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Molgó M, Espinoza-Benavides L, Rojas P, González S. Mycosis Fungoides, Lymphomatoid Papulosis and Hodgkin's Lymphoma in the Same Patient: Apropos of a Possible Monoclonal Origin. Indian J Dermatol 2020; 65:57-60. [PMID: 32029943 PMCID: PMC6986121 DOI: 10.4103/ijd.ijd_16_19] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
A 59-year-old man with Hodgkin's lymphoma was referred by a hematologist for consultation for cutaneous issues. Physical examination revealed generalized scaling and erythematous scaly patches located in the groin, abdomen, and arms. The biopsy was compatible with mycosis fungoides (MF). At his next medical visit, painful nodules with erythematous halo and scabby surface were noted, and a subsequent biopsy was compatible with lymphomatoid papulosis (LyP). Mycosis fungoides, the most common primary cutaneous T-cell lymphoma, is usually defined in its classic form as a CD4+ non-Hodgkin lymphoma; LyP corresponds to a CD30+ lymphoproliferative disorder; and Hodgkin's lymphoma (HL) constitutes a lymphoid neoplasia characterized by the presence of Reed-Sternberg cells and its variants. Although these entities have been defined independently, evidence suggests the possibility of a common monoclonal origin. To our knowledge, this is the first case of MF, LyP, and HL in a single patient.
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Affiliation(s)
- Montserrat Molgó
- Department of Dermatology, Pontificia Universidad Católica de Chile, Santiago de Chile, Chile
| | | | - Patricio Rojas
- Department of Hematology, Pontificia Universidad Católica de Chile, Santiago de Chile, Chile
| | - Sergio González
- Department of Pathology, Pontificia Universidad Católica de Chile, Santiago de Chile, Chile
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Villa A, Cairo G, Pozzi MR, Schiaffonati L, Bardella L, Lucchini R, Delia D, Besana C, Biunno I, Vezzoni P. Lack of TdT and Immunoglobulin and T-Cell Receptor Gene Rearrangements in Hodgkin's Disease. Int J Biol Markers 2018; 2:65-70. [PMID: 3132516 DOI: 10.1177/172460088700200202] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
To study the pathogenesis of Hodgkin's disease (HD), which today remains obscure, we have undertaken a combined experimental approach: determination of TdT and molecular analysis of rearrangements of immunoglobulin heavy chain (IgH), T-cell receptor (TCR) beta chain and the T-cell rearranging gamma (TRG) genes. TdT determination indicate would the presence of immature cells that are not detected in the normal lymphnode; molecular analysis of the rearrangements of these genes would reveal the presence of even a small monoclonal population of both T and B lineages in the lymphnodes. We believe that the combination of these two types of analysis can indicate whether an expanding lymphoid clone is responsible for this disease. TdT determination was negative in all 41 cases tested. Gene rearrangements were studied in 10 cases for IgH and TCR beta genes and in 5 cases for the TRG gene. No abnormal band beside the germ-line ones was detected in any of our cases, ruling out the presence of a minor neoplastic population. We can explain these results in at least three ways: first, the neoplastic population could represent less than 1% of the total, thus escaping detection by current techniques; second, the neoplastic population is not lymphoid in nature or is composed of mature cells that do not rearrange Ig and TCR genes and therefore belongs to a true non-B, non-T lineage; third, the pathogenesis of HD is completely different from that of non-Hodgkin's lymphomas (NHL) and does not involve the clonal expansion of a cell frozen at a particular maturative stage as is thought to happen in most NHL.
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Affiliation(s)
- A Villa
- Centro Studi di Fisiologia del Lavoro Muscolare, CNR, Milano, Italy
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3
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Abstract
This article focuses on cutaneous hematopoietic neoplasms that are more likely to be encountered in the pediatric age-group and includes both lymphoproliferative and histiocytic disorders. The cutaneous hematologic disorders in children have a different epidemiologic profile to what is seen during adulthood. Although mycosis fungoides is the most frequent form of cutaneous lymphoma in adults, it is very rare in children. Because lymphoblastic leukemias and lymphomas are more frequent in the pediatric setting, cutaneous leukemic infiltrates are relatively common in this age-group. Similarly, histiocytic disorders are more common in children, particularly Langerhans cell histiocytosis and juvenile xanthogranuloma. Notably, the histiocytic disorders have undergone significant modifications on their nomenclature in the basis of the molecular characteristics that are present in them. A summary of the most frequent cutaneous hematopoietic disorders in children will be discussed further in this review.
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Affiliation(s)
- Alejandro A Gru
- 1 Department of Pathology, University of Virginia, Charlottesville, Virginia
| | - Louis P Dehner
- 2 Lauren V. Ackerman Laboratory of Surgical Pathology, St. Louis Children's Hospital and Dermatopathology, Washington University Medical Center, St. Louis, Missouri
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Hibler J, Salavaggione AL, Martin A, Gru AA. A unique case of concurrent chronic lymphocytic leukemia/small lymphocytic lymphoma and lymphomatoid papulosis in the same biopsy. J Cutan Pathol 2014; 42:276-84. [PMID: 25382820 DOI: 10.1111/cup.12435] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2013] [Revised: 06/02/2014] [Accepted: 06/08/2014] [Indexed: 11/26/2022]
Abstract
Chronic lymphocytic leukemia (CLL/SLL) is the most common leukemia in the western world and its cutaneous dissemination a very uncommon phenomenon. Lymphomatoid papulosis (LyP) is a CD30+ lymphoproliferative disorder characterized by chronic, recurrent and self healing skin lesions. Up to 20% of patients with LyP have a coexistent lymphoma. While the association between the two entities has been reported, their coexistence has never been documented. We describe a 74-year-old man with known CLL and thrombocytopenia who presented with a 2 year history of recurrent nodules and plaques to both arms and legs that resolved within 4-6 weeks after administration of rituximab and bendamustin for his CLL treatment. His biopsies showed an atypical lymphoid infiltrate, composed of large and pleomorphic cells with a nodular and interstitial pattern in a background of eosinophils. Immunohistochemical staining revealed a pattern of two separate yet coexisting neoplastic processes; a large CD30 positive T-cell lymphoproliferative disorder, while the other one was diagnostic of a neoplastic B-cell process (leukemia cutis). A diagnosis of coexistent LyP and cutaneous involvement by CLL/SLL was rendered. The simultaneous presence of both disorders can be a pitfall in the differential diagnosis of large cell lymphomas, such as Richter's transformation of CLL/SLL.
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Affiliation(s)
- J Hibler
- O'Bleness Hospital, Ohio University, Athens, OH, USA
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Discordant lymphocyte-depleted classical Hodgkin’s and peripheral T-cell lymphoma arising in a patient 11 years after diagnosis of multicentric Castleman’s disease. Int J Hematol 2013; 98:114-21. [DOI: 10.1007/s12185-013-1358-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2012] [Revised: 04/30/2013] [Accepted: 05/01/2013] [Indexed: 12/19/2022]
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6
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Kadin ME. The Reed—Sternberg Cell, An Activated T-cell? The Evidence Has Come Full Circle. Leuk Lymphoma 2009; 2:279-86. [DOI: 10.3109/10428199009106462] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Kempf W, Kutzner H, Cozzio A, Sander CA, Pfaltz M, Müller B, Pfaltz M. MUM1 expression in cutaneous CD30+ lymphoproliferative disorders: a valuable tool for the distinction between lymphomatoid papulosis and primary cutaneous anaplastic large-cell lymphoma. Br J Dermatol 2008; 158:1280-7. [DOI: 10.1111/j.1365-2133.2008.08566.x] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
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WOODROW S, BASARAB T, RUSSELL JONES R. Mycosis fungoides with spontaneously regressing CD30-positive tumorous lesions. Clin Exp Dermatol 2006. [DOI: 10.1111/j.1365-2230.1996.tb00127.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Abstract
BACKGROUND Cutaneous manifestations associated with Hodgkin's Disease (HD) have not been well described. Most existing studies of the cutaneous manifestations of HD are individual case reports or literature reviews. The goal of this study was to define the spectrum of cutaneous manifestations of HD, as observed by the consulting dermatologist at a cancer center. METHODS The tumor registry database maintained by the Department of Medical Informatics and the M.D. Anderson Visits database over a 5-year period was searched to identify patients with a diagnosis of HD and an appointment with Dermatology. The medical records were reviewed to determine frequency and presentation of cutaneous findings in HD. RESULTS The search identified a total of 1049 registered patients with HD, of which 88 were seen at the Dermatology Clinic. Of these 88 patients evaluated by dermatology, 47 patients had either paraneoplastic cutaneous manifestations associated with HD (n = 45) or cutaneous HD (n = 3). The most common paraneoplastic skin manifestations were eczema (n = 18) and pruritus (n = 17), mycosis fungoides (n = 11), and erythema nodosum (n = 3). Mycosis fungoides, observed in 1% of the patients with HD at MDACC, was more than 290 times more common in patients with HD than in the general population. CONCLUSION Although pruritus is the most commonly recognized presenting symptom of Hodgkin's lymphoma, new onset of eczema should also be considered as a possible warning sign deserving further investigation. Patients with adult-onset pruritus or eczema should be evaluated for possible HD with full lymph-node exam, CBC with differential, and chest X-ray. Erythema nodosum and mycosis fungoides should also be considered as cutaneous manifestations of HD.
