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Ehinger M, Béné MC. Morphology and multiparameter flow cytometry combined for integrated lymphoma diagnosis on small volume samples: possibilities and limitations. Virchows Arch 2024:10.1007/s00428-024-03819-3. [PMID: 38805049 DOI: 10.1007/s00428-024-03819-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2024] [Revised: 04/18/2024] [Accepted: 05/02/2024] [Indexed: 05/29/2024]
Abstract
The diagnosis of lymphoma relies mainly on clinical examination and laboratory explorations. Among the latter, morphological and immunohistochemical analysis of a tissue biopsy are the cornerstones for proper identification and classification of the disease. In lymphoma with blood and/or bone marrow involvement, multiparameter flow cytometry is useful. This technique can also be applied to fresh cells released from a biopsy sample. For full comprehension of lymphomas, surgical biopsies are best and indeed recommended by the hematopathological community. Currently, however, there is a global trend towards less invasive procedures, resulting in smaller samples such as core needle biopsies or fine needle aspirations which can make the diagnosis quite challenging. In this review, the possibilities and limitations to make an accurate lymphoma diagnosis on such small volume material are presented. After recalling the major steps of lymphoma diagnosis, the respective value of histology, cytology, and flow cytometry is discussed, including handling of small specimens. The benefits of an integrated approach are then evoked, followed by discussion about which attitude to adopt in different contexts. Perhaps contrary to the prevailing view among many pathologists, a full diagnosis on small volume material, combined with relevant ancillary techniques, is often possible and indeed supported by recent literature. A glimpse at future evolutions, notably the merit of artificial intelligence tools, is finally provided. All in all, this document aims at providing pathologists with an overview of diagnostic possibilities in lymphoma patients when confronted with small volume material such as core needle biopsies or fine needle aspirations.
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Affiliation(s)
- Mats Ehinger
- Division of Pathology, Department of Clinical Sciences Lund, Lund University, Lund, Sweden.
- Department of Clinical Genetics, Pathology and Molecular Diagnostics, Office for Medical Services, Region Skåne, Lund, Sweden.
| | - Marie C Béné
- Faculty of Medicine, Nantes University, Nantes, France
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2
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Kalinova M, Mrhalova M, Kabickova E, Svaton M, Skotnicova A, Prouzova Z, Krenova Z, Kolenova A, Divoka M, Fronkova E, Kodet R. Molecular Screening in Anaplastic Lymphoma Kinase-Positive Anaplastic Large Cell Lymphoma: Anaplastic Lymphoma Kinase Analysis, Next-Generation Sequencing Fusion Gene Detection, and T-Cell Receptor Immunoprofiling. Mod Pathol 2024; 37:100428. [PMID: 38266918 DOI: 10.1016/j.modpat.2024.100428] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Revised: 12/08/2023] [Accepted: 01/16/2024] [Indexed: 01/26/2024]
Abstract
Anaplastic lymphoma kinase-positive anaplastic large cell lymphoma (ALK+ ALCL) originates from the T-lineage and is marked by rearrangements of the ALK gene. More than 10 fusion partners with the ALK gene are known, with the most common being the t(2;5)(p23;q35) translocation resulting in the NPM1::ALK fusion. In 10% to 20% of the ALK+ ALCL cases, the ALK gene fuses with various other partners. Modern molecular techniques, especially next-generation sequencing (NGS), have eased the identification of ALK gene fusion partners and have allowed in-depth characterization of the T-cell receptor (TCR) repertoire. We devised a real-time quantitative reverse-transcription polymerase chain reaction to measure the expression of the translocated portion of the ALK gene. Fusion partners for the ALK gene were analyzed using rapid amplification of 5'cDNA ends (RACE) method or NGS. TCR immunoprofiling was performed by amplicon NGS. We studied 96 ALK+ ALCL patients. NPM1::ALK fusion gene was observed in 71 patients, ATIC::ALK in 9, and TPM3::ALK in 3. CLTC::ALK, MYH9::ALK, and RNF213::ALK fusions were identified in 2 patients each. We also discovered the TPM4::ALK and SATB1::ALK fusion genes, plus the following 2 previously unidentified ALK+ ALCL fusions: SQSTM1::ALK and CAPRIN1::ALK. High expression of the translocated ALK gene segment was observed in all 93 analyzed samples. TCR testing was conducted on 23 patients with available DNA. In 18 (78%) patients, we discerned at least one (ranging from 1 to 4) clonal TCR rearrangement. In 59% of the patients, clonal TCR beta junctions corresponded with sequences previously observed in both healthy donors and under various pathological conditions. Reverse-transcriptase quantitative detection of ALK expression is a fast and reliable method for both diagnosing and monitoring treatment response in ALK+ ALCL patients, irrespective of the ALK gene translocation. NGS reveals new ALK translocation partners. Both malignant and reactive TCR repertoires in ALK+ ALCL patients are unique and do not consistently occur among different patients.
