitaria ibs.GRANADA, Avenida de Madrid 15, 18012 Granada, Spain
| | - Francisco Vílchez-Márquez
- Department of Dermatology, Hospital Universitario Virgen de las Nieves, Avenida de Madrid 15, 18012 Granada, Spain; (F.V.-M.); (S.A.-S.)
- Instituto de Investigación Biosanitaria ibs.GRANADA, Avenida de Madrid 15, 18012 Granada, Spain
| | | | - Salvador Arias-Santiago
- Department of Dermatology, Hospital Universitario Virgen de las Nieves, Avenida de Madrid 15, 18012 Granada, Spain; (F.V.-M.); (S.A.-S.)
- Instituto de Investigación Biosanitaria ibs.GRANADA, Avenida de Madrid 15, 18012 Granada, Spain
- Department of Dermatology, University of Granada, Avenida de la Investigación 11, 18016 Granada, Spain
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9
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Ariza Gómez SA, Dubeibe Abril PA, Niebles Sincelejo OE, Reina HSL. Risk of progression of early-stage mycosis fungoides, 10-year experience. An Bras Dermatol 2024; 99:407-413. [PMID: 38395632 DOI: 10.1016/j.abd.2023.08.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Revised: 08/21/2023] [Accepted: 08/25/2023] [Indexed: 02/25/2024] Open
Abstract
BACKGROUND Mycosis fungoides is the most frequent form of cutaneous T-cell lymphoma. It is characterized by a chronic, slow, and progressive course, and is associated with mortality rates that depend on several factors, such as clinical staging. A median survival time of up to 13 months is found in patients with advanced stages that require more aggressive treatments, with greater toxicity and higher costs. In Latin America, few prognostic studies of the disease are available. OBJECTIVE To determine the rate of progression from early stages (IA, IB, IIA) to more advanced stages (> IIB) in patients older than 18 years with mycosis fungoides treated at two medical centers in Colombia between January 1, 2010, and December 31, 2019. METHODS Retrospective cohort study with a longitudinal design. RESULTS 112 patients diagnosed with early mycosis fungoides were included. 56.2% were male (n = 63), with a median age of 53 years (IQR 43‒67). The most frequent clinical variant was classic (67.9%; n = 76), followed by folliculotropic (16%; n = 18), and hypopigmented (10.7%; n = 12). The most common first-line treatment was NB-UVB phototherapy (27.7%; n = 31), followed by PUVA phototherapy (25.8%; n = 29%), and topical corticosteroids (25%; n = 28). The global rate of disease progression was 8% (n = 9), with an overall mortality of 12.5% (n = 14). STUDY LIMITATIONS Its retrospective design and the lack of molecular studies for case characterization. CONCLUSIONS Early mycosis fungoides is a disease with a good prognosis in most patients, with a progression rate of 8% (n = 9).
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Affiliation(s)
| | | | | | - Henry Santiago Leal Reina
- Dermatology Department, University Foundation of Health Sciences, San José Hospital, Bogotá, Colombia
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10
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Xiong S, Liu F, Sun J, Gao S, Wong CCL, Tu P, Wang Y. Abrogation of USP9X Is a Potential Strategy to Decrease PEG10 Levels and Impede Tumor Progression in Cutaneous T-Cell Lymphoma. J Invest Dermatol 2024:S0022-202X(24)00307-5. [PMID: 38677662 DOI: 10.1016/j.jid.2024.02.039] [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: 10/19/2023] [Revised: 01/30/2024] [Accepted: 02/26/2024] [Indexed: 04/29/2024]
Abstract
Advanced-stage cutaneous T-cell lymphomas (CTCLs) are notorious for their highly aggressive behavior, resistance to conventional treatments, and poor prognosis, particularly when large-cell transformation occurs. PEG10 has been recently proposed as a potent driver for large-cell transformation in CTCL. However, the targeting of PEG10 continues to present a formidable clinical challenge that has yet to be addressed. In this study, we report an important post-translational regulatory mechanism of PEG10 in CTCL. USP9X, a deubiquitinase, interacted with and deubiquitinated PEG10, thereby stabilizing PEG10. Knockdown of USP9X or pharmacological targeting of USP9X resulted in a prominent downregulation of PEG10 and its downstream pathway in CTCL. Moreover, USP9X inhibition conferred tumor cell growth disadvantage and enhanced apoptosis in vitro, an effect that occurred in part through its regulation on PEG10. Furthermore, we demonstrated that inhibition of USP9X obviously restrained CTCL tumor growth in vivo and that high expression of USP9X is associated with poor survival in patients with CTCL. Collectively, our findings uncover USP9X as a key post-translational regulator in the stabilization of PEG10 and suggest that targeting PEG10 stabilization through USP9X inhibition may represent a promising therapeutic strategy for advanced-stage CTCL.
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Affiliation(s)
- Shan Xiong
- Department of Dermatology and Venereology, Peking University First Hospital, Beijing, China; Beijing Key Laboratory of Molecular Diagnosis on Dermatoses, Beijing, China; National Clinical Research Center for Skin and Immune Diseases, Beijing, China
| | - Fengjie Liu
- Department of Dermatology and Venereology, Peking University First Hospital, Beijing, China; Beijing Key Laboratory of Molecular Diagnosis on Dermatoses, Beijing, China; National Clinical Research Center for Skin and Immune Diseases, Beijing, China
| | - Jingru Sun
- Department of Dermatology and Venereology, Peking University First Hospital, Beijing, China; Beijing Key Laboratory of Molecular Diagnosis on Dermatoses, Beijing, China; National Clinical Research Center for Skin and Immune Diseases, Beijing, China
| | - Shuaixin Gao
- Department of Human Sciences & James Comprehensive Cancer Center, The Ohio State University, Columbus, Ohio, USA; James Comprehensive Cancer Center, The Ohio State University, Columbus, Ohio, USA
| | - Catherine C L Wong
- Clinical Research Institute, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Science & Peking Union Medical College, Beijing, China
| | - Ping Tu
- Department of Dermatology and Venereology, Peking University First Hospital, Beijing, China; Beijing Key Laboratory of Molecular Diagnosis on Dermatoses, Beijing, China; National Clinical Research Center for Skin and Immune Diseases, Beijing, China
| | - Yang Wang
- Department of Dermatology and Venereology, Peking University First Hospital, Beijing, China; Beijing Key Laboratory of Molecular Diagnosis on Dermatoses, Beijing, China; National Clinical Research Center for Skin and Immune Diseases, Beijing, China.
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11
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Örnek S, Ozekinci S, Ipin T, Kocaturk E. TOX, TWIST1, STAT4, and SATB1 protein expressions in early-stage mycosis fungoides. J Cutan Pathol 2024; 51:232-238. [PMID: 37932931 DOI: 10.1111/cup.14557] [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: 02/14/2023] [Revised: 10/19/2023] [Accepted: 10/22/2023] [Indexed: 11/08/2023]
Abstract
BACKGROUND Diagnosis of early mycosis fungoides (eMF) is challenging and often delayed as many of its clinical and histopathologic features may mimic various benign inflammatory dermatoses (BIDs). The products of the thymocyte selection-associated high mobility group box (TOX), twist family BHLH transcription factor 1 (TWIST1), signal transducer and activator of transcription 4 (STAT4), and special AT-rich sequence-binding protein 1 (SATB1) genes function as transcription factors and are involved in the pathogenesis of MF. OBJECTIVES We aim to determine the diagnostic value of TOX, TWIST1, STAT4, and SATB1 protein expressions in eMF. METHODS This non-randomized, controlled, prospective analytic study was conducted by performing immunohistochemistry staining with TOX, TWIST1, STAT4, and SATB1 polyclonal antibodies in lesional skin biopsies of eMF and BID patients. Nuclear staining of lymphocytes was compared between eMF and BIDs, and the capacity of these antibodies to predict eMF was determined. RESULTS Immunostainings with anti-TWIST1 showed an increase in protein expression (p = 0.003) and showed a decrease with anti-SATB1 antibodies in eMF compared to BIDs (p = 0.005) while anti-TOX and anti-STAT4 antibodies did not exhibit significant differences (p = 0.384; p = 0.150). Receiver operating characteristic analysis showed that immunohistochemical evaluations of TWIST1 and SATB1 protein expressions can differentiate eMF (area under the curve [AUC]: 0.728, 95% confidence interval [CI]: 0.605-0.851, p = 0.002; AUC: 0.686, 95% CI: 0.565-0.807, p = 0.013). CONCLUSIONS TWIST1 and SATB1 are potential diagnostic markers for the histologic diagnosis of eMF.
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Affiliation(s)
- Sinem Örnek
- Department of Dermatology, Health Sciences University Diskapi Yildirim Beyazit Training and Research Hospital, Ankara, Turkey
| | - Selver Ozekinci
- Department of Pathology, Dicle University Hospital, Diyarbakir, Turkey
| | - Tugba Ipin
- Department of Pathology, Cemil Tascioglu City Hospital, Istanbul, Turkey
| | - Emek Kocaturk
- Department of Dermatology, Koc University School of Medicine, Istanbul, Turkey
- Institute of Allergy, Charité-Universitätsmedizin Berlin, Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
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12
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Mazzetto R, Miceli P, Tartaglia J, Ciolfi C, Sernicola A, Alaibac M. Role of IL-4 and IL-13 in Cutaneous T Cell Lymphoma. Life (Basel) 2024; 14:245. [PMID: 38398754 PMCID: PMC10889933 DOI: 10.3390/life14020245] [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: 01/18/2024] [Revised: 02/03/2024] [Accepted: 02/06/2024] [Indexed: 02/25/2024] Open
Abstract
The interleukins IL-4 and IL-13 are increasingly recognized contributors to the pathogenesis of cutaneous T cell lymphomas (CTCLs), and their role in disease-associated pruritus is accepted. The prevailing Th2 profile in advanced CTCL underscores the significance of understanding IL-4/IL-13 expression dynamics from the early stages of disease, as a shift from Th1 to Th2 may explain CTCL progression. Targeted agents blocking key cytokines of type 2 immunity are established therapeutics in atopic disorders and have a promising therapeutic potential in CTCL, given their involvement in cutaneous symptoms and their contribution to the pathogenesis of disease. IL-4, IL-13, and IL-31 are implicated in pruritus, offering therapeutic targets with dupilumab, tralokinumab, lebrikizumab, and nemolizumab. This review analyzes current knowledge on the IL-4/IL-13 axis in mycosis fungoides and Sezary syndrome, the most common types of CTCL, examining existing literature on the pathogenetic implications with a focus on investigational treatments. Clinical trials and case reports are required to shed light on novel uses of medications in various diseases, and ongoing research into the role of IL-4/IL-13 axis blockers in CTCL therapy might not only improve the management of disease-related pruritus but also provide in-depth insights on the pathophysiologic mechanisms of CTCL.
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Affiliation(s)
| | | | | | | | - Alvise Sernicola
- Dermatology Unit, Department of Medicine (DIMED), University of Padua, 35121 Padova, Italy; (R.M.); (P.M.); (J.T.); (C.C.); (M.A.)