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Affiliation(s)
- Melissa Rubenstein
- Baylor College of Medicine and Department of Dermatology, University of Texas, MD Anderson Cancer Center, Houston, 77030, USA
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Kempf W. CD30+ lymphoproliferative disorders: histopathology, differential diagnosis, new variants, and simulators. J Cutan Pathol 2006; 33 Suppl 1:58-70. [PMID: 16412214 DOI: 10.1111/j.0303-6987.2006.00548.x] [Citation(s) in RCA: 110] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
CD30+ lymphoproliferative disorders of the skin (CD30+ LPD) represent a well-defined spectrum of primary cutaneous T-cell lymphomas which have been recognized as distinct entities in recent lymphoma classifications. Lymphomatoid papulosis and anaplastic large-cell lymphoma share the expression of CD30 antigen as a common phenotypic hallmark but differ in regard to their clinical and histologic features as well as their biologic behavior. This article summarizes the histologic features of CD30+ LPD and presents recently identified new clinicopathologic variants of CD30+ LPD. There is an increasing number of reactive inflammatory disorders and neoplastic diseases which are composed of or contain a significant number of CD30+ cells and mimic LyP or anaplastic large cell lymphoma clinically or histologically. Differential diagnostic considerations focus on other lymphoproliferative processes with CD30+ tumor cells as well as non-lymphoid neoplasms and inflammatory simulators. The term CD30+ pseudolymphoma is proposed to designate inflammatory processes with CD30+ T cells. The final diagnosis of CD30+ LPD is based on a synthesis of clinical, histologic, phenotypic, and molecular genetic findings.
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Affiliation(s)
- Werner Kempf
- Department of Dermatology, University Hospital Zürich, Switzerland.
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Burg G, Kempf W, Cozzio A, Feit J, Willemze R, S Jaffe E, Dummer R, Berti E, Cerroni L, Chimenti S, Diaz-Perez JL, Grange F, Harris NL, Kazakov DV, Kerl H, Kurrer M, Knobler R, Meijer CJLM, Pimpinelli N, Ralfkiaer E, Russell-Jones R, Sander C, Santucci M, Sterry W, Swerdlow SH, Vermeer MH, Wechsler J, Whittaker S. WHO/EORTC classification of cutaneous lymphomas 2005: histological and molecular aspects. J Cutan Pathol 2006; 32:647-74. [PMID: 16293178 DOI: 10.1111/j.0303-6987.2005.00495.x] [Citation(s) in RCA: 215] [Impact Index Per Article: 11.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
UNLABELLED The new WHO/EORTC classification for cutaneous lymphomas comprises mature T-cell and natural killer (NK)-cell neoplasms, mature B-cell neoplasms, and immature hematopoietic malignancies. It reflects the unique features of lymphoproliferative diseases of the skin, and at the same time it is as compatible as possible with the concepts underlying the WHO classification for nodal lymphomas and the EORTC classification of cutaneous lymphomas. This article reviews the histological, phenotypical, and molecular genetic features of the various nosological entities included in this new classification. These findings always have to be interpreted in the context of the clinical features and biologic behavior. AIM To review the histological, phenotypical and molecular genetic features of the various nosological entities of the new WHO/EORTC classification for cutaneous lymphomas. METHODS Extensive review of the literature cited in Medline and own data of the authors. RESULTS The WHO/EORTC classification of cutaneous lymphomas comprises mature T-cell and NK-cell neoplasms, mature B-cell neoplasms and immature hematopoietic malignancies. It reflects the unique features of primary cutaneous lymphoproliferative diseases. CONCLUSION This classification is as much as possible compatible with the concept of the WHO classification for nodal lymphomas and the EORTC classification of cutaneous lymphomas. The histological, phenotypical and molecular genetic features always have to be interpreted in the context of the clinical features and biologic behavior.
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MESH Headings
- Europe
- Humans
- Immunophenotyping
- International Agencies
- Killer Cells, Natural/immunology
- Killer Cells, Natural/pathology
- Lymphoma/classification
- Lymphoma/genetics
- Lymphoma/immunology
- Lymphoma/pathology
- Lymphoma, B-Cell/classification
- Lymphoma, B-Cell/genetics
- Lymphoma, B-Cell/immunology
- Lymphoma, B-Cell/pathology
- Lymphoma, T-Cell, Cutaneous/classification
- Lymphoma, T-Cell, Cutaneous/genetics
- Lymphoma, T-Cell, Cutaneous/immunology
- Lymphoma, T-Cell, Cutaneous/pathology
- Skin Neoplasms/classification
- Skin Neoplasms/genetics
- Skin Neoplasms/immunology
- Skin Neoplasms/pathology
- World Health Organization
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Affiliation(s)
- Günter Burg
- Department of Dermatology, University Hospital Zurich, Switzerland.
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Abstract
Lymphadenopathy is a common clinical finding and is frequently benign. Warning signs suggestive of a malignant etiology include lymph nodes >2 cm in size, supraclavicular location, and generalized lymphadenopathy associated with hepatosplenomegaly or systemic symptoms. A metastatic solid tumor is always in the differential diagnosis of localized lymphadenopathy, particularly in older individuals. In the case of more generalized lymphadenopathy, in addition to the more common lymphomas, benign etiologies as well as benign and atypical lymphoproliferative disorders need to be considered. Benign etiologies of lymphadenopathy can include infections, autoimmune disorders, drug hypersensitivity reactions, sarcoidosis, and amyloidosis. Rare but benign lymphoproliferative disorders include Kikuchi's disease, Rosai-Dorfman disease, and progressive transformation of germinal centers. Atypical lymphoproliferative disorders that bear close surveillance for evolution to a more aggressive malignancy include Castleman's disease, lymphomatoid granulomatosis, and lymphomatoid papulosis. Previously considered in this category but now classified as a true lymphoma is angioimmunoblastic lymphadenopathy with dysproteinemia. Physicians need to be aware of all of these disorders when evaluating suspicious lymphadenopathy, while also considering the more common lymphomas and leukemias.
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Affiliation(s)
- Jennifer R Brown
- Department of Medical Oncology, Dana-Farber Cancer Institute, 44 Binney Street, Boston, Massachusetts 02115, USA
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Oda S, Ochiai T, Yasuda O, Harada N, Muta K, Okada N, Yao T, Takata M, Chijiiwa Y, Nawata H. Gastric mucosa-associated lymphoid tissue lymphoma with adult T cell leukemia/lymphoma cell infiltration. case report. Am J Gastroenterol 2003; 98:491-4. [PMID: 12591074 DOI: 10.1111/j.1572-0241.2003.07254.x] [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] [Indexed: 12/11/2022]
Abstract
This is the first case report of gastric mucosal-associated lymphoid tissue lymphoma with adult T cell leukemia/lymphoma (ATLL) cell infiltration. A 43-yr-old Japanese woman who was seropositive for antihuman T cell leukemia virus-I antibody complained of epigastric pain in April, 1996. Endoscopy showed gastric ulcers in the antrum. Biopsy specimens showed Helicobacter pylori infection. Her symptoms were relieved by treatment with ranitidine. In March, 1998, she complained of epigastric pain and abdominal fullness. Smears of peripheral blood revealed atypical lymphocytes with nuclear irregularity, consistent with ATLL cells. She was diagnosed to have ATLL. Endoscopy revealed multiple gastric ulcers in the antrum and the angle. Biopsy specimens demonstrated small centrocyte-like cells forming lymphoepithelial lesions, with infiltrations of large atypical lymphoid cells of ATLL. On immunohistochemical staining, the small centrocyte-like cells were positive for B cell markers (L26, CD20), whereas the large atypical lymphoid cells were positive for T cell marker (UCHL-1, CD45RO). Her findings were attributed to gastric mucosal-associated lymphoid tissue lymphoma with gastric involvement with ATLL.