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Affiliation(s)
- Marketa Kalinova
- Department of Pathology, 3rd Faculty of Medicine, Charles University, Prague, Czech Republic; Central Laboratories, Faculty Hospital Kralovske Vinohrady, Prague, Czech Republic; Department of Pathology and Molecular Medicine, 2nd Faculty of Medicine, Charles University, Prague, Czech Republic.
| | - Marcela Mrhalova
- Department of Pathology and Molecular Medicine, 2nd Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Edita Kabickova
- CLIP, Department of Pediatric Hematology and Oncology, 2nd Faculty of Medicine, Charles University and University Hospital Motol, Prague, Czech Republic
| | - Michael Svaton
- CLIP, Department of Pediatric Hematology and Oncology, 2nd Faculty of Medicine, Charles University and University Hospital Motol, Prague, Czech Republic
| | - Aneta Skotnicova
- CLIP, Department of Pediatric Hematology and Oncology, 2nd Faculty of Medicine, Charles University and University Hospital Motol, Prague, Czech Republic
| | - Zuzana Prouzova
- Department of Pathology, 3rd Faculty of Medicine, Charles University, Prague, Czech Republic; Department of Pathology and Molecular Medicine, 2nd Faculty of Medicine, Charles University, Prague, Czech Republic; Department of Pathology, 1st Faculty of Medicine, VFN, Charles University, Prague, Czech Republic
| | - Zdenka Krenova
- Department of Pediatric Oncology, University Hospital Brno, Brno, Czech Republic; Department of Pediatrics, Faculty of Medicine Masaryk University, Brno, Czech Republic
| | - Alexandra Kolenova
- Department of Pediatric Hematology and Oncology, Faculty of Medicine, Comenius University Bratislava, Bratislava, Slovak Republic
| | - Martina Divoka
- Department of Hematooncology, Faculty Hospital Olomouc, Olomouc, Czech Republic
| | - Eva Fronkova
- CLIP, Department of Pediatric Hematology and Oncology, 2nd Faculty of Medicine, Charles University and University Hospital Motol, Prague, Czech Republic.
| | - Roman Kodet
- Department of Pathology and Molecular Medicine, 2nd Faculty of Medicine, Charles University, Prague, Czech Republic
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Liu C, Li F, Mao C, Dangzeng Z, Wang L. Pitfalls in diagnosing a case of extranodal NK/T-cell lymphoma with CD20 aberrant expression and IGH gene rearrangement. J Cutan Pathol 2023; 50:1052-1058. [PMID: 37666507 DOI: 10.1111/cup.14528] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2023] [Revised: 08/04/2023] [Accepted: 08/21/2023] [Indexed: 09/06/2023]
Abstract
Extranodal NK/T-cell lymphoma (ENKTL) is a subtype of non-Hodgkin lymphoma mainly derived from NK cells and, uncommonly, T-cells. A diagnostic challenge is presented when an atypical phenotype and gene rearrangement are encountered. Herein, we report a case of ENKTL with CD20 expression and IGH gene rearrangement, which is extremely rare. A 57-year-old female patient was seen in 2021 due to a nodule on her left leg and simultaneously impaired eyesight for 6 months. Skin biopsy and immunohistochemistry were performed. The lymphoid cells were positive for CD3, CD56, granzyme B, and TIA-1, partially positive for CD2, and mildly positive for CD20. In situ hybridization for Epstein-Barr virus was positive. Molecular studies revealed immunoglobulin heavy chain (IGH) gene rearrangement, while no T-cell receptor gene rearrangement was detected. The positron emission tomography scan showed that the lymphoma affected bilateral adrenal glands, pelvic cavity, peritoneal cavity, small intestine, skin, and subcutis of the bilateral lower extremities of the patient. Her disease progressed despite eight cycles of chemotherapy and radiation therapy. The importance of this case lies in the atypical phenotype and IGH gene rearrangements, necessitating comprehensive interpretation of clinicopathological data.