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13
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Booth MR, Booth L, Roberts JL, West C, Dent P. GZ17-6.02 interacts with bexarotene to kill mycosis fungoides cells. Oncotarget 2024; 15:124-133. [PMID: 38329728 PMCID: PMC10852062 DOI: 10.18632/oncotarget.28557] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2023] [Accepted: 01/23/2024] [Indexed: 02/09/2024] Open
Abstract
GZ17-6.02, composed of curcumin, harmine and isovanillin, has undergone phase I evaluation in patients with solid tumors (NCT03775525) with an RP2D of 375 mg PO BID. The biology of GZ17-6.02 in malignant T cells and in particular those derived from mycosis fungoides (MF) patients, has not been studied. GZ17-6.02 alone and in combination with standard-of-care agents was effective in killing MF cells. All three components are necessary for optimal killing of MF cells. GZ17-6.02 activated ATM, the AMPK, NFκB and PERK and inactivated ERK1/2, AKT, ULK1, mTORC1, eIF2α, and reduced the expression of BCL-XL and MCL1. GZ17-6.02 increased ATG13 S318 phosphorylation and the expression of Beclin1, ATG5, BAK and BIM. GZ17-6.02 in a dose-dependent fashion enhanced autophagosome formation and autophagic flux, and tumor cell killing. Signaling by ATM and AMPK were both required for efficient killing but not for the dose-response effect whereas ER stress (eIF2α) and macroautophagy (Beclin1, ATG5) were required for both efficient killing and the dose-response. Knock down of the death receptor CD95 reduced killing by ~20% and interacted with autophagy inhibition to further reduce killing, collectively, by ~70%. Inhibition of autophagy and knock down of death-mediators downstream of the mitochondrion, AIF and caspase 3, almost abolished tumor cell killing. Hence in MF cells, GZ17-6.02 is a multi-factorial killer, utilizing ER stress, macroautophagy, death receptor signaling and directly causing mitochondrial dysfunction.
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Affiliation(s)
- Michael R. Booth
- Department of Biochemistry and Molecular Biology, Virginia Commonwealth University, Richmond, VA 23298, USA
| | - Laurence Booth
- Department of Biochemistry and Molecular Biology, Virginia Commonwealth University, Richmond, VA 23298, USA
| | - Jane L. Roberts
- Department of Biochemistry and Molecular Biology, Virginia Commonwealth University, Richmond, VA 23298, USA
| | - Cameron West
- Genzada Pharmaceuticals, Hutchinson, KS 67502, USA
| | - Paul Dent
- Department of Biochemistry and Molecular Biology, Virginia Commonwealth University, Richmond, VA 23298, USA
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14
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Kawamoto H, Saito-Sasaki N, Sakuragi Y, Sawada Y. A Case Report of Mycosis Fungoides Presenting With Blister Formation. Cureus 2024; 16:e54213. [PMID: 38496187 PMCID: PMC10941054 DOI: 10.7759/cureus.54213] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/14/2024] [Indexed: 03/19/2024] Open
Abstract
Mycosis fungoides (MF) is the most common primary cutaneous T-cell lymphoma with a usually indolent course. Early detection is crucial for effective intervention. We present a case of a 40-year-old male with MF exhibiting blistering as a rare precursor symptom. Despite initial treatment for eczema, the condition worsened over 10 months, leading to erythema, edema, and enlarged lymph nodes. Laboratory and imaging findings confirmed the diagnosis of MF. The patient responded partially to cyclophosphamide/doxorubicin/prednisone in combination with brentuximab vedotin (A-CHP) therapy. This case highlights the significance of recognizing blistering as a prodromal symptom for early detection and management of MF.
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Affiliation(s)
- Hirofumi Kawamoto
- Dermatology, University of Occupational and Environmental Health, Kitakyushu, JPN
| | - Natsuko Saito-Sasaki
- Dermatology, University of Occupational and Environmental Health, Kitakyushu, JPN
| | - Yumiko Sakuragi
- Dermatology, University of Occupational and Environmental Health, Kitakyushu, JPN
| | - Yu Sawada
- Dermatology, University of Occupational and Environmental Health, Kitakyushu, JPN
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15
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André R. Mycosis fungoides palmaris and plantaris. Ital J Dermatol Venerol 2024; 159:1-3. [PMID: 38015570 DOI: 10.23736/s2784-8671.23.07645-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2023]
Abstract
Mycosis fungoides (MF) palmaris and plantaris is a rare form of MF. Only few cases are reported in the literature. Different forms are described: eczematous lesions, dyshidrosis lesions, verrucous lesions, dry pulpitis, ulcerated lesions, pustulosis, and hyperkeratotic lesions. Histology is typical for MF with a positive T-cell receptor gene rearrangement in majority of cases. Prognosis is good. Resistance to topical steroids is common, and classical treatment consist of chlormethine gel and radiotherapy.
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Affiliation(s)
- Raphaël André
- Forever Institute, Geneva, Switzerland -
- Department of Dermatology, Annecy Hospital, Epagny Metz Tessy, France -
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16
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Biazus Soares G, Guitart J, Yosipovitch G. What's New in Cutaneous T-Cell Lymphoma-Associated Pruritus. Am J Clin Dermatol 2024; 25:67-77. [PMID: 37971624 DOI: 10.1007/s40257-023-00823-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/11/2023] [Indexed: 11/19/2023]
Abstract
Cutaneous T-cell lymphomas are a heterogenous group of lymphomas that cause various skin manifestations. Severe pruritus occurs frequently in cutaneous T-cell lymphoma and negatively impacts patients' quality of life. The pathophysiology of cutaneous T-cell lymphoma-associated itch is complex and involves various immune cells, inflammatory cytokines, and neuroimmune interactions. Treating cutaneous T-cell lymphoma pruritus can be challenging, and there have been few randomized controlled studies evaluating the use of antipruritic treatments in these patients. Systemic therapies targeting the disease have also been shown to have some antipruritic effects. Furthermore, although biologic therapy has revolutionized the treatment of other pruritic skin conditions, the use of biologics in cutaneous T-cell lymphoma remains controversial.
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Affiliation(s)
- Georgia Biazus Soares
- Dr. Phillip Frost Department of Dermatology and Cutaneous Surgery, Miami Itch Center, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Joan Guitart
- Department of Dermatology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Gil Yosipovitch
- Dr. Phillip Frost Department of Dermatology and Cutaneous Surgery, Miami Itch Center, University of Miami Miller School of Medicine, Miami, FL, USA.
- , 5555 Ponce de Leon, Coral Gables, FL, 33146, USA.
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17
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Torosian A, Albucker SJ, Gowda G, Boh E, Bitar C. Cutaneous T-cell lymphoma (CTCL) patients' understanding of illness and perception of follow-up. Int J Dermatol 2023; 62:e645-e647. [PMID: 37548249 DOI: 10.1111/ijd.16799] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2023] [Revised: 05/26/2023] [Accepted: 07/14/2023] [Indexed: 08/08/2023]
Affiliation(s)
- Arman Torosian
- Tulane University School of Medicine, New Orleans, LA, USA
| | | | - Geetha Gowda
- Tulane University School of Medicine, New Orleans, LA, USA
| | - Erin Boh
- Department of Dermatology, Tulane Medicine Center, New Orleans, LA, USA
| | - Carole Bitar
- Department of Dermatology, Tulane Medicine Center, New Orleans, LA, USA
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18
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Warda A, Staniszewski LJP, Sabir Z, Livingston S, Sausedo M, Reshi S, Ron E, Applegate MT, Haddad D, Khamisi M, Marshall PA, Wagner CE, Jurutka PW. Development of Bexarotene Analogs for Treating Cutaneous T-Cell Lymphomas. Cells 2023; 12:2575. [PMID: 37947652 PMCID: PMC10647404 DOI: 10.3390/cells12212575] [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: 10/04/2023] [Revised: 10/21/2023] [Accepted: 11/02/2023] [Indexed: 11/12/2023] Open
Abstract
Bexarotene, a drug approved for treatment of cutaneous T-cell lymphoma (CTCL), is classified as a rexinoid by its ability to act as a retinoid X receptor (RXR) agonist with high specificity. Rexinoids are capable of inducing RXR homodimerization leading to the induction of apoptosis and inhibition of proliferation in human cancers. Numerous studies have shown that bexarotene is effective in reducing viability and proliferation in CTCL cell lines. However, many treated patients present with cutaneous toxicity, hypothyroidism, and hyperlipidemia due to crossover activity with retinoic acid receptor (RAR), thyroid hormone receptor (TR), and liver X receptor (LXR) signaling, respectively. In this study, 10 novel analogs and three standard compounds were evaluated side-by-side with bexarotene for their ability to drive RXR homodimerization and subsequent binding to the RXR response element (RXRE). In addition, these analogs were assessed for proliferation inhibition of CTCL cells, cytotoxicity, and mutagenicity. Furthermore, the most effective analogs were analyzed via qPCR to determine efficacy in modulating expression of two critical tumor suppressor genes, ATF3 and EGR3. Our results suggest that these new compounds may possess similar or enhanced therapeutic potential since they display enhanced RXR activation with equivalent or greater reduction in CTCL cell proliferation, as well as the ability to induce ATF3 and EGR3. This work broadens our understanding of RXR-ligand relationships and permits development of possibly more efficacious pharmaceutical drugs. Modifications of RXR agonists can yield agents with enhanced biological selectivity and potency when compared to the parent compound, potentially leading to improved patient outcomes.
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Affiliation(s)
- Ankedo Warda
- School of Mathematical and Natural Sciences, Arizona State University, Glendale, AZ 85306, USA; (A.W.); (L.J.P.S.); (Z.S.); (S.L.); (M.S.); (S.R.); (M.T.A.); (D.H.); (M.K.); (P.A.M.); (C.E.W.)
- College of Medicine, University of Arizona, Phoenix, AZ 85004, USA;
| | - Lech J. P. Staniszewski
- School of Mathematical and Natural Sciences, Arizona State University, Glendale, AZ 85306, USA; (A.W.); (L.J.P.S.); (Z.S.); (S.L.); (M.S.); (S.R.); (M.T.A.); (D.H.); (M.K.); (P.A.M.); (C.E.W.)
