1
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Zhang Y, Zhang M, Li Y, Wang H. Report on a Rare Case of Limited CD4/CD8 Double-Positive Paget Reticulosis with Literature Review. Clin Cosmet Investig Dermatol 2024; 17:1245-1250. [PMID: 38827631 PMCID: PMC11141765 DOI: 10.2147/ccid.s462966] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2024] [Accepted: 05/18/2024] [Indexed: 06/04/2024]
Abstract
Restricted pagetoid reticulosis, also known as Woringer-Kolopp disease, represents a rare cutaneous lymphoproliferative disorder categorized as an isolated variant of mycosis fungoides. This report presents a case involving limited pagetoid reticulosis affecting the right upper extremity in a 25-year-old female. The patient had been experiencing plaques on the right upper extremity for a decade. Dermatologic examination revealed well-defined scaly plaques on the right forearm, surrounded by hyperpigmented patches. Skin histopathology demonstrated atypical mononuclear cell infiltration in the lower part of the epidermis, forming nests. Immunohistochemistry indicated CD3+, CD4+, CD5+, CD7+, CD8+, CD30+, and Ki-67-positive staining. Additionally, CD20, CD79α, and PD-1 were negative. Monoclonal rearrangement of T-cells was identified in TCR β and TCR γ through clonality assessment. The diagnosis of limited paget-like reticulocyte hyperplasia was established, leading to surgical resection. A review of the literature affirmed the variable immunophenotype of pagetoid reticulosis, with atypical cells exhibiting four types: (1) CD3+, CD4+, CD8+-type; (2) CD3+, CD4-, CD8+-type; (3) CD3+, CD4-, CD8-type; and (4) CD3+, CD4+, CD8+-type-relatively uncommon in the restrictive type. This case report details the clinical features, histologic and morphologic characteristics, immunohistochemical phenotype, diagnosis, and differential diagnosis of a rare CD3+, CD4+, CD8+ limited pagetoid reticulosis. The lesion was surgically resected, and the patient underwent a 3-year follow-up to observe its prognosis.
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Affiliation(s)
- Yunfang Zhang
- The Department of Oncology, Hainan Provincial Hospital of TCM, Haikou, Hainan, People’s Republic of China
| | - Ming Zhang
- Department of Dermatology, The Fifth People’s Hospital of Hainan Province, Haikou, Hainan, People’s Republic of China
| | - Yuan Li
- Department of Cosmetic Dermatology, The Fifth People’s Hospital of Hainan Province, Haikou, Hainan, People’s Republic of China
| | - Huaji Wang
- Department of Cosmetic Dermatology, The Fifth People’s Hospital of Hainan Province, Haikou, Hainan, People’s Republic of China
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2
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Huang HY, Nguyen HT, Lin TL, Saenprasarn P, Liu PH, Wang HC. Identification of Skin Lesions by Snapshot Hyperspectral Imaging. Cancers (Basel) 2024; 16:217. [PMID: 38201644 PMCID: PMC10778186 DOI: 10.3390/cancers16010217] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2023] [Revised: 12/28/2023] [Accepted: 01/01/2024] [Indexed: 01/12/2024] Open
Abstract
This study pioneers the application of artificial intelligence (AI) and hyperspectral imaging (HSI) in the diagnosis of skin cancer lesions, particularly focusing on Mycosis fungoides (MF) and its differentiation from psoriasis (PsO) and atopic dermatitis (AD). By utilizing a comprehensive dataset of 1659 skin images, including cases of MF, PsO, AD, and normal skin, a novel multi-frame AI algorithm was used for computer-aided diagnosis. The automatic segmentation and classification of skin lesions were further explored using advanced techniques, such as U-Net Attention models and XGBoost algorithms, transforming images from the color space to the spectral domain. The potential of AI and HSI in dermatological diagnostics was underscored, offering a noninvasive, efficient, and accurate alternative to traditional methods. The findings are particularly crucial for early-stage invasive lesion detection in MF, showcasing the model's robust performance in segmenting and classifying lesions and its superior predictive accuracy validated through k-fold cross-validation. The model attained its optimal performance with a k-fold cross-validation value of 7, achieving a sensitivity of 90.72%, a specificity of 96.76%, an F1-score of 90.08%, and an ROC-AUC of 0.9351. This study marks a substantial advancement in dermatological diagnostics, thereby contributing significantly to the early and precise identification of skin malignancies and inflammatory conditions.