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Affiliation(s)
- Chenxi Liu
- Department of Dermatology, West China Hospital, Sichuan University, Chengdu, China
- Laboratory of Dermatology, Clinical Institute of Inflammation and Immunology, Frontiers Science Center for Disease-related Molecular Network, West China Hospital, Sichuan University, Chengdu, China
| | - Fan Li
- Department of Dermatology, West China Hospital, Sichuan University, Chengdu, China
- Laboratory of Dermatology, Clinical Institute of Inflammation and Immunology, Frontiers Science Center for Disease-related Molecular Network, West China Hospital, Sichuan University, Chengdu, China
| | - Chunyan Mao
- Department of Dermatology, West China Hospital, Sichuan University, Chengdu, China
- Laboratory of Dermatology, Clinical Institute of Inflammation and Immunology, Frontiers Science Center for Disease-related Molecular Network, West China Hospital, Sichuan University, Chengdu, China
| | - Zhuoma Dangzeng
- Department of Dermatology, West China Hospital, Sichuan University, Chengdu, China
- Laboratory of Dermatology, Clinical Institute of Inflammation and Immunology, Frontiers Science Center for Disease-related Molecular Network, West China Hospital, Sichuan University, Chengdu, China
| | - Lin Wang
- Department of Dermatology, West China Hospital, Sichuan University, Chengdu, China
- Laboratory of Dermatology, Clinical Institute of Inflammation and Immunology, Frontiers Science Center for Disease-related Molecular Network, West China Hospital, Sichuan University, Chengdu, China
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Groenen PJTA, van den Brand M, Kroeze LI, Amir AL, Hebeda KM. Read the clonotype: Next-generation sequencing-based lymphocyte clonality analysis and perspectives for application in pathology. Front Oncol 2023; 13:1107171. [PMID: 36845702 PMCID: PMC9945094 DOI: 10.3389/fonc.2023.1107171] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2022] [Accepted: 01/19/2023] [Indexed: 02/10/2023] Open
Abstract
Clonality assessment using the unique rearrangements of immunoglobulin (IG) and T-cell receptor (TR) genes in lymphocytes is a widely applied supplementary test for the diagnosis of B-cell and T-cell lymphoma. To enable a more sensitive detection and a more precise comparison of clones compared with conventional clonality analysis based on fragment analysis, the EuroClonality NGS Working Group developed and validated a next-generation sequencing (NGS)-based clonality assay for detection of the IG heavy and kappa light chain and TR gene rearrangements for formalin-fixed and paraffin-embedded tissues. We outline the features and advantages of NGS-based clonality detection and discuss potential applications for NGS-based clonality testing in pathology, including site specific lymphoproliferations, immunodeficiency and autoimmune disease and primary and relapsed lymphomas. Also, we briefly discuss the role of T-cell repertoire of reactive lymphocytic infiltrations in solid tumors and B-lymphoma.
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Affiliation(s)
- Patricia J. T. A. Groenen
- Department of Pathology, Radboud University Medical Center, Nijmegen, Netherlands,Radboud Institute for Molecular Life Sciences, Radboud University Medical Center, Nijmegen, Netherlands,*Correspondence: Patricia J. T. A. Groenen,
| | - Michiel van den Brand
- Department of Pathology, Radboud University Medical Center, Nijmegen, Netherlands,Pathology-DNA, Location Rijnstate Hospital, Arnhem, Netherlands
| | - Leonie I. Kroeze
- Department of Pathology, Radboud University Medical Center, Nijmegen, Netherlands,Radboud Institute for Molecular Life Sciences, Radboud University Medical Center, Nijmegen, Netherlands
| | - Avital L. Amir
- Department of Pathology, Radboud University Medical Center, Nijmegen, Netherlands
| | - Konnie M. Hebeda
- Department of Pathology, Radboud University Medical Center, Nijmegen, Netherlands
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Chen YL, Ho CL, Hung CY, Chen WL, Chang C, Hou YH, Chen JR, Chen PJ, Chow NH, Huang W, Hsu YT, Chen TY, Liu T. Enhancing diagnosis of T-cell lymphoma using non-recombined T-cell receptor sequences. Front Oncol 2022; 12:1014132. [PMID: 36568146 PMCID: PMC9772823 DOI: 10.3389/fonc.2022.1014132] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Accepted: 11/25/2022] [Indexed: 12/13/2022] Open
Abstract
Clonality assessment, which can detect neoplastic T cells by identifying the uniquely recombined T-cell receptor (TCR) genes, provides important support in the diagnosis of T-cell lymphoma (TCL). BIOMED-2 is the gold standard clonality assay and has proven to be effective in European TCL patients. However, we failed to prove its sensitivity in Taiwanese TCL patients, especially based on the TCRβ gene. To explore potential impact of genetic background in the BIOMED-2 test, we analyzed TCRβ sequences of 21 healthy individuals and two TCL patients. This analysis suggests that genetic variations in the BIOMED-2 primer sites could not explain the difference in sensitivity. The BIOMED-2 test results of the two TCL patients were positive and negative, respectively. Interestingly, a higher percentage (>81%) of non-recombined TCRβ sequences was observed in the test-negative patient than those of the test-positive patient and all healthy individuals (13~66%). The result suggests a new TCR target for enhancing TCL diagnosis. To further explore the hypothesis, we proposed a cost-effective digital PCR assay that quantifies the relative abundance of non-recombined TCRβ sequences containing a J2-2P~J2-3 segment. With the digital PCR assay, bone marrow specimens from TCL patients (n=9) showed a positive outcome (i.e., the relative abundance of the J2-2P~J2-3 sequences ≧5%), whereas non-TCL patients (n=6) gave a negative result. As five of nine TCL patients had a negative BIOMED-2 test result, the J2-2P~J2-3 sequences may improve TCL detection. This is the first report showing the capability of characterizing non-recombined TCR sequences as a supplementary strategy for the BIOMED-2 clonality test.