- College of Medicine, University of Arizona, Tucson, AZ 85724, USA
| | - Zhela Sabir
- School of Mathematical and Natural Sciences, Arizona State University, Glendale, AZ 85306, USA; (A.W.); (L.J.P.S.); (Z.S.); (S.L.); (M.S.); (S.R.); (M.T.A.); (D.H.); (M.K.); (P.A.M.); (C.E.W.)
| | - Sarah Livingston
- School of Mathematical and Natural Sciences, Arizona State University, Glendale, AZ 85306, USA; (A.W.); (L.J.P.S.); (Z.S.); (S.L.); (M.S.); (S.R.); (M.T.A.); (D.H.); (M.K.); (P.A.M.); (C.E.W.)
| | - Michael Sausedo
- School of Mathematical and Natural Sciences, Arizona State University, Glendale, AZ 85306, USA; (A.W.); (L.J.P.S.); (Z.S.); (S.L.); (M.S.); (S.R.); (M.T.A.); (D.H.); (M.K.); (P.A.M.); (C.E.W.)
| | - Sabeeha Reshi
- School of Mathematical and Natural Sciences, Arizona State University, Glendale, AZ 85306, USA; (A.W.); (L.J.P.S.); (Z.S.); (S.L.); (M.S.); (S.R.); (M.T.A.); (D.H.); (M.K.); (P.A.M.); (C.E.W.)
| | - Eyal Ron
- College of Medicine, University of Arizona, Phoenix, AZ 85004, USA;
| | - Michael T. Applegate
- School of Mathematical and Natural Sciences, Arizona State University, Glendale, AZ 85306, USA; (A.W.); (L.J.P.S.); (Z.S.); (S.L.); (M.S.); (S.R.); (M.T.A.); (D.H.); (M.K.); (P.A.M.); (C.E.W.)
| | - Dena Haddad
- School of Mathematical and Natural Sciences, Arizona State University, Glendale, AZ 85306, USA; (A.W.); (L.J.P.S.); (Z.S.); (S.L.); (M.S.); (S.R.); (M.T.A.); (D.H.); (M.K.); (P.A.M.); (C.E.W.)
| | - Madleen Khamisi
- School of Mathematical and Natural Sciences, Arizona State University, Glendale, AZ 85306, USA; (A.W.); (L.J.P.S.); (Z.S.); (S.L.); (M.S.); (S.R.); (M.T.A.); (D.H.); (M.K.); (P.A.M.); (C.E.W.)
| | - Pamela A. Marshall
- School of Mathematical and Natural Sciences, Arizona State University, Glendale, AZ 85306, USA; (A.W.); (L.J.P.S.); (Z.S.); (S.L.); (M.S.); (S.R.); (M.T.A.); (D.H.); (M.K.); (P.A.M.); (C.E.W.)
| | - Carl E. Wagner
- School of Mathematical and Natural Sciences, Arizona State University, Glendale, AZ 85306, USA; (A.W.); (L.J.P.S.); (Z.S.); (S.L.); (M.S.); (S.R.); (M.T.A.); (D.H.); (M.K.); (P.A.M.); (C.E.W.)
| | - Peter W. Jurutka
- School of Mathematical and Natural Sciences, Arizona State University, Glendale, AZ 85306, USA; (A.W.); (L.J.P.S.); (Z.S.); (S.L.); (M.S.); (S.R.); (M.T.A.); (D.H.); (M.K.); (P.A.M.); (C.E.W.)
- College of Medicine, University of Arizona, Phoenix, AZ 85004, USA;
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19
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Erduran F, Adışen E, Soyugür A, Eren F, Neşelioğlu S, Erel Ö. Evaluation of Oxidative Stress by Thiol/Disulphide Homeostasis in Patients with Mycosis Fungoides: A Prospective Double-Centre Study. Indian J Dermatol 2023; 68:724. [PMID: 38371553 PMCID: PMC10869007 DOI: 10.4103/ijd.ijd_339_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/20/2024] Open
Abstract
Background Mycosis fungoides (MF) is the most common cutaneous T-cell lymphoma with unknown etiopathogenesis. Oxidant and antioxidant balance is important for cell function and normal metabolism. An imbalance between pro-oxidants and antioxidants causes oxidative stress. A recent focus has been on thiol/disulphide homeostasis as a novel marker of oxidative stress. Aims and Objectives This study aimed to evaluate the role of oxidative stress in MF by analysing thiol/disulphide homeostasis. Materials and Methods A total of 103 patients (48 female, 55 male) and a control group of 120 healthy individuals (48 female, 72 male) from two tertiary care hospitals were included in our study. Serum native thiol, total thiol and disulphide levels were evaluated using novel method developed by Erel and Neeliolu. Results Native thiol levels were 340.30 ± 87.44 in the patient group and 401.62 ± 69.45 in the control group. Total thiol value was 374.17 ± 87.78 in the patient group and 428.54 ± 70.05 in the control group. Native thiol and total thiol levels were significantly lower in the patient group compared to the control group (P < 0.001 and P < 0.001). The disulphide value was 16.93 ± 6.46 in the patient group and 13.46 ± 5.06 in the control group. Disulphide levels were found to be significantly higher in the patient group compared to the control group (P < 0.001). Conclusions In our study, thiol/disulphide balance shifted towards disulphide which indicates the presence of oxidative stress especially in the early stage while 93.2% of our patients had early-stage MF. We think that this may have pathogenetic and prognostic significance.
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Affiliation(s)
- Funda Erduran
- From the Department of Dermatology, Ankara City Hospital, Ankara, Turkey
| | - Esra Adışen
- Department of Dermatology, Gazi University Faculty of Medicine, Ankara, Turkey
| | - Ahmet Soyugür
- Department of Dermatology, Gazi University Faculty of Medicine, Ankara, Turkey
| | - Funda Eren
- Department of Medical Biochemistry, Ankara City Hospital, Ankara, Turkey
| | - Salim Neşelioğlu
- Department of Medical Biochemistry, Faculty of Medicine, Ankara Yıldırım Beyazıt University, Ankara, Turkey
| | - Özcan Erel
- Department of Medical Biochemistry, Faculty of Medicine, Ankara Yıldırım Beyazıt University, Ankara, Turkey
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20
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Baykal C, Atci T. Eyelid involvement of primary cutaneous lymphomas: A clinical perspective. Australas J Dermatol 2023; 64:463-475. [PMID: 37435706 DOI: 10.1111/ajd.14131] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Revised: 05/25/2023] [Accepted: 06/24/2023] [Indexed: 07/13/2023]
Abstract
Eyelids may be affected in systemic, ocular adnexal and primary cutaneous lymphomas (PCLs). The frequency of eyelid involvement in PCLs is still not well known and it is not a predilection site for any type. While primary cutaneous T-cell lymphomas (CTCLs) are more commonly seen than primary cutaneous B-cell lymphomas (CBCLs), especially mycosis fungoides (MF) as by far the most frequent type, B cell lymphomas are reported to be the commonest type in eyelid localization on the contrary. PCLs may be located on the eyelids, as the sole manifestation or in association with the involvement of other parts of the eye and elsewhere of the body. MF may present with a rich spectrum of clinical features on the eyelids mostly seen in folliculotropic subtype and advanced-stage disease. Erythematous scaly patches or plaques representing the most commonly encountered eyelid MF lesions may mimic many other dermatological conditions. Diffuse thickening, oedema, poikilodermic changes, atrophy and wrinkling are other suggestive findings of eyelid MF. Milia-like papules, madarosis and ectropion are also seen in the folliculotropic variant of MF, as ectropion is more typical for Sezary syndrome. Eyelids are also a typical location for tumoural MF which has been suggested as a poor prognostic indicator in MF. Papulonodular lesions, large tumours, ulceration, diffuse infiltration, oedema and subcutaneous atrophy on the eyelids may also be seen in other types of PCLs. Keep in mind, the rich clinical spectrum of PCLs on the eyelids may be crucial in early diagnosis in this special localization.
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Affiliation(s)
- Can Baykal
- Department of Dermatology and Venereology, Istanbul Medical Faculty, Istanbul University, Istanbul, Turkey
| | - Tugba Atci
- Department of Dermatology and Venereology, Istanbul Medical Faculty, Istanbul University, Istanbul, Turkey
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21
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Gosmann J, Stadler R, Quint KD, Gutzmer R, Vermeer MH. Use of Pegylated Interferon Alpha-2a in Cutaneous T-cell Lymphoma: A Retrospective Case Collection. Acta Derm Venereol 2023; 103:adv10306. [PMID: 37902466 PMCID: PMC10622159 DOI: 10.2340/actadv.v103.10306] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Accepted: 09/19/2023] [Indexed: 10/31/2023] Open
Abstract
Mycosis fungoides and Sézary syndrome are rare and largely incurable types of cutaneous T-cell lymphoma with limited therapeutic options. In 1984 Bunn et al. reported that interferon alpha is an efficient monotherapy in cutaneous T-cell lymphoma and 14 years later it was shown in a prospective, randomized trial that a combination of interferon alpha and psoralen plus ultraviolet A therapy (PUVA) is most efficient in the treatment of cutaneous T-cell lymphoma. Since then interferon alpha as single agent or, most often, in combination with phototherapy and/or retinoids has been integrated as standard of care in cutaneous T-cell lymphoma guidelines worldwide. However, production of interferon alpha was discontinued recently worldwide and pegylated interferon alpha-2a (PEG-IFNα) has been used as an alternative therapy. In contrast to numerous interferon alpha studies, only a few studies focusing on PEG-IFNα are available. Therefore, the aim of this study was to conduct a retrospective data collection to report on the efficacy, adverse events and therapy regimens of PEG-IFNα in cutaneous T-cell lymphoma. In 28 patients with cutaneous T-cell lymphoma treated in Germany and in the Netherlands, 36% of patients achieved complete remission, 36% partial remission and 29% stable disease. Eighteen percent of patients developed adverse events during therapy, which led to the discontinuation of PEG-IFNα therapy in 2 patients. The most common concomittant therapies were oral PUVA phototherapy and local radiotherapy. In conclusion, PEG-IFNα, especially in combination with skin-directed therapies, is an effective treatment option for cutaneous T-cell lymphoma in clinical practice.
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Affiliation(s)
- Janika Gosmann
- University Department for Dermatology, Venereology, Allergology and Phlebology Skin Cancer Center, Johannes Wesling Medical Center Minden, Ruhr University Bochum, Minden, Germany
| | - Rudolf Stadler
- University Department for Dermatology, Venereology, Allergology and Phlebology, Skin Cancer Center, Johannes Wesling Medical Center Minden, Ruhr University Bochum, Minden, Germany.