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Affiliation(s)
- Hung-Yi Huang
- Department of Dermatology, Ditmanson Medical Foundation Chiayi Christian Hospital, Chia Yi City 60002, Taiwan;
| | - Hong-Thai Nguyen
- Department of Mechanical Engineering, National Chung Cheng University, 168, University Rd., Min Hsiung, Chia Yi City 62102, Taiwan
| | - Teng-Li Lin
- Department of Dermatology, Dalin Tzu Chi General Hospital, No. 2, Min-Sheng Rd., Dalin Town, Chia Yi City 62247, Taiwan;
| | - Penchun Saenprasarn
- School of Nursing, Shinawatra University, 99 Moo 10, Bangtoey, Samkhok, Pathum Thani 12160, Thailand;
| | - Ping-Hung Liu
- Division of General Surgery, Department of Surgery, Kaohsiung Armed Forces General Hospital, 2, Zhongzheng 1st.Rd., Lingya District, Kaohsiung City 80284, Taiwan
| | - Hsiang-Chen Wang
- Department of Mechanical Engineering, National Chung Cheng University, 168, University Rd., Min Hsiung, Chia Yi City 62102, Taiwan
- Director of Technology Development, Hitspectra Intelligent Technology Co., Ltd., Kaohsiung City 80661, Taiwan
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3
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Kudoh R, Komiya K, Takaki R, Yokoyama A, Hiramatsu K, Kadota JI. Pneumocystis jirovecii Pneumonia in a Patient With Localized Mycosis Fungoides Not Receiving Immunosuppressive Treatment. Cureus 2024; 16:e51724. [PMID: 38318593 PMCID: PMC10839542 DOI: 10.7759/cureus.51724] [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: 01/05/2024] [Indexed: 02/07/2024] Open
Abstract
Pneumocystis jirovecii pneumonia (PCP) is the most common opportunistic infection in patients with human immunodeficiency virus (HIV), but it may develop in patients without HIV, whose immune system is suppressed by anticancer or immunosuppressive agents even when indicating normal counts of CD4+ T cells. Mycosis fungoides (MF) is a primary cutaneous T-cell lymphoma, which is believed not to cause immunosuppressive conditions unless it develops leukosis or metastasis or is treated with anticancer drugs or systemic immunosuppressants. Here, we report a case of PCP in a patient with localized MF not receiving immunosuppressive treatment. The patient, a woman in her 70s, presented with persistent dyspnea. High-resolution computed tomography (HRCT) showed diffuse ground-glass opacities in both lungs. Bronchoalveolar lavage fluid was positive for P. jirovecii. Moreover, the cytomegalovirus antigenemia test was positive, whereas tests for anti-HIV and antihuman T-cell lymphotropic virus antibodies were negative. The patient was treated with trimethoprim-sulfamethoxazole, prednisolone, and ganciclovir, which gradually improved the symptoms and diminished diffuse ground-glass opacities on HRCT. This case exemplifies a rare presentation of PCP with mild MF that was not treated with chemotherapy or immunosuppressants. The possible mechanisms for the development of PCP are discussed.
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Affiliation(s)
- Ryohei Kudoh
- Respiratory Medicine and Infectious Diseases, Oita University, Oita, JPN
| | - Kosaku Komiya
- Respiratory Medicine and Infectious Diseases, Faculty of Medicine, Oita University, Oita, JPN
| | - Ryuichiro Takaki
- Respiratory Medicine and Infectious Diseases, Oita University, Oita, JPN
| | - Atsushi Yokoyama
- Respiratory Medicine and Infectious Diseases, Oita University, Oita, JPN
| | - Kazufumi Hiramatsu
- Respiratory Medicine and Infectious Diseases, Faculty of Medicine, Oita University, Oita, JPN
| | - Jun-Ichi Kadota
- Respiratory Medicine and Infectious Diseases, Oita University, Oita, JPN
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4
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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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5
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Baykal C, Polat Ekinci A. Annular skin tumors and lymphoproliferative diseases. Clin Dermatol 2023; 41:692-711. [PMID: 37586571 DOI: 10.1016/j.clindermatol.2023.08.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/18/2023]
Abstract
Determining the shape of a skin lesion may provide a diagnostic clue in dermatology practice, more commonly for inflammatory diseases but also for skin tumors. The annular formation may develop by diverse mechanisms in skin tumors. Annular lesions may occur from the onset of the tumor as sparing the central area or depression and/or ulceration in the center of the tumor or outward expansion of the primary lesion. Clustering of multiple papulonodular lesions sparing the central area or relatively independent processes acting on the central and peripheral components of the tumor may also result in an annular appearance. We have explored a wide variety of benign and malignant skin tumors and lymphoproliferative diseases forming an annular shape.