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Affiliation(s)
- Yi-Lin Chen
- Department of Pathology, National Cheng Kung University Hospital, Tainan, Taiwan,Molecular Medicine Core Laboratory, Research Center of Clinical Medicine, National Cheng Kung University Hospital, Tainan, Taiwan,Medical Laboratory Science and Biotechnology, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Chung-Liang Ho
- Department of Pathology, National Cheng Kung University Hospital, Tainan, Taiwan,Molecular Medicine Core Laboratory, Research Center of Clinical Medicine, National Cheng Kung University Hospital, Tainan, Taiwan,Institute of Molecular Medicine, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Chen-Yan Hung
- Department of Biotechnology and Bioindustry Sciences, National Cheng Kung University, Tainan, Taiwan
| | - Wan-Li Chen
- Department of Pathology, National Cheng Kung University Hospital, Tainan, Taiwan,Molecular Medicine Core Laboratory, Research Center of Clinical Medicine, National Cheng Kung University Hospital, Tainan, Taiwan
| | - Chen Chang
- Department of Pathology, National Cheng Kung University Hospital, Tainan, Taiwan
| | - Yi-Hsin Hou
- Department of Pathology, National Cheng Kung University Hospital, Tainan, Taiwan,Molecular Medicine Core Laboratory, Research Center of Clinical Medicine, National Cheng Kung University Hospital, Tainan, Taiwan
| | - Jian-Rong Chen
- Department of Pathology, National Cheng Kung University Hospital, Tainan, Taiwan,Molecular Medicine Core Laboratory, Research Center of Clinical Medicine, National Cheng Kung University Hospital, Tainan, Taiwan
| | - Pin-Jun Chen
- Medical Laboratory Science and Biotechnology, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Nan-Haw Chow
- Department of Pathology, National Cheng Kung University Hospital, Tainan, Taiwan,Molecular Medicine Core Laboratory, Research Center of Clinical Medicine, National Cheng Kung University Hospital, Tainan, Taiwan,Institute of Molecular Medicine, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Wenya Huang
- Department of Pathology, National Cheng Kung University Hospital, Tainan, Taiwan,Medical Laboratory Science and Biotechnology, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Ya-Ting Hsu
- Section of Hematology/Oncology, Department of Internal Medicine, National Cheng Kung University Hospital, Tainan, Taiwan
| | - Tsai-Yun Chen
- Section of Hematology/Oncology, Department of Internal Medicine, National Cheng Kung University Hospital, Tainan, Taiwan
| | - Tsunglin Liu
- Department of Biotechnology and Bioindustry Sciences, National Cheng Kung University, Tainan, Taiwan,*Correspondence: Tsunglin Liu,
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Experiencia en el uso de protocolos Biomed-2 para el estudio de reordenamientos de TCR e inmunoglobulinas en proliferaciones linfoides en el Instituto Nacional de Cancerología, Colombia. BIOMÉDICA 2022; 42:64-78. [PMID: 35866731 PMCID: PMC9385446 DOI: 10.7705/biomedica.5940] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Indexed: 11/21/2022]
Abstract
Introducción. El consorcio europeo BIOMED-2 se creó para determinar si una población linfoide de difícil clasificación patológica es clonal. En Colombia, la implementación de estas pruebas comenzó en el 2015 en el Instituto Nacional de Cancerología E.S.E. (Bogotá). Objetivos. Determinar el comportamiento de las pruebas de reordenamiento clonal o clonalidad linfoide. y determinar las dificultades de su uso en nuestro medio verificando su adaptación local y los resultados en una serie retrospectiva de casos y consecutiva de proliferaciones linfoides sometidas a los protocolos BIOMED-2. Materiales y métodos. A partir de las historias clínicas, se recolectaron los datos clínicos e histológicos y los resultados de los análisis de los reordenamientos en todos los casos de proliferaciones linfoides sometidas a los protocolos BIOMED-2, entre febrero de 2015 y mayo de 2019. Resultados. Se hallaron 132 casos, de los cuales 47 se clasificaron mediante los protocolos de Biomed-2 como hiperplasias linfoides reactivas, 62 como linfomas T, 19 como linfomas B y 3 como neoplasias linfoides de linaje no establecido. Solo en un caso falló la extracción de ADN. Según estos resultados, la mayor dificultad diagnóstica para el patólogo fue el análisis de los infiltrados linfoides T, la mayoría (44) de los cuales correspondía a lesiones cutáneas. Conclusiones. Las pruebas de clonalidad pueden usarse en tejidos de diversa calidad en nuestro medio como ayuda en el diagnóstico de proliferaciones linfoides de difícil clasificación. Es importante hacerlas e interpretarlas de manera multidisciplinaria y considerar cada caso por separado.
