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Zanelli M, Sanguedolce F, Zizzo M, Fragliasso V, Broggi G, Palicelli A, Loscocco GG, Cresta C, Caprera C, Corsi M, Martino G, Bisagni A, Marchetti M, Koufopoulos N, Parente P, Caltabiano R, Ascani S. Skin Involvement by Hematological Neoplasms with Blastic Morphology: Lymphoblastic Lymphoma, Blastoid Variant of Mantle Cell Lymphoma and Differential Diagnoses. Cancers (Basel) 2023; 15:3928. [PMID: 37568745 PMCID: PMC10416851 DOI: 10.3390/cancers15153928] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2023] [Revised: 07/28/2023] [Accepted: 07/31/2023] [Indexed: 08/13/2023] Open
Abstract
Hematological neoplasms sharing a blastic morphology may involve the skin. The skin may be either the primary site of occurrence of hematological malignancies with blastic features or cutaneous lesions are the first manifestation of an underlying systemic malignancy. The assessment of skin biopsies of hematological neoplasms with blastic features poses diagnostic problems and requires expert hematopathologists considering a wide range of differential diagnoses. The precise diagnosis of diseases sharing blastic features but with different outcomes and requiring distinct therapies is essential for patient management. The present paper mainly focuses on cutaneous involvement of the blastoid variant of mantle cell lymphoma and lymphoblastic lymphoma of B-cell or T-cell origin. The relevant literature has been reviewed and the clinical aspects, pathological features, prognosis, and therapy of both blastoid mantle cell lymphoma and lymphoblastic lymphoma involving the skin are discussed. A focus on other hematological entities with blastic features, which may involve the skin, to be taken into consideration in differential diagnosis is also given.
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Affiliation(s)
- Magda Zanelli
- Pathology Unit, Azienda USL-IRCCS di Reggio Emilia, 42123 Reggio Emilia, Italy; (A.P.); (A.B.); (M.M.)
| | | | - Maurizio Zizzo
- Surgical Oncology Unit, Azienda USL-IRCCS di Reggio Emilia, 42123 Reggio Emilia, Italy;
| | - Valentina Fragliasso
- Laboratory of Translational Research, Azienda USL-IRCCS di Reggio Emilia, 42123 Reggio Emilia, Italy;
| | - Giuseppe Broggi
- Department of Medical and Surgical Sciences and Advanced Technologies “G.F. Ingrassia” Anatomic Pathology, University of Catania, 95123 Catania, Italy; (G.B.); (R.C.)
| | - Andrea Palicelli
- Pathology Unit, Azienda USL-IRCCS di Reggio Emilia, 42123 Reggio Emilia, Italy; (A.P.); (A.B.); (M.M.)
| | - Giuseppe Gaetano Loscocco
- Department of Experimental and Clinical Medicine, CRIMM, Center of Research and Innovation of Myeloproliferative Neoplasms, Azienda Ospedaliera-Universitaria Careggi, University of Florence, 50134 Florence, Italy;
- Doctorate School GenOMec, University of Siena, 53100 Siena, Italy
| | - Camilla Cresta
- Pathology Unit, Azienda Ospedaliera Santa Maria di Terni, University of Perugia, 05100 Terni, Italy; (C.C.); (C.C.); (M.C.); (G.M.); (S.A.)
| | - Cecilia Caprera
- Pathology Unit, Azienda Ospedaliera Santa Maria di Terni, University of Perugia, 05100 Terni, Italy; (C.C.); (C.C.); (M.C.); (G.M.); (S.A.)
| | - Matteo Corsi
- Pathology Unit, Azienda Ospedaliera Santa Maria di Terni, University of Perugia, 05100 Terni, Italy; (C.C.); (C.C.); (M.C.); (G.M.); (S.A.)
| | - Giovanni Martino
- Pathology Unit, Azienda Ospedaliera Santa Maria di Terni, University of Perugia, 05100 Terni, Italy; (C.C.); (C.C.); (M.C.); (G.M.); (S.A.)