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Affiliation(s)
- Can Baykal
- Department of Dermatology and Venereology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Algün Polat Ekinci
- Department of Dermatology and Venereology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey.
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6
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Cheng D, Xu Q, Zhang W, Chen J, Yao Z. Refractory lymphomatoid papulosis successfully treated with IFN-α2a and photodynamic therapy. Int J Dermatol 2023; 62:1400-1403. [PMID: 37489708 DOI: 10.1111/ijd.16759] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2023] [Revised: 05/26/2023] [Accepted: 06/15/2023] [Indexed: 07/26/2023]
Affiliation(s)
- Daian Cheng
- Dermatology Center, Xinhua Hospital, School of medicine, Shanghai Jiao Tong University, Shanghai, China
- Department of Dermatology, Xinhua Hospital, School of medicine, Shanghai Jiao Tong University, Shanghai, China
- Institute of Dermatology, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Qianyue Xu
- Dermatology Center, Xinhua Hospital, School of medicine, Shanghai Jiao Tong University, Shanghai, China
- Department of Dermatology, Xinhua Hospital, School of medicine, Shanghai Jiao Tong University, Shanghai, China
- Institute of Dermatology, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Wenqing Zhang
- Dermatology Center, Xinhua Hospital, School of medicine, Shanghai Jiao Tong University, Shanghai, China
- Department of Dermatology, Xinhua Hospital, School of medicine, Shanghai Jiao Tong University, Shanghai, China
- Institute of Dermatology, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Jiawen Chen
- Dermatology Center, Xinhua Hospital, School of medicine, Shanghai Jiao Tong University, Shanghai, China
- Department of Dermatology, Xinhua Hospital, School of medicine, Shanghai Jiao Tong University, Shanghai, China
- Institute of Dermatology, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Zhirong Yao
- Dermatology Center, Xinhua Hospital, School of medicine, Shanghai Jiao Tong University, Shanghai, China
- Department of Dermatology, Xinhua Hospital, School of medicine, Shanghai Jiao Tong University, Shanghai, China
- Institute of Dermatology, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
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7
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Saleh JS, Subtil A, Hristov AC. Primary cutaneous T-cell lymphoma: a review of the most common entities with focus on recent updates. Hum Pathol 2023; 140:75-100. [PMID: 37802757 DOI: 10.1016/j.humpath.2023.09.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Revised: 06/01/2023] [Accepted: 06/07/2023] [Indexed: 10/08/2023]
Abstract
Cutaneous T-cell lymphomas are an heterogeneous group of uncommon lymphoid neoplasms that are challenging to diagnose and require close collaboration between dermatologists, pathologists and hematologists/oncologists. This article reviews the most common cutaneous T-cell lymphomas: mycosis fungoides (both classic and variant forms) as well as its leukemic counterpart Sézary syndrome, CD30+ T-cell lymphoproliferative disorders including the ever-expanding group of lymphomatoid papulosis and primary cutaneous anaplastic large cell lymphoma, and primary cutaneous CD4+ small/medium lymphoproliferative disorder. We discuss the classic clinical and histopathologic features of these lymphomas and review how they can be distinguished from reactive entities. In particularly, updates to these diagnostic categories and current controversies in classification are highlighted. Moreover, we review the prognosis and treatment for each entity. These lymphomas exhibit variable prognosis, and therefore it is important to correctly classify atypical cutaneous T-cell infiltrates for appropriate patient treatment and prognosis. Cutaneous T-cell lymphomas are at the interface of several medical specialties; this review seeks to summarize key features of these lymphomas and highlight new and emerging insights into these lymphomas.
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Affiliation(s)
- Jasmine S Saleh
- Department of Pathology, University of Michigan, Ann Arbor, MI, 48109, USA; Department of Dermatology, University of Michigan, Ann Arbor, MI, 48109, USA
| | - Antonio Subtil
- Department of Pathology, Royal Jubilee Hospital, University of British Columbia, Victoria, British Columbia, V8R1J8, Canada
| | - Alexandra C Hristov
- Department of Pathology, University of Michigan, Ann Arbor, MI, 48109, USA; Department of Dermatology, University of Michigan, Ann Arbor, MI, 48109, USA.