| | - Koen D Quint
- Department of Dermatology of the Leiden University medical Center (LUMC), Leiden, the Netherlands
| | - Ralf Gutzmer
- University Department for Dermatology, Venereology, Allergology and Phlebology Skin Cancer Center, Johannes Wesling Medical Center Minden, Ruhr University Bochum, Minden, Germany
| | - Maarten H Vermeer
- Department of Dermatology of the Leiden University medical Center (LUMC), Leiden, the Netherlands
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22
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Zhao P, Gish TJ, Mannschreck D, Marchi E, Cropley TG. Zosteriform mycosis fungoides and lymphomatoid papulosis arising in an area of prior herpes zoster. JAAD Case Rep 2023; 40:84-88. [PMID: 37771361 PMCID: PMC10523180 DOI: 10.1016/j.jdcr.2023.08.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/30/2023] Open
Affiliation(s)
- Patricia Zhao
- University of Virginia School of Medicine, Charlottesville, Virginia
| | - Tappy J. Gish
- Department of Pathology, University of Virginia Medical Center, Charlottesville, Virginia
| | - Diana Mannschreck
- Department of Dermatology, University of Virginia Medical Center, Charlottesville, Virginia
| | - Enrica Marchi
- Division of Hematology & Oncology, Department of Medicine, University of Virginia Medical Center, Charlottesville, Virginia
| | - Thomas G. Cropley
- Department of Dermatology, University of Virginia Medical Center, Charlottesville, Virginia
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23
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Amitay-Laish I, Didkovsky E, Davidovici B, Friedland R, Ben Amitai D, Landov H, Greenberger S, Ollech A, Prag Naveh H, Hodak E, Barzilai A. Mycosis Fungoides in Solid-Organ Transplant Recipients: A Multicenter Retrospective Cohort Study. Dermatology 2023; 239:898-905. [PMID: 37751718 DOI: 10.1159/000534224] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Accepted: 09/18/2023] [Indexed: 09/28/2023] Open
Abstract
BACKGROUND Mycosis fungoides (MF) in solid-organ transplant recipients (SOTRs) is rare, with limited data on disease characteristics. OBJECTIVE The aim was to study the characteristics of MF in SOTRs with an emphasis on the immunosuppressive therapy. METHODS A retrospective cohort of patients diagnosed with MF, who were also SOTRs, were followed at 3 cutaneous lymphoma outpatient clinics, between January 2010 and February 2022. RESULTS Ten patients were included (7 male; median ages at transplantation and at diagnosis of MF were 33 and 48 years, respectively; 40% were diagnosed before the age of 18 years). Median time from transplantation to diagnosis of MF was 8 years (range 0.5-22). Transplanted organs and immunosuppressive treatments included: liver (n = 5; 4 treated with tacrolimus, 1 with tacrolimus and prednisone), kidney (n = 3), liver and kidney (n = 1), and heart (n = 1), all treated with mycophenolic acid, tacrolimus, and prednisone. Nine had early-stage MF (IA - 4, IB - 5; 40% with early folliculotropic MF), treated with skin-directed therapies, in 2 combined with acitretin, achieving partial/complete response. One patient had advanced-stage MF (IIIA) with folliculotropic erythroderma, treated with ultraviolet A and narrow-band ultraviolet B with acitretin, achieving partial response. Immunosuppression was modified in 3. At last follow-up (median 4 years, range 1-8), no stage progression was observed; 5 had no evidence of disease, 5 had active disease (IA/IB - 4, III - 1). CONCLUSIONS MF in SOTRs is usually diagnosed at an early stage, with overrepresentation of folliculotropic MF, and of children. Immunosuppressive therapy alterations, not conducted in most patients, should be balanced against the risk of organ compromise/rejection. Disease course was similar to MF in immunocompetent patients, during the limited time of follow-up.
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Affiliation(s)
- Iris Amitay-Laish
- Division of Dermatology, Tel Aviv University, Tel Aviv, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Elena Didkovsky
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Institute of Pathology, Rabin Medical Center Beilinson Hospital, Tel Aviv, Israel
| | - Batya Davidovici
- Division of Dermatology, Tel Aviv University, Tel Aviv, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Rivka Friedland
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Pediatric Dermatology Unit, Schneider Children's Medical Center, Petach Tikva, Israel
| | - Dan Ben Amitai
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Pediatric Dermatology Unit, Schneider Children's Medical Center, Petach Tikva, Israel
| | - Hagai Landov
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Department of Dermatology, Sheba Medical Center, Tel Hashomer, Israel
| | - Shoshana Greenberger
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Department of Dermatology, Sheba Medical Center, Tel Hashomer, Israel
| | - Ayelet Ollech
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Department of Dermatology, Sheba Medical Center, Tel Hashomer, Israel
| | | | - Emmilia Hodak
- Division of Dermatology, Tel Aviv University, Tel Aviv, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Aviv Barzilai
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Department of Dermatology, Sheba Medical Center, Tel Hashomer, Israel
- Institute of Pathology, Sheba Medical Center, Tel Hashomer, Israel
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24
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AlOtaibi MN, Basfar AS, Jawhari AM, Alzahrani ES, Althomali MA, Alhindi AE, Alam SS, Al Aboud DM, Abdel-Moneim AS. The Burden of Skin Cancers in Saudi Arabia Through 2011-2022. Cureus 2023; 15:e45052. [PMID: 37829962 PMCID: PMC10566748 DOI: 10.7759/cureus.45052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/06/2023] [Indexed: 10/14/2023] Open
Abstract
Introduction Skin cancers are classified into melanoma and non-melanoma or keratinocyte cancers. No recent data are found about the epidemiology of skin cancers in Saudi Arabia. The current study aims to determine the burden of skin cancer in the last 11 years from 2011 to 2022. Methods Patients who were diagnosed with any type of skin cancer were enrolled in the study. The diagnosis was conducted based on histopathology and immunohistochemistry. Different variables like age, type of cancer, type of lesions, and treatment approach used were measured. Results A total of 91 patients were diagnosed with skin cancers during the study period. The head and neck were the most common sites for skin cancers. Only 4/91 cases reported invasive melanoma. Both squamous cell carcinoma (SCC) (34/91) and basal cell carcinoma (BCC) (28/91) were found to be the most reported skin cancers. Other cancers including mycosis fungoides (MF) (10/91), Kaposi's sarcoma (6/91), and dermatofibrosarcoma protuberans (DFSP) (5/91) were also detected. The rest of the detected tumors were rarely detected. Aggressive CD4+/CD4+/CD8+ MF was more prevalent than CD3+/CD4+/CD8- MF cancer cases. CD34+ /S100- DFSP cancers were evident in most of the DFSP cases. Human herpes virus 8 was detected in all Kaposi's sarcoma cases and all of them were HIV-confirmed cases. Surgical treatment was the most frequently used approach to treat skin cancers, followed by phototherapy (9.9%), surgical/radiotherapy (5.5%), surgical/chemotherapy (4.4%), chemotherapy (3.3%), and then chemoradiotherapy immunotherapy (1.1%). Conclusion The incidences of SCC and BCC are relatively high in comparison to other types of skin cancers with the surgical intervention being most frequently used.
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Affiliation(s)
| | | | | | | | | | | | - Samir S Alam
- Department of Histopathology and Cytology, King AbdulAziz Specialist Hospital, Taif, SAU
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25
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Neinaa YMEH, Elsayed HTI, Alshenawy HA, Gamei MM. YKL-40 immunoexpression as a prognosticator of mycosis fungoides. Int J Dermatol 2023; 62:1147-1153. [PMID: 37391891 DOI: 10.1111/ijd.16758] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Revised: 04/01/2023] [Accepted: 06/14/2023] [Indexed: 07/02/2023]
Abstract
BACKGROUND YKL-40 is a 40 kDa chitinase-like glycoprotein that is predicted to contribute to the pathogenesis of several inflammatory and neoplastic conditions. OBJECTIVES To assess YKL-40 immunoexpression in different stages of mycosis fungoides (MF) to find out if YKL-40 is playing a possible role in disease pathophysiology and progression. METHODS This work included 50 patients with different stages of MF diagnosed on the basis of clinical, histopathological, and both CD4 and CD8 immunophenotyping, in addition to 25 normal control skin. The Immune Reactive Score (IRS) of YKL-40 expression was determined in all specimens and statistically analyzed. RESULTS YKL-40 expression reported a significant rise in MF lesions compared to control skin. Among MF specimens, the mildest expression was observed in the early patch stage followed by the plaque stage, while the strongest was in tumor stages. Positive correlations were discovered between IRS of YKL-40 expression in MF specimens and patients' age, disease chronicity, clinical staging, and TNMB classification. CONCLUSION YKL-40 might participate in MF pathophysiology, and the highest expression is associated with advanced stages of the disease and poor outcomes. Therefore, it might be of value as a prognosticator for monitoring high-risk MF patients and follow-up assessment of treatment success.
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Affiliation(s)
- Yomna Mazid El-Hamd Neinaa
- Dermatology and Venereology Department, Faculty of Medicine, Tanta University, Tanta, Egypt
- Dermatopathology Unite, Faculty of Medicine, Tanta University, Tanta, Egypt
| | | | | | - Mohamed Mahmoud Gamei
- Dermatology and Venereology Department, Faculty of Medicine, Tanta University, Tanta, Egypt
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26
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Lebas E, Collins P, Somja J, Nikkels AF. Causes of Death in Cutaneous T-Cell Lymphoma Patients. Dermatology 2023; 239:860-867. [PMID: 37611553 DOI: 10.1159/000531979] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2022] [Accepted: 07/06/2023] [Indexed: 08/25/2023] Open
Abstract
BACKGROUND The advancing evolution toward a Th2 immune environment confers a progressive immunosuppression in patients with longstanding cutaneous T-cell lymphoma (CTCL). The conjunction of the disease-related immunosuppression as well as the immunosuppressive character of some CTCL treatments increase the risk of infectious and neoplastic diseases, sometimes with fatal outcomes. OBJECTIVES The aim of the study was to prospectively study the causes of death in a cohort of CTCL patients, in a tertiary university skin cancer center. METHODS All CTCL patients who died between 2008 and 2020 were included. The cause of the death was classified as directly or indirectly related or unrelated to CTCL. RESULTS Over the study period, 31 (13F/18m) patients with CTCL died (mean age: 75.2 years), mean delay between diagnosis and death: 3.2 years (min: 1, max: 12 years), 58.1% of death causes were classified as indirect (infection), 12.9% directly related (blastic transformation), 22.5% unrelated, and 6.5% of unknown cause. 51.6% of mycosis fungoides (MF) patients who died had early-stage disease (1A-2A) or were on remission. 45.2% of dead patients had advanced-stage MF (2B-4B). Mean CRP level is increased in patients who died from infection whereas LDH level increased in patients with blastosis. A tertiary center is expected to manage of a higher proportion of CTCL patients with advanced-stage disease. CONCLUSIONS As infection represented more than 50% of the causes of death in CTCL patients, particular attention should be given to preventive measures such as anti-infective vaccination. Regular surveillance of CRP and LDH levels could be helpful for follow-up of MF patients, respectively, with regards to infection and blastosis.
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Affiliation(s)
- Eve Lebas
- Departments of Dermatology, Liège, Belgium
| | - Patrick Collins
- Dermatopathology, Liège University Hospital, CHU Du Sart Tilman, Liège, Belgium
| | - Joan Somja
- Dermatopathology, Liège University Hospital, CHU Du Sart Tilman, Liège, Belgium
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27
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Hu ZH, Lu L, Feng JD, Song HB, Zhang SY, Yang L, Wang T, Liu YH. Real-World Clinical Characteristics, Management, and Outcomes of 44 Paediatric Patients with Hypopigmented Mycosis Fungoides. Acta Derm Venereol 2023; 103:adv6226. [PMID: 37606155 PMCID: PMC10461309 DOI: 10.2340/actadv.v103.6226] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Accepted: 06/19/2023] [Indexed: 08/23/2023] Open
Abstract
Hypopigmented mycosis fungoides is a rare form of mycosis fungoides that is characterized by achromic lesions, early onset of disease, a predilection for darker skinned populations, and a predominance of CD8+ T cells. Due to the rarity and heterogeneous presentation of hypopigmented mycosis fungoides, there are no criteria that clearly define the clinical characteristics and treatment regimens for this condition. This retrospective study of 44 paediatric patients with hypopigmented mycosis fungoides aimed to summarize their epidemiological and clinical characteristics and assess the effectiveness and safety of different treatment regimens. Clinical manifestations were further classified into 3 morphological groups: hypopigmented lesions, papules overlying hypopigmented lesions, and erythematous plaques overlying hypopigmented lesions. In addition, the results of this study suggest that interferon alpha might be an effective and well-tolerated therapy that could shorten the treatment time to complete response compared with other treatments. Maintenance therapy and long-term follow-up reduced the recurrence rate.