- Hematology, Centro di Ricerca Emato-Oncologica—C.R.E.O., University of Perugia, 06129 Perugia, Italy
| | - Alessandra Bisagni
- Pathology Unit, Azienda USL-IRCCS di Reggio Emilia, 42123 Reggio Emilia, Italy; (A.P.); (A.B.); (M.M.)
| | - Marialisa Marchetti
- Pathology Unit, Azienda USL-IRCCS di Reggio Emilia, 42123 Reggio Emilia, Italy; (A.P.); (A.B.); (M.M.)
| | - Nektarios Koufopoulos
- Second Department of Pathology, Medical School, National and Kapodistrian University of Athens, Attikon University Hospital, 15772 Athens, Greece;
| | - Paola Parente
- Pathology Unit, Fondazione IRCCS Casa Sollievo della Sofferenza, 71013 San Giovanni Rotondo, Foggia, Italy;
| | - Rosario Caltabiano
- Department of Medical and Surgical Sciences and Advanced Technologies “G.F. Ingrassia” Anatomic Pathology, University of Catania, 95123 Catania, Italy; (G.B.); (R.C.)
| | - Stefano Ascani
- Pathology Unit, Azienda Ospedaliera Santa Maria di Terni, University of Perugia, 05100 Terni, Italy; (C.C.); (C.C.); (M.C.); (G.M.); (S.A.)
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2
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Fajardo DA, France J, Targonska BI, Kahlon HB, Coppes MJ. Mantle Cell Lymphoma Presenting as a Subcutaneous Mass of the Right Leg. Case Rep Oncol 2020; 13:774-782. [PMID: 32774275 PMCID: PMC7383204 DOI: 10.1159/000507921] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2020] [Accepted: 04/10/2020] [Indexed: 11/19/2022] Open
Abstract
Mantle cell lymphoma (MCL) is a relatively rare B-cell non-Hodgkin lymphoma, typically presenting with extensive lymphadenopathy, bone marrow involvement, and splenomegaly. Extranodal sites can also be involved. We discuss a 73-year-old man whose MCL presented with a 6-month history of a subdermal mass of the right upper thigh and no systemic symptoms.
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Affiliation(s)
- Drew A Fajardo
- University of Nevada Reno School of Medicine, Reno, Nevada, USA
| | - Joel France
- Sierra Pathology Associates, Reno, Nevada, USA
| | - Bogna I Targonska
- Reno Radiological Associates, Reno, Nevada, USA.,Department of Pediatrics, University of Nevada Reno School of Medicine, Reno, Nevada, USA.,Renown Children's Hospital, Reno, Nevada, USA
| | - H Bobby Kahlon
- Family Medicine, Renown Medical Group, Reno, Nevada, USA
| | - Max J Coppes
- Department of Pediatrics, University of Nevada Reno School of Medicine, Reno, Nevada, USA.,Renown Children's Hospital, Reno, Nevada, USA
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3
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Gru AA, Hurley MY, Salavaggione AL, Brodell L, Sheinbein D, Anadkat M, Porcu P, Frater JL. Cutaneous mantle cell lymphoma: a clinicopathologic review of 10 cases. J Cutan Pathol 2016; 43:1112-1120. [PMID: 27539965 DOI: 10.1111/cup.12802] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2016] [Revised: 06/10/2016] [Accepted: 08/08/2016] [Indexed: 01/10/2023]
Abstract
Cutaneous mantle cell lymphoma (MCL) is exceedingly rare, almost always occurring as a dissemination of systemic MCL. To date, only 32 cases have been described. We report a series of 10 cases of MCL in the skin, and provide a comprehensive clinicopathologic review with clinical follow-up. Our cases occurred in older individuals (mean age = 70) and were more frequently in men (90%). Half of them presented in the head and neck region as a mass/nodule, and the remainder in the trunk and extremities as nodules. All patients have stage IV disease. In two of the 10 cases (20%) the cutaneous lesions preceded the diagnosis of disseminated disease. In two of the seven cases with available clinical follow-up information (33%) the skin was immediately involved after the diagnosis of MCL, and in three of the seven the skin was the first site of recurrence (mean interval = 57 months). The mean time to recurrence of the disease was 45.4 months and the overall survival was 66.3 months. Histologically six out of 10 cases (60%) had either pleomorphic or blastoid morphology (four out of 10 and two out of 10, respectively). The mean number of mitoses per 10 high-power fields was 18.44. While nine out of 10 cases expressed cyclin-D1, one case was not positive for cyclin-D1 but did label with SOX-11. Limited cytogenetic data showed trisomy 14 in one case, in addition to the t(11;14) translocation.