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8
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Wikholm CG, Thakker S, Bakhshi PR, Swigost AJ, Moshell A, Cardis MA. Vegetative plaque on the left superior eyelid. SKIN HEALTH AND DISEASE 2023; 3:e277. [PMID: 37799372 PMCID: PMC10549867 DOI: 10.1002/ski2.277] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Revised: 07/12/2023] [Accepted: 07/28/2023] [Indexed: 10/07/2023]
Abstract
Herein we present case report of a 73-year-old female who developed a rapidly growing, ulcerated lesion on her left superior eyelid. Despite treatment for suspected infection, symptoms only marginally improved. Physical examination revealed a diffusely ulcerated multinodular tumour with overlying haemorrhagic and serosanguineous exudate. A shave biopsy led to a diagnosis of primary cutaneous anaplastic large cell lymphoma (pcALCL), a rare CD30+ lymphoproliferative disorder. The patient had no extracutaneous involvement on PET-CT and her prognosis is good given the indolent nature of pcALCL. Differential diagnoses included merkel cell carcinoma, periocular sebaceous carcinoma, lymphomatoid papulosis, and extranodal natural killer/T cell lymphoma. Prognosis for pcALCL is generally good. Treatment recommendation for pcALCL is surgical excision with negative margins for localised disease, while intravenous brentuximab vedotin is suggested for widespread, relapsed, and refractory disease.
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Affiliation(s)
- Colin G. Wikholm
- Department of DermatologyMedStar Washington Hospital Center / Georgetown University HospitalWashingtonColumbiaUSA
| | - Sach Thakker
- Georgetown University School of MedicineWashingtonColumbiaUSA
| | | | - Adam J. Swigost
- Department of DermatologyMedStar Washington Hospital Center / Georgetown University HospitalWashingtonColumbiaUSA
| | - Alan Moshell
- Department of DermatologyMedStar Washington Hospital Center / Georgetown University HospitalWashingtonColumbiaUSA
| | - Michael A. Cardis
- Department of DermatologyMedStar Washington Hospital Center / Georgetown University HospitalWashingtonColumbiaUSA
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9
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McMullan P, Brown R, Bibb L, Ferenczi K. Cutaneous CD30 positive anaplastic large cell lymphoma mimicking breast carcinoma en cuirasse. JAAD Case Rep 2023; 40:37-40. [PMID: 37701888 PMCID: PMC10493232 DOI: 10.1016/j.jdcr.2023.07.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/14/2023] Open
Affiliation(s)
- Patrick McMullan
- Department of Dermatology, University of Connecticut Health Center, Farmington, Connecticut
| | - Regina Brown
- Department of Dermatology, University of Connecticut Health Center, Farmington, Connecticut
| | - Lorin Bibb
- Department of Dermatology, University of Connecticut Health Center, Farmington, Connecticut
| | - Katalin Ferenczi
- Department of Dermatology, University of Connecticut Health Center, Farmington, Connecticut
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10
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Vandebroek AC, Saternus R, Becker SL, Fries FN, Pérez Guerra N, Rickmann A. [Ulcerating mass on the upper eyelid as manifestation of a primary CD30+T-cell lymphoproliferative disease]. DIE OPHTHALMOLOGIE 2023; 120:847-850. [PMID: 36201042 DOI: 10.1007/s00347-022-01739-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/12/2022] [Revised: 09/05/2022] [Accepted: 09/06/2022] [Indexed: 06/16/2023]
Affiliation(s)
- Anne-Cécile Vandebroek
- Augenklinik Sulzbach, Knappschaftsklinikum Saar GmbH, An der Klinik 10, 66280, Sulzbach, Deutschland.