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Affiliation(s)
- Shigeyuki Oda
- Department of Medicine and Bioregulatory Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
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Willenbrock K, Ichinohasama R, Kadin ME, Miura I, Terui T, Meguro K, Fukuhara O, DeCoteau JF, Hansmann ML. T-cell variant of classical Hodgkin's lymphoma with nodal and cutaneous manifestations demonstrated by single-cell polymerase chain reaction. J Transl Med 2002; 82:1103-9. [PMID: 12218070 DOI: 10.1097/01.lab.0000027839.98023.5a] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
The atypical cells of CD30(+) cutaneous lymphoproliferative disorders (CD30CLD) are commonly of T-cell origin and frequently have a similar morphology as Hodgkin or Reed-Sternberg cells of Hodgkin's lymphoma (HL). HL is one of the tumors associated with CD30CLD. Although most studies support a B-cell derivation of the tumor cells in HL, recently a few cases of classical HL with T-cell genotype have been reported. We report a patient who presented with CD30CLD whose lymph nodes showed classical HL of mixed cellularity subtype at presentation. By single-cell PCR, the same clonal gene rearrangements of the T cell receptor-beta gene locus could be assigned to the CD30(+) and CD15(+) cells of both skin and lymph node. In a lymph node biopsy specimen taken in relapse after several courses of chemotherapy, the CD30(+) tumor cells were abundant. The T cell-derived tumor cells displayed aberrant expression of the Pax-5 gene in all specimens. A common clonal origin of both CD30CLD and HL of the lymph node in the patient presented here suggests that HL with T-cell genotype exists in association with CD30CLD as well as in sporadic cases and may share clonal origin with the skin tumor.
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Affiliation(s)
- Klaus Willenbrock
- Senckenberg Institute of Pathology, University of Frankfurt, Frankfurt am Main, Germany.
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Pileri SA, Ascani S, Leoncini L, Sabattini E, Zinzani PL, Piccaluga PP, Pileri A, Giunti M, Falini B, Bolis GB, Stein H. Hodgkin's lymphoma: the pathologist's viewpoint. J Clin Pathol 2002; 55:162-76. [PMID: 11896065 PMCID: PMC1769601 DOI: 10.1136/jcp.55.3.162] [Citation(s) in RCA: 135] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/31/2001] [Indexed: 11/04/2022]
Abstract
Despite its well known histological and clinical features, Hodgkin's lymphoma (HL) has recently been the object of intense research activity, leading to a better understanding of its phenotype, molecular characteristics, histogenesis, and possible mechanisms of lymphomagenesis. There is complete consensus on the B cell derivation of the tumour in most cases, and on the relevance of Epstein-Barr virus infection and defective cytokinesis in at least a proportion of patients. The REAL/WHO classification recognises a basic distinction between lymphocyte predominance HL (LP-HL) and classic HL (CHL), reflecting the differences in clinical presentation and behaviour, morphology, phenotype, and molecular features. CHL has been classified into four subtypes: lymphocyte rich, nodular sclerosing, with mixed cellularity, and lymphocyte depleted. The borders between CHL and anaplastic large cell lymphoma have become sharper, whereas those between LP-HL and T cell rich B cell lymphoma remain ill defined. Treatments adjusted to the pathobiological characteristics of the tumour in at risk patients have been proposed and are on the way to being applied.
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Affiliation(s)
- S A Pileri
- Pathologic Anatomy and Haematopathology, Bologna University, Policlinico S. Orsola, Via Massarenti 9, 40138 Bologna, Italy.
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Bee CS, Blaise YP, Dunphy CH. Composite lymphoma of Hodgkin lymphoma and mycosis fungoides: previously undescribed in the same extracutaneous site. Leuk Lymphoma 2001; 42:543-9. [PMID: 11699423 DOI: 10.3109/10428190109064615] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Mycosis fungoides (MF), diagnosed and limited to the skin, has been associated with the subsequent development of Hodgkin lymphoma (HL), most commonly of the nodular sclerosing (NS) subtype. In the previously described cases, there are none in which the extracutaneous tissue was simultaneously involved by HL and residual/relapsing MF. Here we report a case of HL, mixed cellularity (MC) subtype, arising in an inguinal lymph node in a patient with a previous diagnosis of MF. We describe the immunophenotypic, histologic and immunohistochemical findings of a composite lymphoma containing the HL, MC subtype and MT. The importance of detecting MF in addition to the HL in the extracutaneous site with available diagnostic modalities is highlighted.
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Affiliation(s)
- C S Bee
- Division of Hematopathology, Department of Pathology, St. Louis University Health Sciences Center, St Louis, Missouri, USA
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Abruzzo L, Medeiros L, Elenitoba-Johnson K. Hodgkin's Disease. Diagn Pathol 2000. [DOI: 10.1201/b13994-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
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Hancock JC, Wells A, Halling KC, Tilashalski K, Conner MG, Johns C, Listinsky CM. Composite B-cell and T-cell lymphoma arising 24 years after nodular lymphocyte predominant Hodgkin's disease. Ann Diagn Pathol 1999; 3:23-34. [PMID: 9990110 DOI: 10.1016/s1092-9134(99)80006-9] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Twenty-four years after apparently successful treatment for nodular lymphocyte predominant Hodgkin's disease (nLPHD), a 41-year old male developed "B" symptoms and extensive adenopathy. A right axillary lymph node biopsy showed two distinct regions including (1) histiocyte-rich B-cell lymphoma and (2) diffuse small T-cell lymphoma. A clonal rearrangement of the gene for the T-cell receptor beta chain confirmed the presence of a T-cell neoplasm, and this was further confirmed by selective polymerase chain reaction (PCR) on this morphologic zone. PCR on the morphologic B-cell lymphoma confirmed the presence of an immunoglobulin gene rearrangement. These two regions were separated by a less-defined zone containing a mixture of small CD57 positive T lymphocytes, small B lymphocytes, and rare lymphocytic and histiocytic (L&H) cells, highly suggestive of recurrent LPHD. The development of composite B-cell and T-cell lymphoma in this patient raises the speculation that nLPHD may be a neoplasm of lymphoid cells, which can differentiate in both B- and T-cell directions, with the "L&H" cells constituting their B-cell progeny.
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MESH Headings
- Adolescent
- Adult
- Biopsy
- Flow Cytometry
- Fluorescent Antibody Technique, Indirect
- Gene Rearrangement, B-Lymphocyte, Heavy Chain/genetics
- Gene Rearrangement, beta-Chain T-Cell Antigen Receptor/genetics
- Hodgkin Disease/genetics
- Hodgkin Disease/pathology
- Humans
- Leukemia, Lymphocytic, Chronic, B-Cell/genetics
- Leukemia, Lymphocytic, Chronic, B-Cell/pathology
- Lymph Nodes/pathology
- Lymphoma, B-Cell/genetics
- Lymphoma, B-Cell/pathology
- Lymphoma, Non-Hodgkin/genetics
- Lymphoma, Non-Hodgkin/pathology
- Lymphoma, T-Cell/genetics
- Lymphoma, T-Cell/pathology
- Male
- Polymerase Chain Reaction
- Reed-Sternberg Cells/pathology
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Affiliation(s)
- J C Hancock
- Department of Pathology and Laboratory Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
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Micaily B, Miyamoto C, Kantor G, Lessin S, Rook A, Brady L, Goodman R, Vonderheid EC. Radiotherapy for unilesional mycosis fungoides. Int J Radiat Oncol Biol Phys 1998; 42:361-4. [PMID: 9788416 DOI: 10.1016/s0360-3016(98)00218-1] [Citation(s) in RCA: 80] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
PURPOSE To evaluate the treatment outcome and natural history of patients with the diagnosis of unilesional mycosis fungoides, treated according to a prospective radiotherapy protocol in our institution since July 1975. METHODS AND MATERIALS A total of 325 patients with the diagnosis of mycosis fungoides have been referred to the Department of Radiation Oncology at Allegheny University of Health Sciences from July 1975 through September 1996. Of these, 18 patients (5%) were classified as having unilesional mycosis fungoides and were irradiated with a curative intent using local electron fields. One patient received 22 Gy; 1 patient received 40 Gy, and the rest of the patients 30.6 Gy. Daily fractions ranged from 1.8 to 2.0 Gy. Treatments prior to radiation consisted of topical steroids and/or antifungal creams in the majority of patients, with temporary partial responses. One patient had received 2 years of topical mechlorethamine (HN2) and another patient had received topical carmustine solution (BCNU) without response prior to irradiation. RESULTS The responses were measured clinically; posttreatment skin biopsy was not performed routinely unless there was clinical evidence of disease persistence. Complete response rate was 100%; all treated lesions cleared completely within 4 to 8 weeks after the completion of radiation. With a median follow-up of 43 months (range 12 to 240 months), 2 relapses have occurred, 2 and 71 months after the completion of radiation. Both relapses were confined to the skin and were remote from the original site. Both relapses responded to topical application of HN2. There have been no recurrences in the irradiated field nor systemic dissemination. No long-term side effects were found related to treatment, and all the patients are currently alive and without evidence of disease. Actuarial relapse-free and overall survival at 10 years are, respectively, 86.2% and 100%. CONCLUSION Unilesional mycosis fungoides has a long natural history, is possibly the earliest manifestation of a malignant process, and local treatments, including local radiotherapy, result in long-term disease-free intervals and, possibly, cure. Total skin electron beam radiotherapy is not indicated for this disease entity.