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Affiliation(s)
- Alejandro A Gru
- Department of Pathology, Divisions of Dermatopathology and Hematopathology, University of Virginia, Charlottesville, VA, USA.,Department of Dermatology, Divisions of Dermatopathology and Hematopathology, University of Virginia, Charlottesville, VA, USA
| | - M Yadira Hurley
- Department of Dermatology, Saint Louis University, St. Louis, MO, USA
| | | | - Lindsey Brodell
- Department of Dermatology, University of Rochester, Rochester, NY, USA
| | - David Sheinbein
- Department of Internal Medicine, Division of Dermatology, Washington University, School of Medicine, St. Louis, MO, USA
| | - Milan Anadkat
- Department of Internal Medicine, Division of Dermatology, Washington University, School of Medicine, St. Louis, MO, USA
| | - Pierluigi Porcu
- Division of Hematology, The Ohio State Wexner Medical Center, Columbus, OH, USA
| | - John L Frater
- Department of Pathology & Immunology, Hematopathology Section, Washington University, St. Louis, MO, USA
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4
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Kazlouskaya V, Spizuoco A, Junkins-Hopkins JM. Two cases of systemic mantle cell lymphoma involving the skin. Indian Dermatol Online J 2016; 7:49-52. [PMID: 26951614 PMCID: PMC4763582 DOI: 10.4103/2229-5178.174317] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Mantle cell lymphoma (MCL) is a form of non-Hodgkin lymphoma that rarely affects skin. Cutaneous involvement is non-specific but usually indicates widespread disease. Herein we present two cases of MCL with secondary skin involvement. One case presented as an acneiform eruption on the face and had aberrant expression of bcl-2 and bcl-6 with weak CD5 expression. The second presented with multiple tumors on the abdomen and thighs. In both cases expression of Cyclin-D1 by the tumor cells was seen. Both patients died shortly after the diagnosis was established.
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Affiliation(s)
| | - Amy Spizuoco
- Ackerman Academy of Dermatopathology, New York, USA
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5
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Hrgovic I, Hartmann S, Steffen B, Vogl T, Kaufmann R, Meissner M. Cutaneous involvement as a rare first sign of systemic mantle cell lymphoma: A case report and review of the literature. Mol Clin Oncol 2016; 4:728-732. [PMID: 27123271 PMCID: PMC4840519 DOI: 10.3892/mco.2016.792] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2015] [Accepted: 02/09/2016] [Indexed: 01/28/2023] Open
Abstract
Mantle cell lymphoma (MCL) is a unique type of B-cell non-Hodgkin's lymphoma, which very rarely exhibits skin involvement. We herein describe the case of a 55-year-old woman, who initially presented with a nodular mass of the right infraorbital region. On histological analysis of the subcutaneous tissue, a diffuse neoplastic cell infiltration was identified, composed of medium-sized lymphoid cells with irregular nuclei, which was diagnosed as MCL. The tumor cells were positive for CD5, CD20, CD79a, cyclin D1 and sex-determining region Y-box 11, but negative for CD10 and CD23. Our patient received six cycles of R-CHOP chemotherapy and intrathecal methotrexate as central nervous system prophylaxis. However, the patient relapsed 1 year later and was treated with two cycles of R-DHAP and one cycle of intrathecal methotrexate. After achieving partial remission, the patient was consolidated with peripheral blood stem cell transplantation using the BEAM conditioning regime. While prior case studies suggest that skin invasion by MCL is associated with a poor prognosis, our patient remains alive almost 4 years after the initial presentation. Skin involvement as a first sign of systemic MCL is very rare and must be considered.
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Affiliation(s)
- Igor Hrgovic
- Department of Dermatology, Venereology and Allergology, Johann Wolfgang Goethe University Hospital of Frankfurt, D-60590 Frankfurt am Main, Germany
| | - Sylvia Hartmann
- Institute of Pathology, Johann Wolfgang Goethe University Hospital of Frankfurt, D-60590 Frankfurt am Main, Germany
| | - Björn Steffen
- Division of Hematology/Oncology, Department of Internal Medicine, Johann Wolfgang Goethe University Hospital of Frankfurt, D-60590 Frankfurt am Main, Germany
| | - Thomas Vogl
- Institute for Diagnostic and Interventional Radiology, Johann Wolfgang Goethe University Hospital of Frankfurt, D-60590 Frankfurt am Main, Germany
| | - Roland Kaufmann