| | - Roman Saternus
- Klinik für Dermatologie, Venerologie und Allergologie, Gebäude 6, Universitätsklinikum des Saarlandes, Kirrberger Str., 66421, Homburg/Saar, Deutschland
| | - Sören L Becker
- Institut für Medizinische Mikrobiologie und Hygiene, Universitätsklinikum des Saarlandes, Kirrberger Str., Gebäude 43, 66421, Homburg/Saar, Deutschland
| | - Fabian N Fries
- Klinik für Augenheilkunde, Universitätsklinikum des Saarlandes, Kirrberger Str. 100, Gebäude 22, 66421, Homburg/Saar, Deutschland
| | - Núria Pérez Guerra
- Augenklinik Sulzbach, Knappschaftsklinikum Saar GmbH, An der Klinik 10, 66280, Sulzbach, Deutschland
| | - Annekatrin Rickmann
- Augenklinik Sulzbach, Knappschaftsklinikum Saar GmbH, An der Klinik 10, 66280, Sulzbach, Deutschland
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11
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Saleh JS, Subtil A, Hristov AC. Primary cutaneous T-cell lymphoma: a review of the most common entities with focus on recent updates. Hum Pathol 2023; 138:76-102. [PMID: 37307932 DOI: 10.1016/j.humpath.2023.06.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Revised: 06/01/2023] [Accepted: 06/07/2023] [Indexed: 06/14/2023]
Abstract
Cutaneous T-cell lymphomas are an heterogeneous group of uncommon lymphoid neoplasms that are challenging to diagnose and require close collaboration between dermatologists, pathologists and hematologists/oncologists. This article reviews the most common cutaneous T-cell lymphomas: mycosis fungoides (both classic and variant forms) as well as its leukemic counterpart Sézary syndrome, CD30+ T-cell lymphoproliferative disorders including the ever-expanding group of lymphomatoid papulosis and primary cutaneous anaplastic large cell lymphoma, and primary cutaneous CD4+ small/medium lymphoproliferative disorder. We discuss the classic clinical and histopathologic features of these lymphomas and review how they can be distinguished from reactive entities. In particularly, updates to these diagnostic categories and current controversies in classification are highlighted. Moreover, we review the prognosis and treatment for each entity. These lymphomas exhibit variable prognosis, and therefore it is important to correctly classify atypical cutaneous T-cell infiltrates for appropriate patient treatment and prognosis. Cutaneous T-cell lymphomas are at the interface of several medical specialties; this review seeks to summarize key features of these lymphomas and highlight new and emerging insights into these lymphomas.
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Affiliation(s)
- Jasmine S Saleh
- Department of Pathology, University of Michigan, Ann Arbor, MI, 48109, USA; Department of Dermatology, University of Michigan, Ann Arbor, MI, 48109, USA
| | - Antonio Subtil
- Department of Pathology, Royal Jubilee Hospital, University of British Columbia, Victoria, British Columbia, V8R1J8, Canada
| | - Alexandra C Hristov
- Department of Pathology, University of Michigan, Ann Arbor, MI, 48109, USA; Department of Dermatology, University of Michigan, Ann Arbor, MI, 48109, USA.
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12
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Velarde Loya M, Millan Reza MG, Olaya Cordova M, Chavéz López ZD. Probable Primary Cutaneous CD8+ Aggressive Epidermotropic Cytotoxic T-cell Lymphoma: A Case Report of a Diagnostic Challenge. Cureus 2023; 15:e44375. [PMID: 37654908 PMCID: PMC10467331 DOI: 10.7759/cureus.44375] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/30/2023] [Indexed: 09/02/2023] Open
Abstract
Primary cutaneous CD8+ aggressive epidermotropic cytotoxic T-cell lymphoma is a rare variety of cutaneous lymphoma. This subtype has an aggressive and quickly progressive clinical course with a survival time of 32 months from the commencement of skin lesions. This article describes a probable case of primary cutaneous CD8+ aggressive epidermotropic cytotoxic T-cell lymphoma in a 63-year-old female, which manifested as diffuse non-pruritic erythematous plaques and nodules. The diagnosis of this possible entity was aided by the histopathological and immunohistochemical findings, while immunohistochemistry for T-cell receptor (TCR) gamma/delta could not be done.