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Affiliation(s)
- Zhong-Hui Hu
- Department of Dermatology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, State Key Laboratory of Complex Severe and Rare Diseases, National Clinical Research Center for Dermatologic and Immunologic Diseases, Beijing, China
| | - Lu Lu
- Department of Dermatology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, State Key Laboratory of Complex Severe and Rare Diseases, National Clinical Research Center for Dermatologic and Immunologic Diseases, Beijing, China
| | - Jin-Di Feng
- Department of Dermatology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, State Key Laboratory of Complex Severe and Rare Diseases, National Clinical Research Center for Dermatologic and Immunologic Diseases, Beijing, China
| | - Hong-Bin Song
- Department of Dermatology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, State Key Laboratory of Complex Severe and Rare Diseases, National Clinical Research Center for Dermatologic and Immunologic Diseases, Beijing, China
| | - Shi-Yu Zhang
- Department of Dermatology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, State Key Laboratory of Complex Severe and Rare Diseases, National Clinical Research Center for Dermatologic and Immunologic Diseases, Beijing, China
| | - Lu Yang
- Department of Dermatology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, State Key Laboratory of Complex Severe and Rare Diseases, National Clinical Research Center for Dermatologic and Immunologic Diseases, Beijing, China
| | - Tao Wang
- Department of Dermatology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, State Key Laboratory of Complex Severe and Rare Diseases, National Clinical Research Center for Dermatologic and Immunologic Diseases, Beijing, China.
| | - Yue-Hua Liu
- Department of Dermatology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, State Key Laboratory of Complex Severe and Rare Diseases, National Clinical Research Center for Dermatologic and Immunologic Diseases, Beijing, China.
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28
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Lefebvre MN, Borcherding N, Reis RJ, Mou E, Liu V, Jabbari A. Molecular techniques drive cutting edge advancements in management of cutaneous T cell lymphoma. Front Immunol 2023; 14:1228563. [PMID: 37654486 PMCID: PMC10465366 DOI: 10.3389/fimmu.2023.1228563] [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: 05/25/2023] [Accepted: 07/27/2023] [Indexed: 09/02/2023] Open
Abstract
Cutaneous 5T cell lymphoma (CTCL), characterized by malignant T cells infiltrating the skin with potential for dissemination, remains a challenging disease to diagnose and treat due to disease heterogeneity, treatment resistance, and lack of effective and standardized diagnostic and prognostic clinical tools. Currently, diagnosis of CTCL practically relies on clinical presentation, histopathology, and immunohistochemistry. These methods are collectively fraught with limitations in sensitivity and specificity. Fortunately, recent advances in flow cytometry, polymerase chain reaction, high throughput sequencing, and other molecular techniques have shown promise in improving diagnosis and treatment of CTCL. Examples of these advances include T cell receptor clonotyping via sequencing to detect CTCL earlier in the disease course and single-cell RNA sequencing to identify gene expression patterns that commonly drive CTCL pathogenesis. Experience with these techniques has afforded novel insights which may translate into enhanced diagnostic and therapeutic approaches for CTCL.
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Affiliation(s)
- Mitchell N. Lefebvre
- University of Iowa Carver College of Medicine, Iowa City, IA, United States
- Department of Dermatology, University of Iowa, University of Iowa Hospitals and Clinics, Iowa City, IA, United States
| | - Nicholas Borcherding
- Department of Pathology and Immunology, Washington University School of Medicine, St. Louis, MO, United States
| | - Ryan J. Reis
- University of Iowa Carver College of Medicine, Iowa City, IA, United States
- Cancer Biology Graduate Program, University of Iowa Carver College of Medicine, Iowa City, IA, United States
| | - Eric Mou
- Department of Hematology and Oncology, University of Iowa Hospitals and Clinics, Iowa City, IA, United States
| | - Vincent Liu
- University of Iowa Carver College of Medicine, Iowa City, IA, United States
- Department of Pathology, University of Iowa Hospitals and Clinics, Iowa City, IA, United States
| | - Ali Jabbari
- University of Iowa Carver College of Medicine, Iowa City, IA, United States
- Iowa City Veterans Affairs Medical Center, Iowa City, IA, United States
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29
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Sun J, You R, Lyu B, Li X, Gao Y, Wen Y, Qu C, Wang Y. HLA-DR Helps to Differentiate Erythrodermic Cutaneous T-cell Lymphoma from Erythrodermic Inflammatory Dermatoses in Flow Cytometry. Acta Derm Venereol 2023; 103:adv5668. [PMID: 37526291 PMCID: PMC10413871 DOI: 10.2340/actadv.v103.5668] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Accepted: 05/17/2023] [Indexed: 08/02/2023] Open
Abstract
Differential diagnosis of erythroderma is challenging in dermatology, especially in differentiating erythrodermic cutaneous T-cell lymphoma from erythrodermic inflammatory dermatoses. This study retrospectively reviewed the peripheral blood flow cytometric results of 73 patients diagnosed with erythroderma at Peking University First Hospital from 2014 to 2019. The flow cytometry antibody panel included white blood cell markers, T-cell markers, B-cell markers, T-cell activation markers, and T helper cell differentiation markers. Features of the cell surface antigens were compared between 34 patients with erythrodermic cutaneous T-cell lymphoma and 39 patients with erythrodermic inflammatory dermatoses. The percentage of HLA-DR+/CD4+T cells was the most pronounced marker to distinguish erythrodermic cutaneous T-cell lymphoma from erythrodermic inflammatory dermatoses, with a threshold of 20.85% (sensitivity 96.77%, specificity 70.37%, p = 0.000, area under the curve (AUC) 0.882), suggesting its potential capability in the differential diagnosis of erythrodermic cutaneous T-cell lymphoma from erythrodermic inflammatory dermatoses. Moreover, in contrast to erythrodermic inflammatory dermatoses, the percentage of Th17 cells was significantly downregulated in erythrodermic cutaneous T-cell lymphoma (p = 0.001), demonstrating a dysregulated immune environment in erythrodermic cutaneous T-cell lymphoma.
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Affiliation(s)
- Jingru Sun
- Department of Dermatology and Venereology, Peking University First Hospital, Beijing 100034, China
| | - Ran You
- Department of Clinical Laboratory, Peking University First Hospital, Beijing 100034, China
| | - Beini Lyu
- Peking University Institute for Global Health and Development, Beijing, China
| | - Xueying Li
- Department of Biostatistics, Peking University First Hospital, Beijing 100034, China
| | - Yumei Gao
- Department of Dermatology and Venereology, Peking University First Hospital, Beijing 100034, China
| | - Yujie Wen
- Department of Dermatology and Venereology, Peking University First Hospital, Beijing 100034, China
| | - Chenxue Qu
- Department of Clinical Laboratory, Peking University First Hospital, Beijing 100034, China.
| | - Yang Wang
- Department of Dermatology and Venereology, Peking University First Hospital, Beijing 100034, China.
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30
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Hashida Y, Nakajima K, Higuchi T, Nakai K, Daibata M. Involvement of cutavirus in a subset of patients with cutaneous T-cell lymphoma with an unfavorable outcome. J Clin Virol 2023; 165:105523. [PMID: 37336173 DOI: 10.1016/j.jcv.2023.105523] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2023] [Revised: 06/04/2023] [Accepted: 06/14/2023] [Indexed: 06/21/2023]
Abstract
BACKGROUND European studies suggest an association between cutavirus (CuV) and cutaneous T-cell lymphoma (CTCL); however, the worldwide prevalence of CuV in patients with CTCL and its prognostic impact remain unknown. METHODS We investigated the prevalence and viral loads of CuV DNA using biopsy specimens from the lesional skins of 141 Japanese patients with cutaneous malignancies, including 55 patients with various types of CTCL. RESULTS CuV DNA was detected significantly more frequently in biopsies from patients with mycosis fungoides (MF) (38% [13/34]; the most common subtype of CTCL) than in those from patients with other cutaneous malignancies (6% [6/107]; P<0.001). The viral-load range in patients with CuV DNA-positive MF was 23-3922 copies/103 cells and 8-65 copies/μg of DNA. A phylogenetic analysis using the partial sequences of the CuV viral capsid protein 1 (VP1)/VP2 genes revealed that the CuV sequences identified here were clustered in a Japanese-specific clade distinct from that comprising CuV sequences from European patients with MF. Kaplan-Meier curves and a log-rank test showed that CuV positivity was associated with a shorter disease-specific survival in patients with MF (P = 0.031), whereas no significant difference in overall survival was observed (P = 0.275). No significant correlation was observed between CuV DNA load and survival in patients with CuV-positive MF. CONCLUSIONS Our results suggest that CuV is associated with MF in a subset of Japanese patients. Large-scale prospective studies are warranted to clarify the role of CuV status, especially regarding the viral genotype, on adverse outcomes in patients with CuV-positive MF.
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Affiliation(s)
- Yumiko Hashida
- Department of Microbiology and Infection, Kochi Medical School, Kochi University, Nankoku, Kochi, Japan
| | - Kimiko Nakajima
- Department of Dermatology, Kochi Medical School, Kochi University, Nankoku, Kochi, Japan
| | - Tomonori Higuchi
- Department of Microbiology and Infection, Kochi Medical School, Kochi University, Nankoku, Kochi, Japan
| | - Kozo Nakai
- Department of Dermatology, Kochi Medical School, Kochi University, Nankoku, Kochi, Japan
| | - Masanori Daibata
- Department of Microbiology and Infection, Kochi Medical School, Kochi University, Nankoku, Kochi, Japan.
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31
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Lee H. Mycosis fungoides and Sézary syndrome. Blood Res 2023; 58:66-82. [PMID: 37105561 PMCID: PMC10133849 DOI: 10.5045/br.2023.2023023] [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: 01/26/2023] [Revised: 04/16/2023] [Accepted: 04/17/2023] [Indexed: 04/29/2023] Open
Abstract
Mycosis fungoides (MF) and Sézary syndrome (SS) are a distinct disease entity of cutaneous T-cell lymphoma with heterogenous clinical features and prognosis. MF mainly involves skin and usually shows an indolent and favorable clinical course. In patients with advanced-stage disease, extracutaneous involvement including lymph nodes, viscera, and blood, or large cell transformation may be observed. SS is a leukemic form of advanced-stage MF, characterized by generalized erythroderma. Early-stage MF can be treated with skin-directed therapy. However, patients with refractory or advanced-stage disease are associated with severe symptoms or poor prognosis, requiring systemic therapy. Recent progress in understanding the pathogenesis of MF/SS has contributed to advances in the management of these rare diseases. This review aims to describe the clinical manifestations, diagnosis, risk stratification, and treatment strategy of MF/SS, focusing on the recent updates in the management of these diseases.