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El-Sharkawi D, Attygalle A, Dearden C. Mature T-Cell leukemias: Challenges in Diagnosis. Front Oncol 2022; 12:777066. [PMID: 35359424 PMCID: PMC8961294 DOI: 10.3389/fonc.2022.777066] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Accepted: 01/11/2022] [Indexed: 11/29/2022] Open
Abstract
T-cell clones can frequently be identified in peripheral blood. It can be difficult to appreciate whether these are benign and transient or whether they signify a clonal disorder. We review factors that aid in understanding the relevance of T-cell clones. Conversely, obvious pathological T-cell clones can be detected in blood, but there is uncertainty in how to categorize this clonal T cell population, thus, we adopt a multidisciplinary review of the clinical features, diagnostic material and radiology before making the diagnosis. In this review we shall discuss some of these challenges faced when diagnosing mature T-cell leukemias.
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Affiliation(s)
- Dima El-Sharkawi
- Department of Haematology, The Royal Marsden NHS Foundation Trust, London, United Kingdom.,Division of Molecular Pathology, The Institute of Cancer Research, London, United Kingdom
| | - Ayoma Attygalle
- Department of Histopathology, The Royal Marsden NHS Foundation Trust, London, United Kingdom
| | - Claire Dearden
- Department of Haematology, The Royal Marsden NHS Foundation Trust, London, United Kingdom
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Vermeer MH, Moins-Teisserenc H, Bagot M, Quaglino P, Whittaker S. Flow cytometry for the assessment of blood tumour burden in cutaneous T-cell lymphoma: towards a standardised approach. Br J Dermatol 2022; 187:21-28. [PMID: 35157307 PMCID: PMC9541328 DOI: 10.1111/bjd.21053] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Revised: 01/28/2022] [Accepted: 02/09/2022] [Indexed: 11/30/2022]
Abstract
Mycosis fungoides (MF) and Sézary syndrome (SS) are the best-studied subtypes of cutaneous T-cell lymphoma, a rare non-Hodgkin lymphoma that primarily presents in the skin but can also involve blood, lymph nodes, and viscera. The role of blood involvement in the assessment and staging of MF and SS has evolved in recent years from being classed as simply 'present' or 'absent', with no impact on staging, to full analysis of abnormal peripheral-blood T cells using flow cytometry (FC) to detect and quantify aberrant T-cell phenotypes and polymerase chain reaction (PCR) to characterise T-cell receptor gene rearrangements. These sensitive peripheral-blood assessments are replacing manual Sézary cell counts and have become an important part of clinical work-up in MF and SS, providing the potential for more accurate prognostication and appropriate management. However, although international recommendations now include guidelines for FC analysis of peripheral-blood markers for staging purposes, many clinics only perform these analyses in advanced-stage patients, if at all, and there is still a need for standardised use of validated markers. Standardisation of a single effective multiparameter FC panel would allow for accurate identification and quantification of blood tumour burden for diagnosis, staging, assessment of therapeutic response, and monitoring of disease progression at all stages of disease. Once defined, validation of an MF/SS biomarker FC panel will enable uptake into clinical settings along with associated standardisation of protocols and reagents. This review discusses the evolution of the role of FC in evaluating blood involvement in MF and SS, considers recently published international guidelines, and identifies evidence gaps for future research that will allow for standardisation of FC in MF and SS.
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Affiliation(s)
- Maarten H Vermeer
- Dermatology Department, Leiden University Medical Center, Leiden, the Netherlands
| | - Helene Moins-Teisserenc
- Université de Paris, Institut de Recherche Saint Louis, INSERM UMR1160, Paris, France.,Hematology Laboratory, AP-, HP, Hôpital Saint Louis, Paris, France
| | - Martine Bagot
- Université de Paris, Institut de Recherche Saint Louis, INSERM UMRS976, Onco-Dermatology and Therapies, Paris, France.,Département de Dermatologie, AP-, HP, Hôpital Saint Louis, Paris, France
| | - Pietro Quaglino
- Dermatologic Clinic, Department of Medical Sciences, University of Turin Medical School, Turin, Italy
| | - Sean Whittaker
- St. John's Institute of Dermatology, School of Basic and Medical Biosciences, King's College London, Guy's Hospital, London, SE1 9RT, UK
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Radtanakatikanon A, Moore PF, Keller SM, Vernau W. Novel clonality assays for T cell lymphoma in cats targeting the T cell receptor beta, T cell receptor delta, and T cell receptor gamma loci. J Vet Intern Med 2021; 35:2865-2875. [PMID: 34929760 PMCID: PMC8692208 DOI: 10.1111/jvim.16288] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2021] [Revised: 10/11/2021] [Accepted: 10/13/2021] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND T cell clonality assays in veterinary medicine currently target only the T cell receptor gamma (TRG) locus. Existing assays have suboptimal sensitivity because of insufficient primer coverage of all possible rearrangements. OBJECTIVE Develop higher sensitivity clonality assays targeting the TRG, delta (TRD), and beta (TRB) loci in cats. ANIMALS Cats with histopathologically confirmed lymphoma (n = 89), non-lymphoma (n = 35), and possible hepatic small cell lymphoma (n = 31). METHODS Molecular clonality assay development utilizing our recently reported topology and expressed repertoire data of the T cell receptor loci in cats. Determination of clonality status of lymphoma, non lymphoma, and possible hepatic small cell lymphoma samples, and calculation of assay sensitivity and specificity. RESULTS The new multiplex TRG assay yielded the highest sensitivity (95.5%). All assays yielded 100% specificity except for the new multiplex TRG assay (97.3%). The combination of the new TRG and TRB assays yielded sensitivity of 98.9% and specificity of 97.0%. The new TRG assay detected clonality in 17/31 possible small cell lymphoma livers, whereas an existing TRG assay detected clonality in 6/31 livers. CONCLUSIONS AND CLINICAL IMPORTANCE The assessment of multiple T cell loci compensates for the potential shortcomings of individual assays. Using a combination of molecular clonality assays will increase the overall sensitivity for the diagnosis of T-cell lymphoma in cats, especially intestinal, and hepatic small cell lymphoma. Hepatic small cell lymphomas detected by the new TRG assay utilized rarely expressed V and J genes not recognized by previous assays, likely indicating unique biology of hepatic small cell lymphoma in cats.