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Affiliation(s)
- Marcela Velarde Loya
- Internal Medicine Residency, Hospital General Presidente Lázaro Cárdenas, Instituto de Seguridad y Servicios Sociales de los Trabajadores del Estado (ISSSTE), Chihuahua, MEX
| | - Monica G Millan Reza
- Internal Medicine Residency, Hospital General Presidente Lázaro Cárdenas, Instituto de Seguridad y Servicios Sociales de los Trabajadores del Estado (ISSSTE), Chihuahua, MEX
| | - Mariana Olaya Cordova
- Internal Medicine Residency, Hospital General Presidente Lázaro Cárdenas, Instituto de Seguridad y Servicios Sociales de los Trabajadores del Estado (ISSSTE), Chihuahua, MEX
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13
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Murray DW, Fagan KK, Timmermann PC, Grider DJ. Erythematous Patches and Plaques: What to Make of a Rash that Looks like Pepperoni Pizza? Am J Dermatopathol 2023; 45:427-428. [PMID: 37191374 DOI: 10.1097/dad.0000000000002425] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/17/2023]
Affiliation(s)
| | - Kiley K Fagan
- Section of Dermatology, Department of Internal Medicine, Virginia Tech Carilion School of Medicine, Roanoke, VA
| | - Paul C Timmermann
- Section of Dermatology, Department of Internal Medicine, Virginia Tech Carilion School of Medicine, Roanoke, VA
| | - Douglas J Grider
- Virginia Tech Carilion School of Medicine, Roanoke, VA
- Section of Dermatology, Department of Internal Medicine, Virginia Tech Carilion School of Medicine, Roanoke, VA
- Department of Basic Science Education, Virginia Tech Carilion School of Medicine, Roanoke, VA; and
- Dominion Pathology Associates, Roanoke, VA
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14
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Baykal C, Ekinci AP. Annular skin tumors and lymphoproliferative diseases. Clin Dermatol 2023; 41:382-395. [PMID: 37421997 DOI: 10.1016/j.clindermatol.2023.07.007] [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: 07/10/2023]
Abstract
Determining the shape of the skin lesion may provide a diagnostic clue in dermatology practice, more commonly for inflammatory diseases but also for skin tumors. The annular formation may develop by diverse mechanisms in skin tumors. Annular lesions may occur from the onset of the tumor as sparing the central area or depression and/or ulceration in the center of the tumor or outward expansion of the primary lesion. Clustering of multiple papulonodular lesions sparing the central area or relatively independent processes acting on the central and peripheral components of the tumor may also result in an annular appearance. We have explored a wide variety of benign and malignant skin tumors and lymphoproliferative diseases forming an annular shape.
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Affiliation(s)
- Can Baykal
- Department of Dermatology and Venereology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Algün Polat Ekinci
- Department of Dermatology and Venereology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey.
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15
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Chen M, Lan H, Yao S, Jin K, Chen Y. Metabolic Interventions in Tumor Immunity: Focus on Dual Pathway Inhibitors. Cancers (Basel) 2023; 15:cancers15072043. [PMID: 37046703 PMCID: PMC10093048 DOI: 10.3390/cancers15072043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Revised: 03/23/2023] [Accepted: 03/27/2023] [Indexed: 04/14/2023] Open
Abstract
The metabolism of tumors and immune cells in the tumor microenvironment (TME) can affect the fate of cancer and immune responses. Metabolic reprogramming can occur following the activation of metabolic-related signaling pathways, such as phosphoinositide 3-kinases (PI3Ks) and the mammalian target of rapamycin (mTOR). Moreover, various tumor-derived immunosuppressive metabolites following metabolic reprogramming also affect antitumor immune responses. Evidence shows that intervention in the metabolic pathways of tumors or immune cells can be an attractive and novel treatment option for cancer. For instance, administrating inhibitors of various signaling pathways, such as phosphoinositide 3-kinases (PI3Ks), can improve T cell-mediated antitumor immune responses. However, dual pathway inhibitors can significantly suppress tumor growth more than they inhibit each pathway separately. This review discusses the latest metabolic interventions by dual pathway inhibitors as well as the advantages and disadvantages of this therapeutic approach.
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Affiliation(s)
- Min Chen
- Department of Colorectal Surgery, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou 310016, China
| | - Huanrong Lan
- Department of Surgical Oncology, Affiliated Hangzhou Cancer Hospital, Zhejiang University School of Medicine, Hangzhou 310002, China
| | - Shiya Yao
- Department of Colorectal Surgery, Affiliated Jinhua Hospital, Zhejiang University School of Medicine, Jinhua 321000, China
| | - Ketao Jin
- Department of Colorectal Surgery, Affiliated Jinhua Hospital, Zhejiang University School of Medicine, Jinhua 321000, China
| | - Yun Chen
- Department of Colorectal Surgery, Xinchang People's Hospital, Affiliated Xinchang Hospital, Wenzhou Medical University, Xinchang 312500, China
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16
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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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17
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Diagnosis and management of cutaneous lymphomas and lymphoid proliferations in children, adolescents and young adults (CAYA). Best Pract Res Clin Haematol 2023; 36:101448. [PMID: 36907638 DOI: 10.1016/j.beha.2023.101448] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Accepted: 02/06/2023] [Indexed: 02/12/2023]
Abstract
Cutaneous lymphomas and lymphoid proliferations (LPD) in children, adolescents, and young adults (CAYA) are a heterogeneous group of lymphoid neoplasms that present formidable diagnostic challenges to clinicians and pathologists alike. Although rare overall, cutaneous lymphomas/LPD occur in real-world settings and awareness of the differential diagnosis, potential complications, and various therapeutic approaches will help ensure the optimal diagnostic work-up and clinical management. Lymphomas/LPD involving the skin can occur as primary cutaneous disease in a patient that characteristically has lymphoma/LPD confined to the skin, or as secondary involvement in patients with systemic disease. This review will comprehensively summarize both primary cutaneous lymphomas/LPD that occur in the CAYA population as well as those CAYA systemic lymphomas/LPD with propensity for secondary cutaneous involvement. Focus on the most common primary entities occurring in CAYA will include lymphomatoid papulosis, primary cutaneous anaplastic large cell lymphoma, mycosis fungoides, subcutaneous panniculitis-like T-cell lymphoma, and hydroa vacciniforme lymphoproliferative disorder.