- Department of Dermatology, Venereology and Allergology, Johann Wolfgang Goethe University Hospital of Frankfurt, D-60590 Frankfurt am Main, Germany
| | - Markus Meissner
- Department of Dermatology, Venereology and Allergology, Johann Wolfgang Goethe University Hospital of Frankfurt, D-60590 Frankfurt am Main, Germany
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6
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Mantle cell lymphoma with skin involvement. Postepy Dermatol Alergol 2015; 32:229-34. [PMID: 26161067 PMCID: PMC4495111 DOI: 10.5114/pdia.2014.44028] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2014] [Revised: 03/12/2014] [Accepted: 05/19/2014] [Indexed: 11/17/2022] Open
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7
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Hamad N, Armytage T, McIlroy K, Singh N, Ward C. Primary Cutaneous Mantle-Cell Lymphoma: A Case Report and Literature Review. J Clin Oncol 2014; 33:e104-8. [PMID: 24733805 DOI: 10.1200/jco.2012.47.2829] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Affiliation(s)
- Nada Hamad
- Royal North Shore Hospital; University of Sydney, Sydney, Australia
| | | | - Kirsty McIlroy
- Pathology Laboratory Medicine Services, Sydney, Australia
| | - Nisha Singh
- Pathology Laboratory Medicine Services, Sydney, Australia
| | - Christopher Ward
- Royal North Shore Hospital, Northern Blood Research Centre, Kolling Institute; University of Sydney, Sydney, Australia
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8
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Primary Cutaneous Mantle Cell Lymphoma of the Leg With Blastoid Morphology and Aberrant Immunophenotype. Am J Dermatopathol 2014; 36:e16-8. [DOI: 10.1097/dad.0b013e31828bc7ac] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
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9
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Mantle Cell Lymphoma of Blastoid Variant With Skin Lesion and Rapid Progression. Am J Dermatopathol 2013; 35:851-5. [DOI: 10.1097/dad.0b013e31828de73a] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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10
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Lynch DW, Verma R, Larson E, Geis MC, Jassim AD. Primary cutaneous mantle cell lymphoma with blastic features: report of a rare case with special reference to staging and effectiveness of chemotherapy. J Cutan Pathol 2011; 39:449-53. [PMID: 22121909 DOI: 10.1111/j.1600-0560.2011.01832.x] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
We describe a case of blastic primary cutaneous mantle cell lymphoma (MCL) in an 83-year-old male with a complex medical history. The patient presented to his primary care physician with a nodular erythematous skin eruption on his thighs. Histopathologic examination showed a diffuse lymphoid infiltrate of intermediate to large cells that involved the dermis and subcutis but spared the epidermis. Immunohistochemical staining showed expression of CD20, CD5 and cyclin-D1. The lymphoma cells were negative for CD10 and CD23. Fluorescence in situ hybridization (FISH) analysis revealed a characteristic translocation [t(11;14)(q13;q32)], which is diagnostic of MCL. Cutaneous involvement by MCL is typically secondary because of widespread disease, and primary cutaneous MCL can only be diagnosed in the absence of extracutaneous involvement. Primary cutaneous MCL is extremely rare and requires proper clinical staging. In this case, clinical staging revealed no evidence of bone marrow or peripheral blood involvement, and positron emission tomography (PET) scan revealed weak, abnormal uptake only in a few cervical lymph nodes. Because of the lack of disseminated involvement, we favor the lesion to be a primary cutaneous MCL.
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Affiliation(s)
- Douglas W Lynch
- Department of Pathology, Sanford School of Medicine of the University of South Dakota, Sioux Falls, SD 57106, USA
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11
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Abstract
Mantle cell lymphoma (MCL) commonly involves extranodal sites, usually as a manifestation of disseminated disease. In rare cases, MCLs may arise as a primary tumor in the skin. Blastoid mantle cell lymphoma (BV-MCL) is a rare variant and has a more aggressive clinical course. The phenotype of BV-MCL is characterized as CD20+, CD5+, cyclin D1+, CD23-, and CD10-. Interphase fluorescence in situ hybridization shows a characteristic t(11;14) fusion pattern. We report a case of a BV-MCL arising in skin as primary cutaneous MCL with the characteristic immunophenotype and translocation.