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Affiliation(s)
- Araya Radtanakatikanon
- Department of Pathology, Microbiology and ImmunologySchool of Veterinary Medicine, University of CaliforniaDavisCaliforniaUSA
- Department of Pathology, Faculty of Veterinary ScienceChulalongkorn UniversityBangkokThailand
| | - Peter F. Moore
- Department of Pathology, Microbiology and ImmunologySchool of Veterinary Medicine, University of CaliforniaDavisCaliforniaUSA
| | - Stefan M. Keller
- Department of Pathology, Microbiology and ImmunologySchool of Veterinary Medicine, University of CaliforniaDavisCaliforniaUSA
| | - William Vernau
- Department of Pathology, Microbiology and ImmunologySchool of Veterinary Medicine, University of CaliforniaDavisCaliforniaUSA
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Zhang X, Zhou J, Han X, Wang E, Zhang L. Update on the Classification and Diagnostic Approaches of Mature T-Cell Lymphomas. Arch Pathol Lab Med 2021; 146:947-952. [PMID: 34524423 DOI: 10.5858/arpa.2021-0143-ra] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/10/2021] [Indexed: 11/06/2022]
Abstract
CONTEXT.— In the 2017 revised World Health Organization classification of tumors of hematopoietic and lymphoid tissues, some mature T-cell lymphomas are reclassified and a few new provisional entities are established based on new data from clinical and laboratory studies. T follicular helper cell lymphoma is identified by T follicular helper cell markers. Anaplastic large cell lymphoma, ALK negative, is a better-defined entity based on genetic abnormalities, and breast implant-associated anaplastic large cell lymphoma is recognized as a provisional entity. The gastrointestinal T-cell lymphomas are reclassified, with addition of a new provisional entity, indolent T-cell lymphoproliferative disorder of the gastrointestinal tract, characterized by an indolent clinical course. OBJECTIVE.— To review the diagnostic approaches of reclassified and newly established entities of mature T-cell lymphomas, focusing on significant immunophenotypic features and molecular genetic abnormalities. Relevant new discoveries after the publication of the 2017 World Health Organization classification are included. DATA SOURCES.— Information from the literature most relevant to 2017 World Health Organization revised classification and publications after 2016. CONCLUSIONS.— Incorporating clinical, morphologic, and immunophenotypic features usually provides sufficient evidence to reach a preliminary diagnosis of mature T-cell lymphoma. Molecular genetic studies can be very helpful for the final diagnosis and classification, especially in challenging cases. Some molecular genetic features have been found in breast implant-associated anaplastic large cell lymphoma, distinct from anaplastic large cell lymphoma, ALK negative. Immunohistochemical staining of 4 markers may enable further subtyping of peripheral T-cell lymphomas.