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Affiliation(s)
- Hyewon Lee
- Division of Hemato-Oncology, Department of Internal Medicine, and Center for Hematologic Malignancy, Research Institute and Hospital, National Cancer Center, Goyang, Korea
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32
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Flaum-Dunoyer P, Noor SJ, Myskowski PL. Cutaneous lymphomas in African American/Black patients: pitfalls and presentations. Int J Dermatol 2023; 62:357-368. [PMID: 36017957 DOI: 10.1111/ijd.16374] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Revised: 06/24/2022] [Accepted: 07/26/2022] [Indexed: 11/27/2022]
Abstract
This review describes and highlights differences in clinical presentations of cutaneous lymphomas (CLs), particularly in darker skin types, i.e., Skin of Color (SOC). We illustrate differences in clinical features on physical exam that can be a diagnostic challenge and suggest ways to recognize and identify these conditions at an early stage through a high level of suspicion. The review includes a summary of the epidemiology of various CLs, specifically highlighting the presentation and incidence in African American/Black patients, where the data are available. We also include a discussion of adult HTLV-1-associated T-cell leukemia/lymphoma (ATLL) which, although a systemic T-cell lymphoma, may present with skin manifestations and mimic MF, other CTCL subtypes, or other inflammatory dermatoses. Finally, this review highlights the possible use of imaging modalities, such as dermoscopy and reflectance-confocal microscopy, in diagnosing and recognizing cutaneous lymphomas in patients with darker skin types.
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Affiliation(s)
| | - Sarah J Noor
- Memorial Sloan Kettering Cancer Center, New York, NY, USA
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33
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Spigariolo CB, Berti E, Cerri A, Venegoni L, Croci G, Violetti SA. T follicular helper phenotype mycosis fungoides associated with acanthosis nigricans. J Cutan Pathol 2023; 50:420-424. [PMID: 36764679 DOI: 10.1111/cup.14405] [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: 12/13/2022] [Revised: 01/30/2023] [Accepted: 02/06/2023] [Indexed: 02/12/2023]
Abstract
The association between acanthosis nigricans (AN) and mycosis fungoides (MF) has rarely been described, but it is known that MF may appear as AN-like vegetating and papillomatous plaques in skin folds, or may be associated with paraneoplastic AN. There have also been recent descriptions of a form of "intertriginous MF" that is characterized by skin fold involvement and the expression of T follicular helper (TFH) markers, and that often has an aggressive course. We describe the case of a 48-year-old man affected by MF associated with AN, whose lesions were characterized by a TFH immunophenotype and the expression of the GATA-3 nuclear master regulator that may be related to a TFH-2 subpopulation or possible disease progression.
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Affiliation(s)
- Cristina B Spigariolo
- Unit of Dermatology, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.,Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
| | - Emilio Berti
- Unit of Dermatology, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.,Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
| | - Amilcare Cerri
- Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy.,Dermatology Unit, ASST Santi Paolo e Carlo, Milan, Italy
| | - Luigia Venegoni
- Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
| | - Giorgio Croci
- Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy.,Division of Pathology, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Silvia Alberti Violetti
- Unit of Dermatology, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.,Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
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34
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Groenen PJTA, van den Brand M, Kroeze LI, Amir AL, Hebeda KM. Read the clonotype: Next-generation sequencing-based lymphocyte clonality analysis and perspectives for application in pathology. Front Oncol 2023; 13:1107171. [PMID: 36845702 PMCID: PMC9945094 DOI: 10.3389/fonc.2023.1107171] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2022] [Accepted: 01/19/2023] [Indexed: 02/10/2023] Open
Abstract
Clonality assessment using the unique rearrangements of immunoglobulin (IG) and T-cell receptor (TR) genes in lymphocytes is a widely applied supplementary test for the diagnosis of B-cell and T-cell lymphoma. To enable a more sensitive detection and a more precise comparison of clones compared with conventional clonality analysis based on fragment analysis, the EuroClonality NGS Working Group developed and validated a next-generation sequencing (NGS)-based clonality assay for detection of the IG heavy and kappa light chain and TR gene rearrangements for formalin-fixed and paraffin-embedded tissues. We outline the features and advantages of NGS-based clonality detection and discuss potential applications for NGS-based clonality testing in pathology, including site specific lymphoproliferations, immunodeficiency and autoimmune disease and primary and relapsed lymphomas. Also, we briefly discuss the role of T-cell repertoire of reactive lymphocytic infiltrations in solid tumors and B-lymphoma.
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Affiliation(s)
- Patricia J. T. A. Groenen
- Department of Pathology, Radboud University Medical Center, Nijmegen, Netherlands,Radboud Institute for Molecular Life Sciences, Radboud University Medical Center, Nijmegen, Netherlands,*Correspondence: Patricia J. T. A. Groenen,
| | - Michiel van den Brand
- Department of Pathology, Radboud University Medical Center, Nijmegen, Netherlands,Pathology-DNA, Location Rijnstate Hospital, Arnhem, Netherlands
| | - Leonie I. Kroeze
- Department of Pathology, Radboud University Medical Center, Nijmegen, Netherlands,Radboud Institute for Molecular Life Sciences, Radboud University Medical Center, Nijmegen, Netherlands
| | - Avital L. Amir
- Department of Pathology, Radboud University Medical Center, Nijmegen, Netherlands
| | - Konnie M. Hebeda
- Department of Pathology, Radboud University Medical Center, Nijmegen, Netherlands
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35
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Miyashiro D, Sanches JA. Mycosis fungoides and Sézary syndrome: clinical presentation, diagnosis, staging, and therapeutic management. Front Oncol 2023; 13:1141108. [PMID: 37124514 PMCID: PMC10140754 DOI: 10.3389/fonc.2023.1141108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Accepted: 03/27/2023] [Indexed: 05/02/2023] Open
Abstract
Mycosis fungoides (MF) and Sézary syndrome (SS) are cutaneous T-cell lymphomas. MF is the most common cutaneous lymphoma, and it is classified into classic Alibert-Bazin MF, folliculotropic MF, pagetoid reticulosis, and granulomatous slack skin, each with characteristic clinical presentation, histopathological findings, and distinct clinical behaviors. SS is an aggressive leukemic variant of cutaneous lymphoma, and it is characterized by erythroderma, lymphadenopathy, and peripheral blood involvement by malignant cells. There is a wide range of dermatological manifestations of MF/SS, and prompt recognition is essential for early diagnosis. Skin biopsy for histopathology and immunohistochemical analysis is imperative to confirm the diagnosis of MF/SS. Histopathology may also provide information that may influence prognosis and treatment. Staging follows the TNMB system. Besides advanced stage, other factors associated with poorer prognosis are advanced age, male gender, folliculotropism in histopathology of patients with infiltrated plaques and tumors in the head and neck region, large cell transformation, and elevated lactate dehydrogenase. Treatment is divided into skin-directed therapies (topical treatments, phototherapy, radiotherapy), and systemic therapies (biological response modifiers, targeted therapies, chemotherapy). Allogeneic bone marrow transplantation and extracorporeal photopheresis are other treatment modalities used in selected cases. This review discusses the main clinical characteristics, the histopathological/immunohistochemical findings, the staging system, and the therapeutic management of MF/SS.
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Cohen JM, Damsky W, Girardi M. Comment on "Diagnostic testing of eczematous dermatitis with incomplete response to dupilumab". J Am Acad Dermatol 2022; 87:e241-e242. [PMID: 35933070 DOI: 10.1016/j.jaad.2022.05.069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2022] [Revised: 05/19/2022] [Accepted: 05/26/2022] [Indexed: 11/18/2022]
Affiliation(s)
- Jeffrey M Cohen
- Department of Dermatology, Yale School of Medicine, New Haven, Connecticut.
| | - William Damsky
- Department of Dermatology, Yale School of Medicine, New Haven, Connecticut; Department of Pathology, Yale School of Medicine, New Haven, Connecticut
| | - Michael Girardi
- Department of Dermatology, Yale School of Medicine, New Haven, Connecticut
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Dupilumab-Associated Mycosis Fungoides with a CD8+ Immunophenotype. Dermatopathology (Basel) 2022; 9:385-391. [PMID: 36547219 PMCID: PMC9776571 DOI: 10.3390/dermatopathology9040045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Revised: 11/24/2022] [Accepted: 11/28/2022] [Indexed: 12/05/2022] Open
Abstract
Dupilumab is a humanized IgG4 monoclonal-antibody that is approved by the United States Food and Drug Administration (FDA) for the treatment of moderate-to-severe atopic dermatitis (AD) in patients aged 12 years and older. In recent years, several case studies have associated the unmasking or progression of cutaneous T-cell lymphomas (CTCL) with dupilumab treatment. To date, all reported cases of dupilumab-associated CTCL have shown a CD4+ T-helper-cell-predominant immunophenotype. Here, we report a case of a 72-year-old man who presented with a 2-year history of a diffuse, pruritic eruption, who was started on dupilumab for 9 weeks. He subsequently developed mycosis fungoides (MF) with a CD8+-predominant immunophenotype. Overall, cases of CD8+ mycosis fungoides are less common and relatively less understood than their CD4+ counterparts, with varied presentations and courses. We present a case of dupilumab-associated CD8+ MF to highlight this presentation for pathologists and providers.
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Mycosis Fungoides in Skin of Color. JOURNAL OF THE DERMATOLOGY NURSES' ASSOCIATION 2022. [DOI: 10.1097/jdn.0000000000000708] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Pediatric Mycosis Fungoides: Retrospective Analysis of a Series With CD8 + Profile and Female Predominance. J Pediatr Hematol Oncol 2022; 44:e994-e998. [PMID: 34699461 DOI: 10.1097/mph.0000000000002354] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Accepted: 09/21/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND Mycosis fungoides (MF) in children is a rare disease and there are limited data regarding the behavior of the disease in this age group. We aimed to collect additional data to better understand the clinicopathologic features of MF in children. MATERIALS AND METHODS This study was a retrospective analysis of pediatric MF patients (diagnosed at age 0 to 18 y). RESULTS Thirteen pediatric patients with MF were identified. Female predominance was observed with a ratio of 1.6:1. Median values for age of onset of skin lesions and age at the time of histologic diagnosis were 5 and 12 years, respectively. All patients had early stage (stage IA to IIA) of MF at the time of diagnosis. Hypopigmented MF comprised 77% of all study patients, followed by classic MF (15%) and pagetoid reticulosis (8%). The lower extremity (especially proximal leg) followed by trunk and upper extremity were most commonly affected sites. Seven of 9 patients who had available immunohistochemistry data showed CD8 + predominance. Five of 8 patients whose follow-up data was available, achieved complete response with narrowband ultraviolet B treatment, while 2 and 1 had near complete response and partial response, respectively. CONCLUSIONS Our study demonstrated female sex and CD8 + profile predominance. Hypopigmented MF constituted the majority of cases. We observed good responses with narrowband ultraviolet B treatment.