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Affiliation(s)
- B Micaily
- Department of Radiation Oncology, Allegheny University Hospitals, Hahnemann, Philadelphia, PA 19102, USA
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20
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Silva MM, Morais JC, Spector N, Maceira J, Sousa MA, Filgueira AL. Lymphomatoid papulosis followed by Hodgkin's disease. Int J Dermatol 1998; 37:541-3. [PMID: 9679697 DOI: 10.1046/j.1365-4362.1998.00471.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Affiliation(s)
- M M Silva
- Department of Pathology, University Hospital, Federal University of Rio de Janeiro, Brazil
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21
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Chandu A, Mitchell DA, Corrigan AM. Cutaneous CD30 positive large T cell lymphoma of the upper lip: a rare presentation. Br J Oral Maxillofac Surg 1997; 35:193-5. [PMID: 9212298 DOI: 10.1016/s0266-4356(97)90563-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Primary cutaneous CD30 positive large T cell lymphomas (PCLCL) are very rare in the head and neck region. We report a case which presented on the right upper lip in a 48-year-old male. This was an isolated cutaneous lesion and in these circumstances this otherwise aggressive lymphoma has an excellent prognosis.
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Affiliation(s)
- A Chandu
- Department of Oral and Maxillofacial Surgery, Leeds Dental Institute
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22
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Yagi H, Tokura Y, Furukawa F, Takigawa M. Th2 cytokine mRNA expression in primary cutaneous CD30-positive lymphoproliferative disorders: successful treatment with recombinant interferon-gamma. J Invest Dermatol 1996; 107:827-32. [PMID: 8941669 DOI: 10.1111/1523-1747.ep12330845] [Citation(s) in RCA: 48] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Primary cutaneous CD30 (Ki-1)+ large cell lymphoma (KiL) and lymphomatoid papulosis (LyP) type A are collectively termed as primary cutaneous CD30-positive lymphoproliferative disorders. We examined the cytokine profile of skin-infiltrating cells and the therapeutic efficacy of recombinant interferon-gamma (rIFN-gamma) in primary cutaneous KiL and LyP type A. By reverse transcriptase-polymerase chain reaction, mRNAs for interleukin-4 (IL-4) and IL-10 were detected in the dermis of skin lesions in all cases (three cases of KiL and four cases of LyP). In addition, tissue from one KiL patient transcribed IL-2 and IFN-gamma messages, and one LyP patient showed IL-2 mRNA. In contrast, normal skin from ten healthy donors contained mRNA for IL-2 or IFN-gamma, or both, but not for IL-4. Before the therapeutic trial of rIFN-gamma, the response of skin lesions was assessed by a predictive skin test with local injection of rIFN-gamma (0.5 x 10(6) Japan Reference Units [JRU; 1 JRU roughly corresponds to 4 NIH units]) for 3 consecutive days in two KiL and two LyP patients. Numbers of skin-infiltrating CD30+ cells were decreased, and transcription of mRNA for IL-4 and IL-10 was downregulated after the skin test in one KiL and two LyP cases. One KiL patient showed no histologic response or change in mRNA expression. In the therapeutic trial, rIFN-gamma (total doses of 1.2-4.0 x 10(7) JRU) was administered intravenously (n = 2) or locally (n = 2). In three patients who responded to the skin test, the lesions were objectively improved and the numbers of skin-infiltrating CD30+ cells were markedly decreased after the therapeutic trial. No improvement was observed in one KiL patient who did not respond to the skin test. These findings suggest that the skin-infiltrating CD30+ cells in KiL and LyP have a Th2 cytokine profile and raise the possibility that the administration of rIFN-gamma improves the conditions by inhibiting cytokine mRNA transcription and proliferation of CD30+ cells.
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Affiliation(s)
- H Yagi
- Department of Dermatology, Hamamatsu University School of Medicine, Japan
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23
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Brousset P, Lamant L, Viraben R, Schlaifer D, Gorguet B, Duhault P, Delsol G. Hodgkin's disease following mycosis fungoides: phenotypic and molecular evidence for different tumour cell clones. J Clin Pathol 1996; 49:504-7. [PMID: 8763268 PMCID: PMC500544 DOI: 10.1136/jcp.49.6.504] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
AIMS (1) To assess the clonality of tumour cells in two patients with mycosis fungoides who subsequently developed Hodgkin's disease; and (2) to determine whether there is a clonal relation between these two disorders. METHODS Cutaneous tissue samples involved by mycosis fungoides and lymph nodes involved by Hodgkin's disease from both patients were investigated by immunohistochemistry and the polymerase chain reaction. RESULTS Mycosis fungoides tumour cells in both patients expressed multiple T cell associated antigens; Reed-Sternberg (RS) cells had the null phenotype. T cell receptor gamma chain genes were clonally rearranged in mycosis fungoides cells but not in RS cells, including variants, in both patients. In the patient with intermediate transformation to large cell lymphoma, immunoglobulin heavy chain genes were rearranged in the cutaneous tumour, but not in the lymph node involved by Hodgkin's disease. CONCLUSION The divergent antigen expression and gene rearrangements observed in these two patients strongly suggest that Hodgkin's disease and mycosis fungoides are not derived from a single tumour cell clone.
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Affiliation(s)
- P Brousset
- Department of Pathology, CHU Purpan, Toulouse, France
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24
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Balus L, Manente L, Remotti D, Grammatico P, Bellocci M. Granulomatous slack skin. Report of a case and review of the literature. Am J Dermatopathol 1996; 18:199-206. [PMID: 8739997 DOI: 10.1097/00000372-199604000-00015] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
We describe a patient with granulomatous slack skin (GSS) who has been followed for 15 years and present clinical, histological, immunohistochemical, ultrastructural, cytogenetic, and molecular findings. The clinical and pathological aspects of the 20 cases of GSS reported in the recent literature are reviewed and compared with those of the present case.
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Affiliation(s)
- L Balus
- Histopathology Section, Ospedale San Gallicano, Rome, Italy
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25
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Angel CA, Slater DN, Royds JA, Nelson SN, Bleehen SS. Absence of Epstein-Barr viral encoded RNA (EBER) in primary cutaneous t-cell lymphoma. J Pathol 1996; 178:173-5. [PMID: 8683385 DOI: 10.1002/(sici)1096-9896(199602)178:2<173::aid-path428>3.0.co;2-y] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
Epstein-Barr virus (EBV) has been associated with various extracutaneous lymphoproliferative diseases and it has been suggested that EBV may have a similar aetiological role in cutaneous T-cell lymphoma. In this study, in situ hybridization was used to investigate the presence of EBV encoded RNAs (EBER-1 and EBER-2) in 37 biopsies from 28 cases of primary cutaneous T-cell lymphoma originating from the U.K. The results showed that EBV had no demonstrable pathogenic role in the lymphomas studied, as EBER was not detected in any case.