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Affiliation(s)
- Xiaohui Zhang
- From the Department of Pathology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida (X. Zhang)
| | - Jiehao Zhou
- The Department of Pathology and Laboratory Medicine, Indiana University School of Medicine, Indianapolis (Zhou)
| | - Xin Han
- The Department of Laboratory Medicine, The University of Texas MD Anderson Cancer Center, Houston (Han)
| | - Endi Wang
- The Department of Pathology, Duke University Medical Center, Durham, North Carolina (Wang)
| | - Linsheng Zhang
- The Department of Pathology and Laboratory Medicine, Emory University School of Medicine, Atlanta, Georgia (L. Zhang)
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Cani AK, Toral MA, Balikov DA, Betz BL, Hu K, Liu CJ, Prifti MV, Chinnaiyan AM, Tomlins SA, Mahajan VB, Rao RC. Molecular Characterization of a Rare Case of Bilateral Vitreoretinal T Cell Lymphoma through Vitreous Liquid Biopsy. Int J Mol Sci 2021; 22:ijms22116099. [PMID: 34198843 PMCID: PMC8201094 DOI: 10.3390/ijms22116099] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Revised: 05/19/2021] [Accepted: 05/30/2021] [Indexed: 02/04/2023] Open
Abstract
Vitreoretinal lymphoma (VRL) is an uncommon eye malignancy, and VRLs of T cell origin are rare. They are difficult to treat, and their molecular underpinnings, including actionable genomic alterations, remain to be elucidated. At present, vitreous fluid liquid biopsies represent a valuable VRL sample for molecular analysis to study VRLs. In this study, we report the molecular diagnostic workup of a rare case of bilateral T cell VRL and characterize its genomic landscape, including identification of potentially targetable alterations. Using next-generation sequencing of vitreous-derived DNA with a pan-cancer 126-gene panel, we found a copy number gain of BRAF and copy number loss of tumor suppressor DNMT3A. To the best of our knowledge, this represents the first exploration of the T cell VRL cancer genome and supports vitreous liquid biopsy as a suitable approach for precision oncology treatments.
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Affiliation(s)
- Andi K. Cani
- Department of Internal Medicine, University of Michigan, Ann Arbor, MI 48105, USA;
- Rogel Cancer Center, University of Michigan, Ann Arbor, MI 48109, USA;
| | - Marcus A. Toral
- Medical Scientist Training Program, University of Iowa, Iowa City, IA 52242, USA;
- Graduate Program in Molecular Medicine, University of Iowa, Iowa City, IA 52242, USA
- Molecular Surgery Laboratory, Byers Eye Institute, Stanford University, Palo Alto, CA 94303, USA
| | - Daniel A. Balikov
- W.K. Kellogg Eye Center, Department of Ophthalmology and Visual Science, University of Michigan, Ann Arbor, MI 48105, USA;
| | - Bryan L. Betz
- Department of Pathology, University of Michigan, Ann Arbor, MI 48109, USA; (B.L.B.); (K.H.); (C.-J.L.); (S.A.T.)
| | - Kevin Hu
- Department of Pathology, University of Michigan, Ann Arbor, MI 48109, USA; (B.L.B.); (K.H.); (C.-J.L.); (S.A.T.)
- Department of Computational Medicine and Bioinformatics, University of Michigan, Ann Arbor, MI 48109, USA
| | - Chia-Jen Liu
- Department of Pathology, University of Michigan, Ann Arbor, MI 48109, USA; (B.L.B.); (K.H.); (C.-J.L.); (S.A.T.)
- Michigan Center for Translational Pathology, University of Michigan, Ann Arbor, MI 48109, USA
| | - Matthew V. Prifti
- A. Alfred Taubman Medical Research Institute, University of Michigan, Ann Arbor, MI 48105, USA;
- Department of Biological Sciences, Wayne State University, Detroit, MI 48202, USA
| | - Arul M. Chinnaiyan
- Rogel Cancer Center, University of Michigan, Ann Arbor, MI 48109, USA;
- Department of Pathology, University of Michigan, Ann Arbor, MI 48109, USA; (B.L.B.); (K.H.); (C.-J.L.); (S.A.T.)
- Michigan Center for Translational Pathology, University of Michigan, Ann Arbor, MI 48109, USA
| | - Scott A. Tomlins
- Department of Pathology, University of Michigan, Ann Arbor, MI 48109, USA; (B.L.B.); (K.H.); (C.-J.L.); (S.A.T.)
- Michigan Center for Translational Pathology, University of Michigan, Ann Arbor, MI 48109, USA
| | - Vinit B. Mahajan
- Molecular Surgery Laboratory, Byers Eye Institute, Stanford University, Palo Alto, CA 94303, USA
- Palo Alto Veterans Health Care System, Palo Alto, CA 94304, USA
- Correspondence: (V.B.M.); (R.C.R.); Tel.: +1-650-723-6995 (V.B.M.); +1-734-647-1226 (R.C.R.); Fax: +1-650-498-1528 (V.B.M.); +1-734-232-8030 (R.C.R.)
| | - Rajesh C. Rao
- Rogel Cancer Center, University of Michigan, Ann Arbor, MI 48109, USA;
- W.K. Kellogg Eye Center, Department of Ophthalmology and Visual Science, University of Michigan, Ann Arbor, MI 48105, USA;
- Department of Pathology, University of Michigan, Ann Arbor, MI 48109, USA; (B.L.B.); (K.H.); (C.-J.L.); (S.A.T.)
- Department of Computational Medicine and Bioinformatics, University of Michigan, Ann Arbor, MI 48109, USA
- A. Alfred Taubman Medical Research Institute, University of Michigan, Ann Arbor, MI 48105, USA;
- Division of Ophthalmology, Surgical Service, Veterans Administration Ann Arbor Healthcare System, Ann Arbor, MI 48105, USA
- Correspondence: (V.B.M.); (R.C.R.); Tel.: +1-650-723-6995 (V.B.M.); +1-734-647-1226 (R.C.R.); Fax: +1-650-498-1528 (V.B.M.); +1-734-232-8030 (R.C.R.)