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12
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Burton JD, Ely S, Reddy PK, Stein R, Gold DV, Cardillo TM, Goldenberg DM. CD74 Is Expressed by Multiple Myeloma and Is a Promising Target for Therapy. Clin Cancer Res 2004; 10:6606-11. [PMID: 15475450 DOI: 10.1158/1078-0432.ccr-04-0182] [Citation(s) in RCA: 98] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
PURPOSE CD74 (HLA-DR-associated invariant chain) plays a role in antigen presentation. In addition to its expression on antigen-presenting cells, it is expressed by carcinomas of renal, lung, gastric, and thymic origin and by certain sarcomas. The restricted expression of CD74 by normal tissues and its very rapid internalization make CD74 an attractive therapeutic target for both cancer and immunologic diseases. Preclinical efficacy of anti-CD74 monoclonal antibody (mAb) therapy has been demonstrated in B-lymphoma models. Because there are few validated antigenic targets in multiple myeloma, CD74 expression was examined. EXPERIMENTAL DESIGN CD74 expression was assessed by immunohistochemistry in bone marrow biopsies of known multiple myeloma cases. Its expression was measured by flow cytometry in multiple myeloma lines, and CD74 mRNA expression was determined by reverse transcription-PCR. In addition, the in vitro antiproliferative effect of LL1 mAb was evaluated on a CD74+ multiple myeloma cell line using a [3H]thymidine incorporation assay. RESULTS CD74 expression was observed in 19 of 22 cases of multiple myeloma, with most expressing moderate to high levels in the majority of malignant plasma cells. CD74 was expressed by most multiple myeloma cell lines, as was CD74 mRNA, at levels mirroring CD74 protein. Also, unlabeled LL1 mAb mediated in vitro growth inhibition of a CD74+ multiple myeloma cell line. CONCLUSIONS CD74 expression is frequent in multiple myeloma, with predominant expression by the malignant plasma cells. Because anti-CD74 mAbs internalize very rapidly and LL1 mAb has shown efficacy in B-lymphoma models, CD74 represents a novel and promising target for treatment of multiple myeloma. Therefore, LL1 mAb is well suited as a carrier of radionuclides, drugs, or toxins, and also has activity as an unlabeled mAb, thereby supporting its development for this unmet need in cancer therapy.
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MESH Headings
- Animals
- Antibodies, Monoclonal/pharmacology
- Antigens, Differentiation, B-Lymphocyte/genetics
- Antigens, Differentiation, B-Lymphocyte/immunology
- Antigens, Differentiation, B-Lymphocyte/metabolism
- Cell Line, Tumor
- Cell Proliferation/drug effects
- Flow Cytometry
- Gene Expression Regulation, Neoplastic
- Histocompatibility Antigens Class II/genetics
- Histocompatibility Antigens Class II/immunology
- Histocompatibility Antigens Class II/metabolism
- Humans
- Immunohistochemistry
- Lymphoma, B-Cell/drug therapy
- Lymphoma, B-Cell/metabolism
- Lymphoma, B-Cell/pathology
- Mice
- Multiple Myeloma/genetics
- Multiple Myeloma/metabolism
- Multiple Myeloma/pathology
- Plasma Cells/chemistry
- Plasma Cells/pathology
- RNA, Messenger/genetics
- RNA, Messenger/metabolism
- Reverse Transcriptase Polymerase Chain Reaction
- Thymidine/pharmacokinetics
- Tritium
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Affiliation(s)
- Jack D Burton
- Center for Molecular Medicine and Immunology and Garden State Cancer Center, Belleville, New Jersey 07109, USA.
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13
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Dubus P, Young P, Beylot-Barry M, Belaud-Rotureau MA, Courville P, Vergier B, Parrens M, Lenormand B, Joly P, Merlio JP. Value of interphase FISH for the diagnosis of t(11:14)(q13;q32) on skin lesions of mantle cell lymphoma. Am J Clin Pathol 2002; 118:832-41. [PMID: 12472275 DOI: 10.1309/508r-ybww-y0ac-82ga] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
Abstract
The diagnosis of skin lesions of mantle cell lymphoma (MCL) may be difficult at the onset of the disease. We observed 2 patients with papules of the trunk and 1 with diffuse infiltration of the trunk and the face and 2 subcutaneous nodules. Skin samples showed diffuse infiltration of the dermis (n = 1) or perivascular infiltration (n = 2). The infiltrate corresponded to centrocytic cells (n = 2) or pleomorphic blastoid cells (n = 1) with a B-cell phenotype: CD3-, CD5+ (2/3), CD20+, CD23-, and CD43+. In only 1 case was cyclin D1 immunoreactivity detected, and the t(11;l4)(q13;q32) breakpoint was amplified from both lymph node and skin DNA. Competitive reverse transcriptase-polymerase chain reaction was not contributive for skin specimens. In all 3 cases, interphase fluorescence in situ hybridization (FISH) demonstrated t(11;14) fusion signals either on paraffin sections or on fresh frozen touch preparations of skin biopsies. The recognition of skin lesions of MCL from other B-cell infiltrates can be established by interphase FISH.