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Affiliation(s)
- C A Angel
- Department of Pathology, University of Sheffield Medical School, UK
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26
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DeGregorio R, Fenske NA, Glass LF. Granulomatous slack skin: a possible precursor of Hodgkin's disease. J Am Acad Dermatol 1995; 33:1044-7. [PMID: 7490351 DOI: 10.1016/0190-9622(95)90316-x] [Citation(s) in RCA: 26] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Affiliation(s)
- R DeGregorio
- University of South Florida College of Medicine, Tampa, USA
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27
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Abstract
Hodgkin's disease (HD) is not currently included within the Centers for Disease Control (CDC) classification system for AIDS. Upon HD diagnosis, HIV(human immunosuppressive virus)-positive patients are generally found within Stages III or IV of the Ann Arbor HD classification system, already exacerbating the problem of treatment. In contrast, HIV-negative patients diagnosed with HD are generally found within Stages I or II. Epidemiology and the presence of secondary lymphomas, opportunistic infections, or aggressive pathologies, accompanied by low survival rate and timing of HD diagnosis suggest that HD should be included among conditions indicating AIDS manifestation.
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Affiliation(s)
- M Gerold
- University of Michigan-Dearborn, Department of Natural Sciences 48128, USA
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28
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Orscheschek K, Merz H, Hell J, Binder T, Bartels H, Feller AC. Large-cell anaplastic lymphoma-specific translocation (t[2;5] [p23;q35]) in Hodgkin's disease: indication of a common pathogenesis? Lancet 1995; 345:87-90. [PMID: 7815887 DOI: 10.1016/s0140-6736(95)90061-6] [Citation(s) in RCA: 79] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
Chromosomal aberrations are characteristic and specific events; the detection of chromosomal abnormalities often provides information on diagnosis and prognosis of disease. Some patients with large-cell anaplastic lymphoma (Ki 1 lymphoma) have the translocation t(2;5) (p23; q35), involving a possible growth-regulating tyrosine kinase. We found this translocation in 11 patients with Hodgkin's disease of nodular sclerosis and mixed-cellularity types. This finding has implications for the understanding of the relation between large-cell anaplastic lymphoma and Hodgkin's disease, diseases with morphological and immunophenotypical similarities. Study of this translocation may help understanding of the origins of cancer and cancer growth. It also allows a more precise definition of Hodgkin's disease and may be used as an indicator for clonality--which has long been sought.
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Affiliation(s)
- K Orscheschek
- Department of Pathology, Medical University of Lübeck, Germany
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29
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Ohshima K, Kikuchi M, Shibata T, Sumiyoshi Y, Kobari S, Yoneda S, Takeshita M, Kimura N. Clonal analysis of Hodgkin's disease shows absence of TCR/Ig gene rearrangement, compared with T-cell-rich B-cell lymphoma and incipient adult T-cell leukemia/lymphoma. Leuk Lymphoma 1994; 15:469-79. [PMID: 7874004 DOI: 10.3109/10428199409049750] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
To better characterize the clonality and pathogenesis of Hodgkin's disease (HD), we used polymerase chain reaction (PCR) and Southern blot to analyze the rearrangement of immunoglobulin (Ig) and T-cell receptor (TCR) genes, the bcl-2 oncogene, and the Epstein-Barr virus (EBV) genotype. In situ hybridization studies of EBV were also done. Twenty-six cases of HD were compared with 15 cases of non-specific lymphadenitis, 7 with incipient adult T-cell leukemia/lymphoma (ATLL), and 4 T-cell rich B-cell lymphomas (TRBL), all of which histologically resembled HD. EBV genes were detected in 20 of 26 HD patients (77%) and in 7 of 15 patients with non-specific lymphadenitis (47%), 5 of 7 with incipient ATLL (71%), and 1 of 4 with TRBL (25%). In contrast to specimens of non-specific lymphadenitis, TRBL, and incipient ATLL, only one EBV genotype was evident in the specimens of HD. EBV latent membrane protein (LMP) was detected immunologically in 16 of 26 HD patients (62%), one of four TRBL (25%) and one of seven incipient ATLL (14%), but it was not evident in non-specific lymphadenitis. The LMP positive cases showed amplified EBV genomes. Only one of the 26 cases of HD had a bcl-2 gene rearrangement by PCR, but this was not seen in any other disease. The bcl-2 protein was detected immunologically in seven of the 26 HD patients (27%) and in one of the seven incipient ATLL cases (14%). EBV has been reported to upregulate bcl-2 expression, but in this study the presence of bcl-2 protein did not correlate with the presence of the t(14;18) translocation or EBV-LMP. All TRBLs showed rearrangement of the immunoglobulin genes by PCR and/or Southern blot, and the giant cells were of B-cell type. All incipient ATLLs displayed rearrangement of the TCR genes, and the giant cells were of T-cell origin. In seven of 26 HD cases, the giant cells were weakly stained with T-cell antibodies, in another seven positive with B-cell antibodies and in 18 instances polyclonally positive for both kappa and lambda. However, PCR and Southern blot displayed only two cases of TCR gene rearrangement, while two others had very weak rearrangements of immunoglobulin gene positive only by PCR. Thus the T and B-cell genotype did not correlate with the T and B-cell phenotype recorded in these cases. The absence of Ig and TCR gene rearrangements seems to be common in HD, compared with in TRBL and incipient ATLL.
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Affiliation(s)
- K Ohshima
- Department of Pathology and Internal Medicine, School of Medicine, Fukuoka University, Japan
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30
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Wood GS, Tung RM, Haeffner AC, Crooks CF, Liao S, Orozco R, Veelken H, Kadin ME, Koh H, Heald P. Detection of clonal T-cell receptor gamma gene rearrangements in early mycosis fungoides/Sezary syndrome by polymerase chain reaction and denaturing gradient gel electrophoresis (PCR/DGGE). J Invest Dermatol 1994; 103:34-41. [PMID: 8027579 DOI: 10.1111/1523-1747.ep12389114] [Citation(s) in RCA: 272] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
We used a gene amplification strategy to analyze T-cell receptor (TCR) gene rearrangements in 185 specimens, including mycosis fungoides/Sezary syndrome (MF/SS), other cutaneous neoplasms, inflammatory dermatoses, reactive lymphoid tissues, and normal skin. Genomic DNA was extracted from lesional tissues and rearrangements of the TCR-gamma chain gene were amplified using the polymerase chain reaction (PCR) with primers specific for rearrangements involving V gamma 1-8 or V gamma 9 gene segments. The resulting PCR products were then separated according to their nucleotide sequence as well as size by denaturing gradient gel electrophoresis (DGGE). Dominant clonal TCR-gamma gene rearrangements were detected in 61 of 68 MF/SS cases by PCR/DGGE. This sensitivity of 90% compared to a sensitivity of only 59% when dominant clonality was sought in 17 of these same cases by Southern blot analysis of TCR-beta gene rearrangements. This difference in sensitivity was greatest in early, minimally infiltrated skin lesions. PCR/DGGE was also more sensitive than Southern blot analysis for detecting peripheral blood involvement in two cases of early MF. Among 12 additional specimens of suspected MF/SS, nine (75%) showed clonal TCR-gamma gene rearrangements by PCR/DGGE including six of eight cases with a previously confirmed diagnosis of MF/SS and three of four cases without prior known MF/SS. Among 105 non-MF/SS specimens, dominant TCR-gamma gene rearrangements were detected in only six cases (6%). Four were diagnosed as chronic dermatitis and two were diagnosed as cutaneous lymphoid hyperplasia. We conclude that the large majority of MF/SS cases, including patch phase disease, possess dominant clonal TCR-gamma gene rearrangements. PCR/DGGE is more sensitive than Southern blot analysis for detecting dominant clonality and staging disease in patients with a confirmed diagnosis of MF/SS. However, because PCR/DGGE is sensitive enough to detect dominant TCR-gamma gene rearrangements in a subset of patients with chronic dermatitis, it cannot be used as the sole criterion for establishing a diagnosis of T-cell lymphoma. As with other molecular biologic clonality assays, clinicopathologic correlation is essential. Nevertheless, the detection of dominant clonality in some cases of histologically nonspecific dermatitis allows the identification of a previously unrecognized subset of patients, i.e., those with "clonal dermatitis." It will be important to determine the long-term risk of MF/SS among these patients because our study indicated that MF/SS can sometimes present with lesions indistinguishable from clonal dermatitis.