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Park A, Wong L, Lang A, Kraus C, Anderson N, Elsensohn A. Cutaneous T-cell lymphoma following dupilumab use: a systematic review. Int J Dermatol 2022. [PMID: 36073768 DOI: 10.1111/ijd.16388] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2022] [Revised: 06/20/2022] [Accepted: 07/28/2022] [Indexed: 11/30/2022]
Abstract
In recent years, studies have associated dupilumab with unmasking or progression of cutaneous T-cell lymphoma (CTCL). The objective of this study was to synthesize reported cases of CTCL in the setting of dupilumab use. Two independent reviewers conducted a systematic review using PubMed and Embase databases. Twelve studies, of 27 total patients, were included. Dupilumab-associated CTCL was diagnosed on average 7.8 months following dupilumab initiation. Of reports that included body surface area (BSA), 100% had a BSA >50% prior to diagnosis, and the majority of patients were diagnosed at later stages of disease: stage III (4/18) or IV (6/18). Post-dupilumab biopsies revealed a greater density of cells and a predominant lichenoid pattern, compared to various histologic patterns and less cell density in pre-dupilumab biopsies. The majority of TCR gene rearrangement studies were equivocal (20%) or negative (60%), posing a potential diagnostic pitfall. Limitations included lack of standardized data collection and reporting and a small number of studies. We suggest that earlier biopsies, three to four months after initiation of dupilumab, may be helpful for earlier recognition of CTCL in patients who are not improving, progressing, or have morphologic changes on dupilumab.
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Affiliation(s)
- Ariel Park
- Department of Dermatology, Loma Linda University, Loma Linda, CA, USA
| | - Lulu Wong
- Department of Dermatology, Loma Linda University, Loma Linda, CA, USA
| | - Annalise Lang
- Department of Dermatology, Loma Linda University, Loma Linda, CA, USA
| | - Christina Kraus
- Department of Dermatology, University of California, Irvine, Irvine, CA, USA
| | - Nancy Anderson
- Department of Dermatology, Loma Linda University, Loma Linda, CA, USA
| | - Ashley Elsensohn
- Department of Dermatology, Loma Linda University, Loma Linda, CA, USA
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Yu S, Zhang J, Ding Y, Kang X, Pu X. Genome-wide identification of alternative splicing associated with histone deacetylase inhibitor in cutaneous T-cell lymphomas. Front Genet 2022; 13:937623. [PMID: 36147491 PMCID: PMC9485882 DOI: 10.3389/fgene.2022.937623] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2022] [Accepted: 08/19/2022] [Indexed: 11/18/2022] Open
Abstract
Cutaneous T-cell lymphomas (CTCLs) are a kind of non-Hodgkin lymphoma that originates from skin, which is difficult to treat with traditional drugs. Human histone deacetylase inhibitors (HDACi) targeted therapy has become a promising treatment strategy in recent years, but some patients can develop resistance to the drug, leading to treatment failure. There are no public reports on whether alternative splicing (AS) and RNA binding proteins (RBP) affect the efficacy of targeted therapy. Using data from the Gene Expression Omnibus (GEO) database, we established a co-change network of AS events and RBP in CTCLs for the first time, and analyzed the potential regulatory effects of RBP on HDACi-related AS events. The dataset GSE132053, which contained the RNA sequence data for 17 HDACi samples, was downloaded and clean reads were aligned to the human GRCh38 genome by hierarchical indexing for spliced alignment of the transcripts, allowing four mismatches. Gene expression levels were evaluated using exons per million fragments mapped for each gene. Student’s t-tests were performed to evaluate the significance of changes in ratios for AS events, and regulated alternative splicing events (RASEs) were defined as events with p values less than 0.05. To sort the differentially expressed genes functional categories, Gene Ontology terms and Kyoto Encyclopedia of Genes and Genomes pathways were identified using the KOBAS 2.0 server. The regulatory mechanisms of the RASEs and RBPs were evaluated using Pearson’s correlation coefficient. Seven indirect events of HDACi resistance or sensitivity were identified: NIR_5151_RP11-977G19.10, NIR_4557_IRAG2, NIR_11870_SUMO1, NIR_5347_ING4, NIR_17935_DNAJC2, NIR_17974_CBLL1, and NIR_422_SLC50A1. The potential regulatory relationships between RBPs and HDACi-sensitive RASEs were also analyzed. LEPR and HNRNPAO significantly affected NIR_11870_SUMO1, suggesting a potential regulatory relationship. Additionally, CNN1 may regulate NIR_5347_ING4, CNOT3 may regulate NIR_17935_DNAJC2, and DQX1 and LENG9 may regulate NIR_422_SLC5A1. Overall, our findings establish a theoretical foundation for the precise targeted treatment of CTCLs with HDACi.
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Affiliation(s)
- Shirong Yu
- Xinjiang Medical University, Urumqi, China
| | | | - Yuan Ding
- Department of Dermatology, People’s Hospital of Xinjiang Uygur Autonomous Region, Urumqi, China
- Xinjiang Clinical Research Center for Dermatologic Diseases, Urumqi, China
- Xinjiang Key Laboratory of Dermatology Research, Urumqi, China
| | - Xiaojing Kang
- Department of Dermatology, People’s Hospital of Xinjiang Uygur Autonomous Region, Urumqi, China
- Xinjiang Clinical Research Center for Dermatologic Diseases, Urumqi, China
- Xinjiang Key Laboratory of Dermatology Research, Urumqi, China
| | - Xiongming Pu
- Department of Dermatology, People’s Hospital of Xinjiang Uygur Autonomous Region, Urumqi, China
- Xinjiang Clinical Research Center for Dermatologic Diseases, Urumqi, China
- Xinjiang Key Laboratory of Dermatology Research, Urumqi, China
- *Correspondence: Xiongming Pu,
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Kohn Kucharik A, Sivesind TE, Schmitt J, Weberschock T, Wu P, Masood M, Dellavalle RP. From the Cochrane Library: Interventions for Mycosis Fungoides. JMIR DERMATOLOGY 2022; 5:e34448. [PMID: 37632890 PMCID: PMC10334910 DOI: 10.2196/34448] [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: 10/25/2021] [Revised: 06/30/2022] [Accepted: 07/31/2022] [Indexed: 11/13/2022] Open
Affiliation(s)
- Alison Kohn Kucharik
- Charles E Schmidt College of Medicine, Florida Atlantic University, Boca Raton, FL, United States
| | - Torunn E Sivesind
- Department of Dermatology, University of Colorado Anschutz Medical Campus, Aurora, CO, United States
| | - Jochen Schmitt
- Center for Evidence-based Healthcare, Faculty of Medicine Carl Gustav, Technische Universität Dresden, Dresden, Germany
| | - Tobias Weberschock
- Department of Dermatology, Venereology and Allergology, University Hospital Frankfurt, Frankfurt, Germany
- Working group Evidence-based Medicine Frankfurt, Institute for General Practice, Goethe University Frankfurt, Frankfurt, Germany
| | - Peggy Wu
- Department of Dermatology, University of California Davis, Sacramento, CA, United States
| | - Mavra Masood
- Virginia Commonwealth University School of Medicine, Richmond, VA, United States
| | - Robert P Dellavalle
- Department of Dermatology, University of Colorado Anschutz Medical Campus, Aurora, CO, United States
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Chen YW, Yang HZ, Zhao SS, Zhang Z, Chen ZM, Feng HH, An MH, Wang KK, Duan R, Chen BD. Ultrasound-guided microwave ablation as a palliative treatment for mycosis fungoides eyelid involvement: A case report. World J Clin Cases 2022; 10:5825-5832. [PMID: 35979116 PMCID: PMC9258385 DOI: 10.12998/wjcc.v10.i17.5825] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Revised: 03/11/2022] [Accepted: 04/04/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Mycosis fungoides (MF) is a form of lymphoma derived from heterogeneous T cells, and eyelid involvement is extremely rare. The common methods to treat eyelid involvement are radiotherapy and chemotherapy, but their efficacies are limited. Herein, we report a case of advanced-stage MF eyelid involvement, propose ultrasound (US)-guided microwave ablation (MWA) therapy and present a literature review.
CASE SUMMARY A male patient was admitted to our hospital in June 2018 and diagnosed with MF via radiological and histopathological examinations. The patient’s condition was not well controlled by various conventional chemotherapies. US-guided MWA was performed to relieve the patient’s symptoms and improve his quality of life, showing satisfactory efficacy.
CONCLUSION Eyelid involvement is one of the most troublesome clinical problems for advanced-stage MF patients. This is the first report on the use of US-guided MWA as a palliative therapy for MF eyelid involvement; the treatment successfully relieved the patient’s clinical symptoms and reduced his anxiety behaviours. Our study sheds new light on methods for improving the clinical management of eyelid involvement in MF.
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Affiliation(s)
- Yan-Wei Chen
- Department of Medical Ultrasound, The Affiliated Hospital of Jiangsu University, Zhenjiang 212000, Jiangsu Province, China
| | - Hai-Zhen Yang
- Department of Medical Ultrasound, The Affiliated Hospital of Jiangsu University, Zhenjiang 212000, Jiangsu Province, China
| | - Shuang-Shuang Zhao
- Department of Medical Ultrasound, The Affiliated Hospital of Jiangsu University, Zhenjiang 212000, Jiangsu Province, China
| | - Zheng Zhang
- Department of Medical Ultrasound, The Affiliated Hospital of Jiangsu University, Zhenjiang 212000, Jiangsu Province, China
| | - Zhe-Ming Chen
- Department of Medical Ultrasound, The Affiliated Hospital of Jiangsu University, Zhenjiang 212000, Jiangsu Province, China
| | - Hua-Hui Feng
- Department of Medical Ultrasound, The Affiliated Hospital of Jiangsu University, Zhenjiang 212000, Jiangsu Province, China
| | - Mao-Hui An
- Department of Medical Ultrasound, The Affiliated Hospital of Jiangsu University, Zhenjiang 212000, Jiangsu Province, China
| | - Ke-Ke Wang
- Department of Medical Ultrasound, The Affiliated Hospital of Jiangsu University, Zhenjiang 212000, Jiangsu Province, China
| | - Ran Duan
- Department of Medical Ultrasound, The Affiliated Hospital of Jiangsu University, Zhenjiang 212000, Jiangsu Province, China
| | - Bao-Ding Chen
- Department of Medical Ultrasound, The Affiliated Hospital of Jiangsu University, Zhenjiang 212000, Jiangsu Province, China
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Ortiz-Romero PL, Maroñas Jiménez L, Muniesa C, Estrach T, Servitje O, Fernández-de-Misa R, Gallardo F, Sanmartín O, Riveiro-Falkenbach E, García-Díaz N, Vega R, Lora D, Postigo C, Jiménez B, Sánchez-Beato M, Pedro Vaqué J, Rodríguez Peralto JL, de la Cámara AG, de la Cruz J, Piris Pinilla MÁ. Activity and safety of topical pimecrolimus in patients with early stage mycosis fungoides (PimTo-MF): a single-arm, multicentre, phase 2 trial. THE LANCET HAEMATOLOGY 2022; 9:e425-e433. [DOI: 10.1016/s2352-3026(22)00107-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/14/2022] [Revised: 03/25/2022] [Accepted: 03/30/2022] [Indexed: 12/19/2022]
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Subtlety of Granulomatous Mycosis Fungoides: A Retrospective Case Series Study and Proposal of Helpful Multimodal Diagnostic Approach With Literature Review. Am J Dermatopathol 2022; 44:559-567. [PMID: 35476045 DOI: 10.1097/dad.0000000000002181] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
ABSTRACT Granulomatous mycosis fungoides (GMF) harbors a worse prognosis compared with classic MF and remains a significant diagnostic dilemma. We analyzed clinicopathologic, immunophenotypic, and molecular characteristics of GMF to develop a diagnostic algorithm. Our methodology involved a retrospective case series study of patients with GMF from our database between 2014 and 2020. A total of 8 patients with 9 biopsies of GMF were identified. Skin manifestations had variable clinical phenotype. Histologically, all cases demonstrated atypical CD4+ T-cell infiltrate with scant in 50% (n = 4), focal 37.5% (n = 3), and absent 25% (n = 2) epidermotropism. Granuloma formation was seen in 77.8% biopsies (n = 7) with sarcoid-type granulomas in 57.1% (n = 4) and granuloma annulare-like type in 42.9% (n = 3). In 66.7% of biopsies (n = 6), the CD4:CD8 ratio was >4:1 and 66.6% (n = 6) of biopsies showed ≥50% loss of CD7 expression. T-cell receptor gene rearrangement studies performed on biopsy sections were positive in all biopsies (n = 6), whereas peripheral blood T-cell receptor gene rearrangement studies did not identify clonality. In conclusion, GMF has subtle or absent epidermotropism and variable granulomatous reaction; thus, the diagnosis requires a multimodal approach, and our proposed algorithm provides a framework to approach this diagnostic challenge.