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MESH Headings
- Aged
- Aged, 80 and over
- Chromosomes, Human, Pair 11
- Chromosomes, Human, Pair 14
- Cyclin D1/metabolism
- Humans
- Immunohistochemistry
- In Situ Hybridization, Fluorescence
- Interphase
- Lymphoma, Mantle-Cell/genetics
- Lymphoma, Mantle-Cell/metabolism
- Lymphoma, Mantle-Cell/pathology
- Male
- Middle Aged
- Reverse Transcriptase Polymerase Chain Reaction
- Skin Neoplasms/genetics
- Skin Neoplasms/metabolism
- Skin Neoplasms/pathology
- Translocation, Genetic
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Affiliation(s)
- Pierre Dubus
- Histology and Molecular Pathology Laboratory, University of Bordeaux 2, France
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14
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Sen F, Medeiros LJ, Lu D, Jones D, Lai R, Katz R, Abruzzo LV. Mantle cell lymphoma involving skin: cutaneous lesions may be the first manifestation of disease and tumors often have blastoid cytologic features. Am J Surg Pathol 2002; 26:1312-8. [PMID: 12360046 DOI: 10.1097/00000478-200210000-00008] [Citation(s) in RCA: 49] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
We describe five cases of mantle cell lymphoma involving skin. Three patients initially presented with skin lesions but had evidence of widespread disease at time of diagnosis or with relatively short follow-up. One patient was known to have disseminated disease before he developed skin lesions. One patient presented with a solitary skin nodule on the thigh and has developed multiple smaller nodules on the same leg, but no other sites of disease over 30 months of clinical follow-up. This case fulfills the criteria for primary cutaneous lymphoma as proposed by the European Organization for Research and Treatment of Cancer. Biopsy of the skin lesions in all cases showed predominantly dermal and focally subcutaneous lymphoid infiltrates, preferentially perivascular and periadnexal in four cases, and nodular in one case. The tumors were composed of small- to medium-sized lymphocytes with irregular nuclear contours. Four cases had blastoid and one case had typical cytologic features. Immunophenotypic studies showed that all cases were positive for CD20 and cyclin D1, and four of five were positive for CD5. Four cases, including the CD5-negative case, had evidence of the t(11;14) shown by either fluorescence in situ hybridization methods performed on skin tumors or conventional cytogenetic analysis performed on involved bone marrow. We conclude that mantle cell lymphoma can involve skin, usually as a manifestation of disseminated disease, and is often associated with blastoid cytologic features. Rare cases of mantle cell lymphoma may arise in skin.
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Affiliation(s)
- Filiz Sen
- Division of Pathology and Loboratory Medicine, university of Texas M.D. Anderson Center, Houston, Texas 77030, USA
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15
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Fung MA, Murphy MJ, Hoss DM, Grant-Kels JM. Practical evaluation and management of cutaneous lymphoma. J Am Acad Dermatol 2002; 46:325-57; quiz, 358-60. [PMID: 11862169 DOI: 10.1067/mjd.2002.121355] [Citation(s) in RCA: 72] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
UNLABELLED Accurate evaluation of patients with suspected or known cutaneous lymphoma requires the integration of many sources and types of information, including clinical evaluation, microscopic analysis of tissue, immunophenotyping, gene rearrangement studies, clinical staging, and longitudinal observation. Diagnoses should be based on knowledge of specific lymphoma types as described in modern classification systems. Management of patients with cutaneous lymphoma requires collaboration among dermatologists, dermatopathologists, hematopathologists, and medical, surgical and radiation oncologists. (J Am Acad Dermatol 2002;46:325-57.) LEARNING OBJECTIVE At the conclusion of this learning activity, participants should better understand how to evaluate and manage patients for suspected or established lymphoma of the skin. Components include the clinical history and physical examination, optimal biopsy and tissue handling, interpretation of pathology and adjunctive test results, clinicopathologic correlation, and therapy. Participants should also understand the basis for establishing a specific diagnosis of cutaneous lymphoma based on current classification and staging.
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Affiliation(s)
- Maxwell A Fung
- Department of Dermatology, University of Connecticut Health Center, 263 Farmington Ave., Farmington, CT 06030, USA
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16
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Moody BR, Bartlett NL, George DW, Price CR, Breer WA, Rothschild Y, Kraus MD. Cyclin D1 as an aid in the diagnosis of mantle cell lymphoma in skin biopsies: a case report. Am J Dermatopathol 2001; 23:470-6. [PMID: 11801782 DOI: 10.1097/00000372-200110000-00014] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Mantle cell lymphoma (MCL), an uncommon and aggressive form of non-Hodgkin lymphoma, typically involves lymph nodes. It usually only secondarily involves extranodal sites. We describe an unusual case of a MCL that presented and relapsed in the earlobes. Light microscopic findings were initially regarded as suggestive of small lymphocytic lymphoma, although subsequent analysis of fresh tissue by flow cytometry led to the diagnosis of MCL. Retrospective application of a broad panel of recently developed markers suitable for analysis of routinely processed tissue yielded results that also permitted a diagnosis of MCL. If these results had been available at the time of initial presentation, they would have obviated the need for rebiopsy. Greater awareness not only of the phenotypic criteria by which lymphomas are classified but of the lymphoma markers available for evaluation of routinely processed tissue should facilitate the accurate diagnosis of diseases like MCL and minimize the risk of misdiagnosis as an indolent disorder.