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MESH Headings
- Base Sequence
- Blotting, Southern
- Cloning, Molecular
- DNA, Neoplasm/analysis
- DNA, Neoplasm/genetics
- Electrophoresis/methods
- Gene Rearrangement, gamma-Chain T-Cell Antigen Receptor
- Humans
- Molecular Sequence Data
- Mycosis Fungoides/genetics
- Mycosis Fungoides/pathology
- Polymerase Chain Reaction/methods
- Receptors, Antigen, T-Cell, gamma-delta/analysis
- Receptors, Antigen, T-Cell, gamma-delta/genetics
- Sezary Syndrome/genetics
- Sezary Syndrome/pathology
- Skin Neoplasms/genetics
- Skin Neoplasms/pathology
- T-Lymphocytes/chemistry
- T-Lymphocytes/pathology
- T-Lymphocytes/ultrastructure
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Affiliation(s)
- G S Wood
- Department of Dermatology, Case Western Reserve University, Cleveland, Ohio
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31
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Matsumoto M, Takada K, Hato T, Horiuchi T, Yasukawa M, Murao S, Fujita S. Monoclonal proliferation of double-negative (CD4-CD8-) T-cells bearing T-cell receptor-alpha beta followed by subsequent development of Hodgkin's disease. Cancer 1994; 73:2818-23. [PMID: 8194023 DOI: 10.1002/1097-0142(19940601)73:11<2818::aid-cncr2820731126>3.0.co;2-l] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
Expression of CD4 or CD8 on the cell surface is an important guide for discriminating the immunologic functions of T-cells. However, a minor T-cell subset lacking both CD4 and CD8 molecules but bearing the usual form of T-cell receptor (TCR)-alpha beta (CD4-CD8-TCR-alpha beta+ T-cells) has recently been found not only in mice but also in humans, and the clinical relevance of this newly defined subpopulation to human diseases is now of considerable interest. The authors present a patient in whom CD4-CD8-TCR-alpha beta+ T-cells showed monoclonal proliferation in the peripheral blood for more than 3 years, then disappeared spontaneously, followed by subsequent development of Hodgkin's disease. The pathologic roles of double-negative T-cell proliferation in this case are discussed from the viewpoint of premalignancy in lymphoproliferative diseases.
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Affiliation(s)
- M Matsumoto
- First Department of Internal Medicine, School of Medicine, Ehime University, Japan
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32
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Abstract
Lymphomatoid papulosis is a chronic disease of cutaneous lymphoid infiltration characterized clinically by involuting and recurring papules, plaques, and nodules. The intriguing combination of a usually benign clinical course, a cytologically malignant lymphoid infiltrate on histologic examination, and a clear, but sporadic association with extracutaneous lymphomas has stimulated significant investigation. Application of recent technical advances to research in lymphomatoid papulosis prompts this review.
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Affiliation(s)
- D L Karp
- Department of Dermatology, Johns Hopkins University, Baltimore, MD
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33
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Su IJ, Tsai TF, Cheng AL, Chen CC. Cutaneous manifestations of Epstein-Barr virus-associated T-cell lymphoma. J Am Acad Dermatol 1993; 29:685-92. [PMID: 8227539 DOI: 10.1016/0190-9622(93)70231-h] [Citation(s) in RCA: 46] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
BACKGROUND In addition to human T-lymphotropic virus (HTLV-I), the Epstein-Barr virus (EBV) has recently been demonstrated to be associated with cutaneous T-cell lymphoma (CTCL). OBJECTIVE Our purpose was to investigate characteristic clinicopathologic features of the cutaneous lesions of EBV-associated T-cell malignancies. METHODS Clinical records, laboratory data, and histopathologic sections were reviewed. Freshly frozen tumor tissues were immunophenotyped. Southern blot and in situ hybridization studies were performed to detect the EBV genomes. RESULTS Ten of 35 CTCL biopsy specimens collected between 1985 and 1992 were found to be EBV-associated. Clonotypic proliferation of EBV genomes was demonstrated in each case, and the atypical T lymphoid cells contained EBV genomes. The cutaneous eruptions of these patients included multiple violaceous papules or nodules, chronic ulcers, and tumors on the trunk or extremities. Three distinct clinicopathologic subgroups could be recognized. The most consistent was the angiocentric T-cell lymphoma or lymphomatoid granulomatosis (type III CTCL) (four cases), presenting with chronic ulcers or violaceous papules. The second group was the T large-cell lymphoma (type II CTCL), Ki-1 antigen (CD30) (positive or negative) (four cases). Three patients with Ki-1- lymphoma had fulminant disease, whereas the remaining Ki-1+ case had a benign course. The third group was the secondary type CTCL (type V CTCL) (two cases), representing systemic EBV-associated T-cell lymphoma. The prognosis was grave. The common features of these EBV-associated CTCLs are resistance to conventional chemotherapy, poor prognosis, and the terminal manifestation of a hemophagocytic syndrome. No EBV genome could be detected in 12 cases of classic CTCL/mycosis fungoides (type I CTCL), or in three cases of HTLV-I-associated adult T-cell lymphoma (type IV CTCL). CONCLUSION Three distinct clinicopathologic subtypes of EBV-associated CTCL were recognized, including one additional type of virus-associated CTCL.
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MESH Headings
- Adult
- Aged
- Antigens, CD/analysis
- Biopsy
- DNA, Neoplasm/analysis
- DNA, Viral/analysis
- Female
- Gene Expression
- Herpesviridae Infections/complications
- Herpesvirus 4, Human/genetics
- Humans
- Lymphoma, Large-Cell, Anaplastic/genetics
- Lymphoma, Large-Cell, Anaplastic/immunology
- Lymphoma, Large-Cell, Anaplastic/microbiology
- Lymphoma, Large-Cell, Anaplastic/pathology
- Lymphoma, T-Cell, Cutaneous/genetics
- Lymphoma, T-Cell, Cutaneous/immunology
- Lymphoma, T-Cell, Cutaneous/microbiology
- Lymphoma, T-Cell, Cutaneous/pathology
- Lymphomatoid Granulomatosis/genetics
- Lymphomatoid Granulomatosis/immunology
- Lymphomatoid Granulomatosis/microbiology
- Lymphomatoid Granulomatosis/pathology
- Male
- Middle Aged
- Skin Neoplasms/genetics
- Skin Neoplasms/immunology
- Skin Neoplasms/microbiology
- Skin Neoplasms/pathology
- Tumor Virus Infections/complications
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Affiliation(s)
- I J Su
- Department of Pathology, National Taiwan University Hospital and College of Medicine, Taipei
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34
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Volkenandt M, Bertino JR, Shenoy BV, Koch OM, Kadin ME. Molecular evidence for a clonal relationship between lymphomatoid papulosis and Ki-1 positive large cell anaplastic lymphoma. J Dermatol Sci 1993; 6:121-6. [PMID: 8274457 DOI: 10.1016/0923-1811(93)90001-6] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
Currently, considerable controversy surrounds questions about the clonal evolution of lymphomas in patients with lymphomatoid papulosis. In order to analyze a possible clonal relationship between lesions of lymphomatoid papulosis and a Ki 1+ large cell anaplastic lymphoma in the same patient, a highly specific molecular probe for the malignant lymphoid clone of the large cell anaplastic lymphoma was developed. As a clone specific molecular marker, highly variable junctional sequences of rearranged T-cell receptor-gamma genes were used. An oligonucleotide primer complementary to these sequences was synthesized and, using the polymerase chain reaction, clone specific DNA was detected in all lesions of lymphomatoid papulosis of the patient. These results provide evidence for a clonal relationship between lesions of lymphomatoid papulosis and large cell anaplastic lymphoma developing in the same patient.