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18
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Yamamoto H, Kambayashi Y, Tamabuchi E, Hashimoto A, Asano Y, Fujimura T. Successful treatment of CD8+ syringotropic mycosis fungoides with bexarotene and local radiotherapy. Dermatol Ther 2022; 35:e15850. [PMID: 36137929 DOI: 10.1111/dth.15850] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2022] [Revised: 09/20/2022] [Accepted: 09/20/2022] [Indexed: 11/28/2022]
Affiliation(s)
- Haruka Yamamoto
- Department of Dermatology, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Yumi Kambayashi
- Department of Dermatology, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Erika Tamabuchi
- Department of Dermatology, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Akira Hashimoto
- Department of Dermatology, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Yoshihide Asano
- Department of Dermatology, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Taku Fujimura
- Department of Dermatology, Tohoku University Graduate School of Medicine, Sendai, Japan
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19
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Cutaneous Involvement of Extranodal NK/T Cell Lymphoma, Nasal Type, a Clinical and Histopathological Mimicker of Various Skin Diseases. Dermatopathology (Basel) 2022; 9:307-320. [PMID: 36135102 PMCID: PMC9497790 DOI: 10.3390/dermatopathology9030037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2022] [Revised: 08/30/2022] [Accepted: 08/31/2022] [Indexed: 11/16/2022] Open
Abstract
Background: Extranodal NK/T cell lymphoma, nasal type (ENK/T) with cutaneous involvement has various histopathological findings and diverse clinical manifestations. Methods: A retrospective study of cutaneous involvement of ENK/T lymphoma between 2006 and 2018 was conducted. Results: Twenty-two cases were eligible for this study. Twelve cases could be proven as secondary cutaneous involvement by ENK/T lymphoma, while the remaining could not be confirmed as primary cutaneous ENK/T lymphoma. The histopathological patterns included dermal and subcutaneous nodular infiltration pattern in 11/22 cases (50%), lobular panniculitis pattern in 6/22 cases (27.3%), interface dermatitis pattern in 4/22 cases (18.2%), and granulomatous dermatitis pattern in 1/22 case (4.5%). The median follow-up was 18.3 months. Overall, the one-year and five-year survival rates were 31.3% and 13.3%, respectively. Conclusions: A variety of histopathological patterns of cutaneous involvement by ENK/T lymphoma should be differentiated from other cutaneous lymphomas, dermatitis, and infection. When atypical medium or large-sized lymphoid cells are encountered within skin lesions, pathologists should realize these lesions can be ENK/T lymphoma, especially in cases with coexisting tumor necrosis or angioinvasion. A complete evaluation of the upper aerodigestive tract is mandatory to identify the occult primary site of ENK/T lymphoma before establishing primary cutaneous ENK/T lymphoma.
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20
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Xu J, Li J, Sun YJ, Quan W, Liu L, Zhang QH, Qin YD, Pei XC, Su H, Chen JJ. CD20-positive subcutaneous panniculitis-like T-cell lymphoma presenting as polycranial neuropathy: A CARE-compliant case report and literature review. Medicine (Baltimore) 2022; 101:e30233. [PMID: 36107521 PMCID: PMC9439810 DOI: 10.1097/md.0000000000030233] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Subcutaneous panniculitis-like T-cell lymphoma(SPTCL) is a very rare cytotoxic T-cell skin lymphoma involving subcutaneous tissue, and mainly affects young females. T-cell phenotype is characterized by CD3+, CD8+, and CD4-. SPTCT with polycranial neuropathy has rarely been described. SPTCL is believed to show an indolent clinical course unless patients develop haemophagocytic syndrome or sudden respiratory failure. Its treatment has not been established yet. CASE PRESENTATION We report a case of intractable SPTCT in a 66-year-old woman with multiple cranial nerve palsies and diabetes. She showed involvement of the bilateral facial nerve, left trigeminal nerve, left auditory nerve, and right oculomotor nerve. The single inconspicuous skin lesion in the trunk presented with an erythematous nodule with a diameter of <5 cm and a slightly pink infiltrated plaque. Electromyography revealed bilateral damage to the facial nerve. Differential immunohistochemical characteristics were observed. Immunohistochemistry demonstrated diffuse CD20 positivity. Cerebral spinal fluid analysis revealed elevated protein levels of 0.92 (0.15-0.45) g/L. Her condition regressed severely over time. She was treated with chemotherapy but died 10 months later, the probable cause of death was lung involvement. CONCLUSION The patient's involvement with the central nervous system may be associated with positivity for CD20. Molecular biomarkers may act as therapeutic targets for SPTCL.