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Affiliation(s)
- B R Moody
- Division of Dermatology, Washington University School of Medicine, St. Louis, Missouri, USA
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Sander CA, Flaig MJ, Jaffe ES. Cutaneous manifestations of lymphoma: a clinical guide based on the WHO classification. World Health Organization. CLINICAL LYMPHOMA 2001; 2:86-100; discussion 101-2. [PMID: 11707848 DOI: 10.3816/clm.2001.n.014] [Citation(s) in RCA: 40] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Cutaneous lymphomas are a heterogeneous group of lymphomas that show variations in histology, immunophenotype, and prognosis. At the time of presentation, cutaneous lymphomas may be primary or may involve the skin as a secondary site of involvement. Primary cutaneous lymphomas, in many instances, are distinct from morphologically similar lymphomas arising in lymph nodes. Their natural history is often more indolent than nodal lymphomas, and for that reason, they often require different therapeutic approaches. A classification scheme should recognize those lymphomas that are unique to the skin, as well as those arising in other sites. The mode of presentation of a lymphoma is often an indication of underlying biological distinctions. However, organ-specific classification systems undermine communication among medical specialists. The World Health Organization classification of hematopoietic and lymphoid malignancies offers a comprehensive approach and proposes that lymphomas should be viewed as a list of individual diseases and that each disease can be defined by a constellation of morphological, biological, and clinical features. The current review will focus on the spectrum of primary and secondary cutaneous lymphomas, emphasizing those features of importance to the clinical oncologist.
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Affiliation(s)
- C A Sander
- Department of Dermatology, Ludwig-Maximilians-Universitaet, Munich, Germany
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Martí RM, Campo E, Bosch F, Palou J, Estrach T. Cutaneous lymphocyte-associated antigen (CLA) expression in a lymphoblastoid mantle cell lymphoma presenting with skin lesions. Comparison with other clinicopathologic presentations of mantle cell lymphoma. J Cutan Pathol 2001; 28:256-64. [PMID: 11401669 DOI: 10.1034/j.1600-0560.2001.028005256.x] [Citation(s) in RCA: 21] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
BACKGROUND Cutaneous lymphocyte-associated antigen (CLA) is a lymphocyte homing receptor selectively expressed by T cells of the cutaneous immune system and their malignant counterpart, that is to say, cutaneous T-cell lymphomas. However it is absent in the vast mayority of other T-cell malignancies and B-cell lineage lymphomas irrespective on primary tumor site. METHODS Expression of CLA was investigated on six cases of mantle cell lymphoma (MCL) which differed in their histopathological subtype (typical or blastic) and their tendency to infiltrate skin and/or central nervous system (CNS). RESULTS CLA immunostaining on neoplastic cells was only observed in a 61-year-old female suffering from a lymphoblastoid MCL which clinically presented with specific skin lesions and further developped CNS disease. In this patient, coexpression of CLA with MCL markers (CD20 and CD5) was confirmed by conventional immunohistochemistry and double immunofluorescence studies. CONCLUSIONS To our knowledge, CLA immunoreactivity on B-cell lymphomas has not beeen previously reported. The expression of this skin-related adhesion molecule on malignant MCL cells could explain the clinical behavior of our case which presented and relapsed with cutaneous lesions. However, CLA seems not to be a MCL marker nor a CNS-related adhesion molecule. The authors review the clinical and histopathological characteristics of MCL-specific skin lesions and their diagnostic clues based on cell morphology, immunohistochemistry and molecular investigations.
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Affiliation(s)
- R M Martí
- Department of Dermatology, Hospital Clínic i Provincial de Barcelona, Barcelona, Spain.