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MESH Headings
- Aged
- Base Sequence
- Biomarkers, Tumor
- Clone Cells
- DNA, Complementary/metabolism
- Female
- Humans
- Ki-1 Antigen/analysis
- Lymphoma, Large B-Cell, Diffuse/immunology
- Lymphoma, Large B-Cell, Diffuse/metabolism
- Lymphoma, Large B-Cell, Diffuse/pathology
- Lymphomatoid Papulosis/metabolism
- Lymphomatoid Papulosis/pathology
- Molecular Sequence Data
- Receptors, Antigen, T-Cell, gamma-delta/genetics
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Affiliation(s)
- M Volkenandt
- Department of Dermatology, Ludwig-Maximilians-University, Munich, Germany
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35
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Williams HC. Epidemiology of lymphomatoid papulosis. Cancer 1993; 72:297-9. [PMID: 8508421 DOI: 10.1002/1097-0142(19930701)72:1<297::aid-cncr2820720151>3.0.co;2-h] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
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36
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Ortiz-Romero PL, Lopez-Estebaranz JL, Gil-Martin R, Corell-Almuzara A, Ballestin-Carcavilla C, Pablo-Martin P, Iglesias-Diez L. Lymphomatoid papulosis: a study of 18 cases*. J Eur Acad Dermatol Venereol 1992. [DOI: 10.1111/j.1468-3083.1992.tb00634.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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37
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Denton K, Wilson CL, Venning VA. Primary cutaneous anaplastic large-cell lymphoma with a prolonged erythrodermic prodrome. Br J Dermatol 1992; 126:297-300. [PMID: 1532505 DOI: 10.1111/j.1365-2133.1992.tb00663.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Anaplastic large cell lymphoma (ALCL) is a high grade non-Hodgkins lymphoma recognized by the expression of the CD30 marker and by its morphology. We report a patient with a 6-year history of a non-specific erythroderma in whom ALCL developed with rapid and fatal dissemination to the lymph nodes and internal organs.
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Affiliation(s)
- K Denton
- Department of Histopathology, John Radcliffe Hospital, Oxford, U.K
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38
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39
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Maggi E, Parronchi P, Macchia D, Piccinni MP, Simonelli C, Romagnani S. Role of T cells in the pathogenesis of Hodgkin's disease. INTERNATIONAL REVIEW OF EXPERIMENTAL PATHOLOGY 1992; 33:141-64. [PMID: 1733870 DOI: 10.1016/b978-0-12-364933-1.50011-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Affiliation(s)
- E Maggi
- Department of Clinical Immunology, University of Florence, Italy
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40
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Payne CM, Grogan TM, Spier CM, Bjore CG, Richter LC, Cromey DW, Rangel CS. A multidisciplinary approach to the diagnosis of cutaneous T-cell lymphomas. Ultrastruct Pathol 1992; 16:99-125. [PMID: 1557836 DOI: 10.3109/01913129209074555] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
The cutaneous T-cell lymphomas (CTCLs) comprise a spectrum of non-Hodgkin lymphomas with a predilection for the skin. This heterogeneous group of CTCLs include the prototypic CTCL mycosis fungoides (MF) and the recently described Ki-1+ lymphomas. MF is notoriously difficult to diagnose in its early stages. The histologic appearance of early MF is indistinguishable from that of chronic dermatitis. The limitations of light microscopy in the diagnosis of the CTCLs have led to the development of other diagnostic laboratory techniques. The best approach to the diagnosis of the CTCLs is a multidisciplinary one and should include ultrastructural morphometry, immunophenotyping, immunogenotyping, and histologic evaluation whenever possible. It is the purpose of this overview to point out the strengths and weaknesses of each of these techniques and, together with clinical input, to provide a comprehensive and rational approach to patient care.
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Affiliation(s)
- C M Payne
- Department of Pathology, College of Medicine, University of Arizona, Tucson 85724
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41
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Slater D. Epstein-Barr virus: an aetiological factor in cutaneous lymphoproliferative disorders? J Pathol 1991; 165:1-4. [PMID: 1659624 DOI: 10.1002/path.1711650102] [Citation(s) in RCA: 20] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
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42
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Kaudewitz P, Herbst H, Anagnostopoulos I, Eckert F, Braun-Falco O, Stein H. Lymphomatoid papulosis followed by large-cell lymphoma: immunophenotypical and genotypical analysis. Br J Dermatol 1991; 124:465-9. [PMID: 1645581 DOI: 10.1111/j.1365-2133.1991.tb00627.x] [Citation(s) in RCA: 42] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
The immunophenotype and genotype of atypical cells in skin and lymph node infiltrates were investigated in a patient with lymphomatoid papulosis (LyP) complicated by anaplastic large-cell lymphoma of the lymph nodes. The large atypical cells in both skin and lymph nodes displayed an almost identical immunophenotype, i.e. CD30+ and CD25+. Southern blot analysis for T-cell receptor beta-chain gene rearrangement revealed an identical gene configuration in DNA extracted from skin and lymph node. Our results strongly support the hypothesis that clonal populations of T cells arising in cutaneous LyP lesions may undergo malignant transformation, spread into regional lymph nodes, and give rise to secondary malignant lymphomas, such as anaplastic large-cell lymphoma.
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MESH Headings
- Adult
- Antigens, CD/analysis
- Antigens, Neoplasm/analysis
- Blotting, Southern
- DNA/genetics
- Gene Rearrangement, beta-Chain T-Cell Antigen Receptor/physiology
- Humans
- Ki-1 Antigen
- Lymphoma, Large B-Cell, Diffuse/complications
- Lymphoma, Large B-Cell, Diffuse/genetics
- Lymphoma, Large B-Cell, Diffuse/immunology
- Male
- Receptors, Interleukin-2/analysis
- Skin/immunology
- Skin Diseases/complications
- Skin Diseases/genetics
- Skin Diseases/immunology
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Affiliation(s)
- P Kaudewitz
- Dermatologische Klinik, Ludwig-Maximilians-Universität, München, Germany
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43
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Whittaker S, Smith N, Jones RR, Luzzatto L. Analysis of beta, gamma, and delta T-cell receptor genes in lymphomatoid papulosis: cellular basis of two distinct histologic subsets. J Invest Dermatol 1991; 96:786-91. [PMID: 1850775 DOI: 10.1111/1523-1747.ep12471773] [Citation(s) in RCA: 47] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
To investigate the histogenesis of lymphomatoid papulosis (LYP), we have analyzed the configuration of the beta, gamma, and delta T-cell receptor (TCR) and Ig genes in DNA from 31 biopsies of 18 patients with this condition and also from peripheral blood mononuclear cells of eight of these patients. Immunoglobulin genes were in a germ-line configuration in all patients, and TCR genes were in a germ-line configuration in six patients. In nine patients, one or two rearranged bands (RB) were detected with both beta and gamma TCR probes and in one patient with beta, gamma, and delta TCR probes. Two patients, in whom beta and delta TCR genes were in a germline configuration, had evidence of multiple discrete rearrangements of gamma TCR genes, consistent with a polyclonal T-cell population. Analysis of multiple biopsies revealed that RB, when present, were identical in different lesions from individual patients. All but one of the peripheral blood samples showed a germ-line configuration. The exception had evidence of a rearrangement of gamma and delta in peripheral blood and a beta and gamma rearrangement within tissue. This study has established that only a proportion of patients with LYP have a monoclonal T-cell proliferation. Correlation with the clinicopathologic and immunophenotypic data revealed that a T-cell clone was limited to patients with Willemze type B LYP or "mixed type" LYP, whereas patients with type A LYP consistently showed a germline configuration of TCR genes. This study indicates that in LYP the atypical hyperchromatic cerebriform mononuclear cells of type B invariably constitute a monoclonal T-cell population whereas the atypical CD30 positive type A cells represent a proliferation of cells of non-B, non-T-cell lineage.