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Cheng M, Zain J, Rosen ST, Querfeld C. Emerging drugs for the treatment of cutaneous T-cell lymphoma. Expert Opin Emerg Drugs 2022; 27:45-54. [PMID: 35235473 DOI: 10.1080/14728214.2022.2049233] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
INTRODUCTION Cutaneous T cell lymphoma (CTCL) is a rare and incurable group of non-Hodgkin lymphomas that manifests as patches, plaques, tumors, and/or erythroderma in the skin. Standard skin-directed therapies for CTCL are effective in patients with indolent early-stage disease but more advanced/refractory stage patients require systemic therapies. However, none of the treatments are considered curative and most patients suffer from relapses. Biologic therapies and immunotherapy provide novel treatment options for patients with advanced or refractory disease. AREAS COVERED This review provides a discussion of recently approved biological and novel therapeutics that are actively developed for the management of the heterogenous group of CTCL. EXPERT OPINION Mogamulizumab and brentuximab vedotin have reached the market and are approved for the treatment of CTCL, providing valuable options. Additionally, therapies utilizing immune checkpoint inhibitors, miRNA inhibitors, and peptide inhibitors show promising results in clinical trials. Durvalumab, pembrolizumab, TTI-621, BNZ-1, and MRG-106 are several of the emerging treatments still in trials. Further combinatorial studies are needed as none of the treatments have demonstrated long term remissions.
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Affiliation(s)
- Melissa Cheng
- Division of Dermatology, City of Hope National Medical Center, Duarte, CA, USA.,Western University of Health Sciences College of Osteopathic Medicine of the Pacific, Pomona, CA, USA
| | - Jasmine Zain
- Department of Hematology and Hematopoietic Cell Transplantation, City of Hope National Medical Center, Duarte, CA, USA
| | - Steven T Rosen
- Department of Hematology and Hematopoietic Cell Transplantation, City of Hope National Medical Center, Duarte, CA, USA.,Beckman Research Institute, Duarte, CA, USA
| | - Christiane Querfeld
- Division of Dermatology, City of Hope National Medical Center, Duarte, CA, USA.,Department of Pathology, City of Hope National Medical Center, Duarte, CA, USA.,Beckman Research Institute, Duarte, CA, USA
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Beksaç B, Gleason L, Baik S, Ringe JM, Porcu P, Nikbakht N. Dermal fibroblasts promote cancer cell proliferation and exhibit fibronectin overexpression in early mycosis fungoides. J Dermatol Sci 2022; 106:53-60. [PMID: 35331619 PMCID: PMC9133159 DOI: 10.1016/j.jdermsci.2022.03.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Revised: 02/07/2022] [Accepted: 03/13/2022] [Indexed: 10/18/2022]
Abstract
BACKGROUND Mycosis fungoides (MF) is caused by proliferation of malignant T-cells in the skin and may progress to involve blood, lymph nodes, and viscera. While the skin microenvironment is essential for the initiation and progression of MF in early stages, little is known about the impact of skin stroma on the growth and survival of malignant lymphocytes. OBJECTIVE We investigated the effect of dermal fibroblasts and their product, fibronectin, on the survival and proliferation of malignant MF cells. METHODS Fibroblasts and malignant MF CD4 T-cells were isolated from skin of patients with early-stage MF. Fibroblast-lymphocyte co-culture experiments and lymphocyte cultures on fibronectin-coated plates were established utilizing the cells derived from lesional skin, blood, and MF cell lines. The survival and proliferation rates of lymphocytes were assessed via Annexin V and carboxyfluorescein succinimidyl ester assays respectively. Additionally, integrin and fibronectin expressions in MF skin were assessed via immunofluorescence. RESULTS We found that dermal fibroblasts increased the proliferation rates of MF cells, but not normal skin or blood CD4 T-cells. However, fibroblasts did not rescue MF cells from apoptosis in co-cultures. In MF skin, we found an overexpression of a fibronectin isoform not normally found in healthy skin. MF cells expressed fibronectin-binding integrins and adhered to fibronectin but did not exhibit adhesion-mediated survival via fibronectin-integrin interactions. CONCLUSION Overall, our results suggest a direct role for fibroblasts, independent of fibronectin-mediated adhesion, in promoting MF cell proliferation. These findings have implications in understanding and targeting the malignant skin stromal microenvironment in cutaneous lymphomas.
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Leng L, Liu Z, Ma J, Zhang S, Wang Y, Lv L, Zhu Y, Gao D, Wang Y, Wang J, Liu Y, Liu J. Proteomic identification of new diagnostic biomarkers of early-stage cutaneous mycosis fungoides. Cancer Commun (Lond) 2022; 42:558-562. [PMID: 35049132 PMCID: PMC9198347 DOI: 10.1002/cac2.12266] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2021] [Revised: 01/10/2022] [Accepted: 01/13/2022] [Indexed: 11/17/2022] Open
Affiliation(s)
- Ling Leng
- Department of Dermatology, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, National Clinical Research Center for Dermatologic and Immunologic Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100730, P. R. China.,Stem cell and Regenerative Medicine Lab, State Key Laboratory of Complex Severe and Rare Diseases, Department of Medical Science Research Center, Translational Medicine Center, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100730, P. R. China
| | - Zhaorui Liu
- Department of Dermatology, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, National Clinical Research Center for Dermatologic and Immunologic Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100730, P. R. China
| | - Jie Ma
- State Key Laboratory of Proteomics, Beijing Proteome Research Center, National Center for Protein Sciences (Beijing), Beijing Institute of Lifeomics, Beijing, 102206, P. R. China
| | - Shiyu Zhang
- Department of Dermatology, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, National Clinical Research Center for Dermatologic and Immunologic Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100730, P. R. China
| | - Yukun Wang
- Department of Dermatology, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, National Clinical Research Center for Dermatologic and Immunologic Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100730, P. R. China
| | - Luye Lv
- Institute of NBC Defense, Beijing, 102205, P. R. China
| | - Yunping Zhu
- State Key Laboratory of Proteomics, Beijing Proteome Research Center, National Center for Protein Sciences (Beijing), Beijing Institute of Lifeomics, Beijing, 102206, P. R. China.,Basic Medical School, Anhui Medical University, Feihe, Anhui, 230032, P. R. China
| | - Dunqin Gao
- Stem cell and Regenerative Medicine Lab, State Key Laboratory of Complex Severe and Rare Diseases, Department of Medical Science Research Center, Translational Medicine Center, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100730, P. R. China
| | - Yujie Wang
- Stem cell and Regenerative Medicine Lab, State Key Laboratory of Complex Severe and Rare Diseases, Department of Medical Science Research Center, Translational Medicine Center, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100730, P. R. China
| | - Juncheng Wang
- Department of Dermatology, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, National Clinical Research Center for Dermatologic and Immunologic Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100730, P. R. China
| | - Yuehua Liu
- Department of Dermatology, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, National Clinical Research Center for Dermatologic and Immunologic Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100730, P. R. China
| | - Jie Liu
- Department of Dermatology, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, National Clinical Research Center for Dermatologic and Immunologic Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100730, P. R. China
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Alojail HY, Alshehri H, Kaliyadan F. Clinical Patterns and Treatment Response of Patients With Mycosis Fungoides a Retrospective Study. Cureus 2022; 14:e21231. [PMID: 35174031 PMCID: PMC8841018 DOI: 10.7759/cureus.21231] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/14/2022] [Indexed: 11/08/2022] Open
Abstract
Background Mycosis fungoides (MF) is one of the primary cutaneous T-cell lymphomas and is considered to be the most common extranodal non-Hodgkin lymphomas. MF is characterized by different subtypes based on clinical presentation and immunophenotyping studies. We aimed to study the clinical patterns and treatment response in cases of MF among the patients attending a tertiary referral hospital in Saudi Arabia. Methodology A retrospective study, case record-based study was done to review all the patients diagnosed with MF from January 2011 to May 2016. All cases with histopathological confirmation and immunophenotyping were included in the study. Treatment follow-up was reviewed for 9 months in all cases. Treatment response was graded based on a global physician assessment-complete response, good response, moderate response, and minimal or no response. Results Out of 34 cases of MF included in the study, 11 were hyperpigmented MF, 21 were hypopigmented MF, and there was one case each of poikilodermatous MF and pagetoid reticulosis. Of the total, fourteen (66.7%) of hypopigmented MF patients showed a complete response to phototherapy Narrowband UVB (NB-UVB) in combination with topical corticosteroids. Nine (81.8%) of hyperpigmented MF patients showed partial to the phototherapy NB-UVB in combination with the topical corticosteroid. Among the other types; one case of poikilodermatous MF (2.9%) showed a moderate response to phototherapy NB-UVB with topical corticosteroid and systemic acitretin. Conclusions The most common type of MF seen in our study was the hypopigmented type, affecting a younger age group, and the same showed a good response to phototherapy NB-UVB combined with topical corticosteroids.
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Jairath R, Raval NS, Musiek AC. SnapshotDx Quiz: January 2022. J Invest Dermatol 2022. [DOI: 10.1016/j.jid.2021.11.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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