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Pandolfino TL, Siegel RS, Kuzel TM, Rosen ST, Guitart J. Primary cutaneous B-cell lymphoma: review and current concepts. J Clin Oncol 2000; 18:2152-68. [PMID: 10811681 DOI: 10.1200/jco.2000.18.10.2152] [Citation(s) in RCA: 74] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE Primary cutaneous B-cell lymphoma (PCBCL) has only recently been recognized as a distinct clinical entity. With the advent of improved immunophenotyping and immunogenotyping, increasing numbers of PCBCL cases are being diagnosed. However, there is much confusion regarding the classification, treatment, and prognosis of these patients. The purpose of this article is to review and analyze the available data to provide the clinician with a concise summary of the diagnosis, prognosis, and treatment of PCBCL. DESIGN We conducted a thorough review of the medical literature on PCBCL, with a focus on classification, prognosis, and treatment trials. RESULTS AND CONCLUSION PCBCL is defined as a B-cell lymphoma originating in the skin. There is no evidence of extracutaneous disease at presentation and for 6 months after diagnosis, as assessed by adequate staging procedures. Currently, the European Organization for Research and Treatment of Cancer classification is the most concise disease classification scheme, dividing the subtypes of PCBCL by clinical behavior and histopathologic findings. Based on this classification, the most common subtype of PCBCL is follicular center cell lymphoma. PCBCL is generally an indolent form of lymphoma with a good prognosis. Although local cutaneous recurrences are observed in 25% to 68% of patients, dissemination to internal organs is rare. Five-year survival rates typically range from 89% to 96%. A specific subtype, large B-cell lymphoma of the leg, is noted to have a poorer prognosis, with a 5-year survival rate of 58%. Overly aggressive treatment of PCBCL has not been shown to improve survival or prevent relapse. The treatment of choice usually varies depending on the type of PCBCL, the body surface area, and the location of the involvement, as well as the age and general health condition of the patient. The majority of studies indicate that PCBCL is highly responsive to radiation therapy. Polychemotherapy should be reserved for involvement of noncontiguous anatomic sites or those with extracutaneous spread.
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Affiliation(s)
- T L Pandolfino
- Department of Medicine, Section of Hematology and Oncology, Northwestern University Medical School, Chicago, IL 60611, USA
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Abstract
Cutaneous B-cell lymphomas represent a heterogeneous group of entities which show variation in histology, immunophenotype, and in prognosis. In the current review the morphologic spectrum of cutaneous B-cell lymphomas comprising primary and secondary cutaneous B-cell lymphomas is discussed according to the REAL classification scheme.
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Affiliation(s)
- C A Sander
- Department of Dermatology, Ludwig Maximilians Universität München, Germany
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Sander CA, Kind P, Kaudewitz P, Raffeld M, Jaffe ES. The Revised European-American Classification of Lymphoid Neoplasms (REAL): a new perspective for the classification of cutaneous lymphomas. J Cutan Pathol 1997; 24:329-41. [PMID: 9243360 DOI: 10.1111/j.1600-0560.1997.tb00801.x] [Citation(s) in RCA: 54] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Differing classification schemes for malignant lymphomas have been used in Europe and the United States. Attempts to translate between the principle classifications have been unsuccessful and historically it has been difficult to arrive at an unified approach. In addition, many new lymphoma entities have been recognized in recent years that are not delineated in any of the existing classification schemes. To provide a unified international basis for clinical and investigative work in this field, in 1994 the International Lymphoma Study Group (ILSG) proposed a new classification termed Revised European-American Classification of Lymphoid Neoplasms (REAL). This review discusses the REAL classification, especially as it pertains to cutaneous lymphomas, and provides insight into the clinicopathologic features of lymphoproliferative disease involving the skin. The premise of the REAL classification is that a classification scheme should be based on the delineation of disease entities, utilizing pathologic, immunophenotypic, genetic, and clinical features. Therefore, if cutaneous involvement is an integral aspect of any lymphoma subtype, this clinical information is included in the definition of that neoplasm. We conclude that the principles of the REAL classification are applicable to cutaneous lymphomas, as well as lymphomas involving other anatomic sites.
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Affiliation(s)
- C A Sander
- Department of Dermatology, Ludwig-Maximilians-Universitaet, Munich, Germany
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Willemze R, Rijlaarsdam JU, Meijer CJ. Are most primary cutaneous B-cell lymphomas 'marginal cell lymphomas'? Br J Dermatol 1995; 133:950-2; discussion 953-4. [PMID: 8547050 DOI: 10.1111/j.1365-2133.1995.tb06931.x] [Citation(s) in RCA: 22] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Affiliation(s)
- R Willemze
- Department of Dermatology, Free University Hospital, Amsterdam, The Netherlands
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