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Affiliation(s)
- Jing Xu
- Department of Neurology, China–Japan Union Hospital of Jilin University, Jilin, China
| | - Jia Li
- Department of Neurology, China–Japan Union Hospital of Jilin University, Jilin, China
| | - Ya-juan Sun
- Department of Neurology, China–Japan Union Hospital of Jilin University, Jilin, China
| | - Wei Quan
- Department of Neurology, China–Japan Union Hospital of Jilin University, Jilin, China
| | - Li Liu
- Department of Neurology, China–Japan Union Hospital of Jilin University, Jilin, China
| | - Qing-hui Zhang
- Department of Neurology, China–Japan Union Hospital of Jilin University, Jilin, China
| | - Yi-dan Qin
- Department of Neurology, China–Japan Union Hospital of Jilin University, Jilin, China
| | - Xiao-chen Pei
- Department of Neurology, China–Japan Union Hospital of Jilin University, Jilin, China
| | - Hang Su
- Department of Neurology, China–Japan Union Hospital of Jilin University, Jilin, China
| | - Jia-Jun Chen
- Department of Neurology, China–Japan Union Hospital of Jilin University, Jilin, China
- *Correspondence: Jia-Jun Chen, Department of Neurology, China–Japan Union Hospital of Jilin University, No. 126 Xiantai Road, Erdao District, Changchun, Jilin 130033, China (e-mail: )
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21
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Ceglie G, De Vito R, Cossutta M, Tiberi A, Carta R, Boccieri E, Palumbo G. Brentuximab vedotin as a single agent in the treatment of a pediatric primary cutaneous CD30 + lymphoproliferative disorder: A case report. Pediatr Blood Cancer 2022; 69:e29626. [PMID: 35322542 DOI: 10.1002/pbc.29626] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Accepted: 02/08/2022] [Indexed: 11/07/2022]
Affiliation(s)
- Giulia Ceglie
- Department of Pediatric Hematology and Oncology, Cell and Gene Therapy, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy.,Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy
| | - Rita De Vito
- Department of Pathology, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Matilde Cossutta
- University Department of Pediatrics, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Alice Tiberi
- University Department of Pediatrics, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Roberto Carta
- Department of Pediatric Hematology and Oncology, Cell and Gene Therapy, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Emilia Boccieri
- Department of Pediatric Hematology and Oncology, Cell and Gene Therapy, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Giuseppe Palumbo
- Department of Pediatric Hematology and Oncology, Cell and Gene Therapy, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy.,University Department of Pediatrics, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
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22
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Ali AA, Shabani-Rad MT, Chia JC. Solitary pink papule in an elderly man. JAAD Case Rep 2022; 24:48-51. [PMID: 35600569 PMCID: PMC9120047 DOI: 10.1016/j.jdcr.2022.04.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
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23
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Cutaneous Anaplastic Large Cell Lymphoma: A Case Report about Masking Effect of Facial Masks in the COVID-19 Pandemic. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2021; 9:e3783. [PMID: 34422530 PMCID: PMC8376388 DOI: 10.1097/gox.0000000000003783] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Accepted: 06/30/2021] [Indexed: 11/25/2022]
Abstract
The COVID-19 global pandemic commenced widespread usage of face masks. Due to covering of the lower face in public settings, limited social interaction, and patient hesitancy for seeking in-person healthcare, dermatologic conditions of the lower face are prone to delayed diagnosis and management. With society recovering from the pandemic and social distancing restrictions being lifted, an increasing number of patients present with malignant skin conditions at advanced stage. The authors describe a 47-year-old female patient who presented with a 4-month-old facial mass that was initially believed to originate from skin irritation caused by mask-wearing. A biopsy revealed primary cutaneous anaplastic large cell lymphoma (PC-ALCL). This case report outlines the management of the rare PC-ALCL lesion and diagnostic challenges related to facial masks and social distancing.
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