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MESH Headings
- Adult
- Aged
- Antigens, Differentiation/analysis
- Antigens, Neoplasm/analysis
- Female
- Gene Rearrangement
- Genes, Immunoglobulin
- Genotype
- Humans
- Ki-1 Antigen
- Male
- Middle Aged
- Phenotype
- Receptors, Antigen, T-Cell/genetics
- Receptors, Antigen, T-Cell, alpha-beta
- Receptors, Antigen, T-Cell, gamma-delta
- Skin Diseases/genetics
- Skin Diseases/immunology
- Skin Diseases/pathology
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Affiliation(s)
- S Whittaker
- Department of Haematology, Hammersmith Hospital, London, U.K
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44
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Payne CM. Ultrastructural morphometry in the diagnosis of mycosis fungoides and Sézary's syndrome. Clin Dermatol 1991; 9:187-203. [PMID: 1747854 DOI: 10.1016/0738-081x(91)90009-a] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Affiliation(s)
- C M Payne
- Department of Pathology, College of Medicine, University of Arizona, Tucson 85724
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45
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Slater DN. Cutaneous lymphoproliferative disorders: an assessment of recent investigative techniques. Br J Dermatol 1991; 124:309-23. [PMID: 2025552 DOI: 10.1111/j.1365-2133.1991.tb00590.x] [Citation(s) in RCA: 20] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Affiliation(s)
- D N Slater
- Department of Histopathology, Rotherham District Hospital, Rotherham, UK
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46
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Abstract
Using a monoclonal antibody specific to the Lewis X antigen (anti-Lex), the authors studied 103 cases of Hodgkin's disease (HD) in comparison with 57 cases of non-Hodgkin's lymphoma (NHL); three cases of granulocytic sarcoma (GS); two cases of malignant histiocytosis (MH); one case of monoblastic leukemia (ML); one case of interdigitating reticulum cell sarcoma (IRCS); six cases of histiocytosis X (HX); one case of reticulohistiocytoma (RH); 44 various reactive conditions of the lymph node (LN). Reed-Sternberg and related (R-S) cells stained selectively in 80 of 92 cases of HD (87.0%), excluding 11 cases of lymphocyte predominance type. The stain was better in B-5-fixed specimens than in formalin-fixed specimens, showing a dense deposit of reaction products at a paranuclear site and on the cell surface. The staining results were compared with those of Leu-M1 and found to be superior both qualitatively and quantitatively (detection rate of R-S cells: 87.0% versus 68.5% of Leu-M1). Granulocytes, rare epithelioid histiocytes, and some endothelial and/or erythrocytes also stained with anti-Lex. The stain had positive results in three cases of GS showing a diffuse cytoplasmic staining pattern. Of NHL, two of 29 peripheral T-cell lymphomas stained to show rare paranuclear deposits without cell surface staining. The stain had negative results in MH, ML, IRCS, HX, and RH. Of 45 reactive LN, minute subcapsular collections of Lewis X+, altered-appearing Langerhans'-like cells, were observed in all ten LN from human immunodeficiency virus (HIV)-associated persistent generalized lymphadenopathy (PGL). The stain had negative results in all other various reactive conditions of LN. In conclusion, Lewis X staining is useful as a marker for R-S cells in paraffin sections with staining results superior to those of Leu-M1. Lewis X staining also detects subcapsular clustering of altered-appearing Langerhans'-like cells in PGL, which has not been described previously and warrants additional study.
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Affiliation(s)
- H J Ree
- Department of Pathology, Beth Israel Medical Center, New York, NY 10003
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47
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Hoppe RT, Wood GS, Abel EA. Mycosis fungoides and the Sézary syndrome: pathology, staging, and treatment. Curr Probl Cancer 1990; 14:293-371. [PMID: 2245651 DOI: 10.1016/0147-0272(90)90018-l] [Citation(s) in RCA: 63] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Mycosis fungoides and the Sézary syndrome are forms of cutaneous T-cell lymphoma. Mycosis fungoides is an uncommon disease: only about 500 new cases are diagnosed in the United States annually. The median age of onset is 55 years and there is a 2:1 male predominance. The etiology of mycosis fungoides is unknown. Although occupational exposures have been implicated, case control studies fail to support this hypothesis. Mycosis fungoides is typified by cutaneous plaques which may evolve into tumors over the course of time. It is often preceded by a lengthy pre-mycotic phase prior to the time of definitive diagnosis. In its earliest diagnostic phase, there may only be slightly scaling patches with a limited distribution. Indurated lesions evolve into plaques, which may become more generalized in their distribution. As the severity of skin involvement increases, there is an increasing likelihood of spread to extracutaneous sites. The pathology of this disease is marked by involvement of the epidermis (Pautrier microabscesses). Immunologic studies characterize these cells as belonging to the helper T-cell subset. Genotypic analysis demonstrates monoclonal rearrangements of the T-cell receptors of the infiltrating cells. The staging system for mycosis fungoides considers the extent of skin involvement, presence of lymph node or visceral disease, and detection of abnormal cells in the peripheral blood. Patients with disease limited to the skin (90% of newly diagnosed cases) are treated best with topical or cutaneous therapies. Common modalities include psoralen photochemotherapy (PUVA), topical chemotherapy (nitrogen mustard) and total skin electron beam therapy. Both topical nitrogen mustard and electron beam therapy have good initial response rates (73% and 100%) and may achieve long-term disease-free survival, especially in patients with initially limited disease. Even if the response is incomplete or relapse occurs, substantial and very important palliation is generally achieved with topical therapy. Recurrent or resistant cutaneous disease will require the use of sequential topical treatment. The median survival time of patients who present with disease limited to the skin is greater than 10 years, and many deaths in this group are from intercurrent causes, especially in patients with limited or generalized plaque disease. If cutaneous tumors are present, the majority of these patients will eventually die from disease-related causes. The prognosis of patients who develop extracutaneous disease is exceedingly poor (median survival time, approximately 1 year).(ABSTRACT TRUNCATED AT 400 WORDS)
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Affiliation(s)
- R T Hoppe
- Department of Radiation Oncology, Stanford University, California
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48
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Abstract
Patients with malignant lymphoma may have cutaneous and subcutaneous involvement that exhibits a striking symmetry about the coronal axis. The symmetry of these lesions may be caused by site-specific migration from the circulation, preferential proliferation by lymphocytes of the neoplastic clones at defined anatomical sites, or both mechanisms. Similar behaviour by benign lymphocytes may explain the symmetry and selective anatomical distribution of lesions in other skin diseases.
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Affiliation(s)
- R B Goudie
- University Department of Pathology, Glasgow Royal Infirmary, UK
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49
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Ben-Ezra J, Sheibani K, Swartz W, Stroup R, Traweek ST, Kezirian J, Rappaport H. Relationship between eosinophil density and T-cell activation markers in lymph nodes of patients with Hodgkin's disease. Hum Pathol 1989; 20:1181-5. [PMID: 2591947 DOI: 10.1016/s0046-8177(89)80009-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Hodgkin's disease (HD) is characterized morphologically by a variable infiltration of tissues by eosinophilic granulocytes. The lesions also contain numerous T cells, predominantly of the CD4+ immunophenotype. To investigate whether the presence or absence of tissue eosinophilia is related to the immunophenotype of the T cells, we studied 43 cases of HD (28 nodular sclerosing, ten mixed cellularity, and five unclassifiable) for the relative numbers of lymphocytes positive for CD2, CD3, CD4, CD5, CD8, CD25, CD38, T9, TQ1, HLA-DR, and beta F1, and for the number of eosinophils in tissue sections. By univariate and multivariate analysis, we determined that there was an inverse relationship between the number of eosinophils and the presence of TQ1+ (P less than .0005) and CD25+ (P less than .0005) lymphocytes. In addition, we observed that TQ1 stained the Reed-Sternberg cells in these lesions. We also determined that the T cells expressed HLA-DR more frequently in the nodular sclerosis subtype than in other subtypes of HD (P less than or equal to .0001). We therefore conclude that the degree of tissue eosinophilia in the lymph nodes of patients with HD may be explained, at least in part, by the immunophenotype of the T cells present in the affected lymph nodes.
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Affiliation(s)
- J Ben-Ezra
- James Irvine Center for the Study of Leukemia and Lymphoma, Division of Anatomic Pathology, City of Hope National Medical Center, Duarte, CA 91010
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50
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Pinto GM, Gonçalves L, Gonçalves H, Graça F, Quental A, Fonseca I, Monteiro A. A case of lymphomatoid papulosis and Hodgkin's disease. J Am Acad Dermatol 1989; 21:1051-6. [PMID: 2681291 DOI: 10.1016/s0190-9622(89)70294-2] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Lymphomatoid papulosis is a unique paradoxic entity characterized by recurrent self-healing papulonodular lesions with histologic features of malignancy. Usually the disease has a protracted benign course; however, it can be associated with or evolve to a lymphoproliferative disorder. Thus "lymphoma-associated papulosis" represents the malignant end of a wide spectrum. We describe a case of a patient with lymphomatoid papulosis who developed Hodgkin's disease 8 years after the onset of skin lesions. Systemic chemotherapy achieved complete remission of Hodgkin's disease, but recurrent papulonodular lesions continued to form in the subsequent 18 months.
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Affiliation(s)
- G M Pinto
- Department of Dermatology, Curry Cabral Hospital, Lisboa, Portugal
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