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12
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T-lymphoblastic leukemia/lymphoma with interfollicular growth pattern and Castleman-like morphologic features. J Hematop 2021. [DOI: 10.1007/s12308-021-00446-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
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13
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Keppens C, Boone E, Gameiro P, Tack V, Moreau E, Hodges E, Evans P, Brüggemann M, Carter I, Lenze D, Sarasquete ME, Möbs M, Liu H, Dequeker EMC, Groenen PJTA. Evaluation of a worldwide EQA scheme for complex clonality analysis of clinical lymphoproliferative cases demonstrates a learning effect. Virchows Arch 2021; 479:365-376. [PMID: 33686511 PMCID: PMC8364525 DOI: 10.1007/s00428-021-03046-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Revised: 11/18/2020] [Accepted: 01/28/2021] [Indexed: 11/26/2022]
Abstract
Clonality analysis of immunoglobulin (IG) or T-cell receptor (TR) gene rearrangements is routine practice to assist diagnosis of lymphoid malignancies. Participation in external quality assessment (EQA) aids laboratories in identifying systematic shortcomings. The aim of this study was to evaluate laboratories' improvement in IG/TR analysis and interpretation during five EQA rounds between 2014 and 2018. Each year, participants received a total of five cases for IG and five cases for TR testing. Paper-based cases were included for analysis of the final molecular conclusion that should be interpreted based on the integration of the individual PCR results. Wet cases were distributed for analysis of their routine protocol as well as evaluation of the final molecular conclusion. In total, 94.9% (506/533) of wet tests and 97.9% (829/847) of paper tests were correctly analyzed for IG, and 96.8% (507/524) wet tests and 93.2% (765/821) paper tests were correctly analyzed for TR. Analysis scores significantly improved when laboratories participated to more EQA rounds (p=0.001). Overall performance was significantly lower (p=0.008) for non-EuroClonality laboratories (95% for IG and 93% for TR) compared to EuroClonality laboratories (99% for IG and 97% for TR). The difference was not related to the EQA scheme year, anatomic origin of the sample, or final clinical diagnosis. This evaluation showed that repeated EQA participation helps to reduce performance differences between laboratories (EuroClonality versus non-EuroClonality) and between sample types (paper versus wet). The difficulties in interpreting oligoclonal cases highlighted the need for continued education by meetings and EQA schemes.
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Affiliation(s)
- Cleo Keppens
- Department of Public Health and Primary Care, Biomedical Quality Assurance Research Unit, University of Leuven, Kapucijnenvoer 35 block d, 1st floor, box 7001, 3000 Leuven, Belgium
| | - Elke Boone
- AZ Delta vzw - Laboratorium Moleculaire Diagnostiek, Deltalaan 1, 8800 Roeselare, Belgium
| | - Paula Gameiro
- Laboratory of Hemato-Oncology, Portuguese Institute of Oncology of Lisbon, Rua Prof Lima Basto, 1099-023 Lisboa, Portugal
| | - Véronique Tack
- Department of Public Health and Primary Care, Biomedical Quality Assurance Research Unit, University of Leuven, Kapucijnenvoer 35 block d, 1st floor, box 7001, 3000 Leuven, Belgium
| | - Elisabeth Moreau
- AZ Delta vzw - Laboratorium Moleculaire Diagnostiek, Deltalaan 1, 8800 Roeselare, Belgium
| | - Elizabeth Hodges
- Precision Medicine Centre, Queen’s University Belfast, Health Science Building, 97 Lisburn Road, Belfast, BT9 7AE UK
| | - Paul Evans
- HMDS, Leeds Institute of Oncology, St. James University Hospital, Level 3 Bexley Wing Leeds, Leeds, LS9 7TF UK
| | - Monika Brüggemann
- Department of Hematology, University Hospital Schleswig-Holstein, Langer Segen 8-10, 24105 Kiel, Germany
| | - Ian Carter
- Molecular Diagnostics, Histopathology, Nottingham University Hospitals NHS Trust, City Campus, Hucknall Rd., Nottingham, NG5 1PB UK
| | - Dido Lenze
- Institut für Pathologie, Molekularpathologie, Charité –Universitätsmedizin Berlin, Chariteplatz 1, 10117 Berlin, Germany
| | - Maria Eugenia Sarasquete
- Laboratorio Biología Molecular, Servicio de Hematología, Hospital Universitario de Salamanca, Paseo de San Vicente, 58-182, 37007 Salamanca, Spain
| | - Markus Möbs
- Institut für Pathologie, Molekularpathologie, Charité –Universitätsmedizin Berlin, Chariteplatz 1, 10117 Berlin, Germany
| | - Hongxiang Liu
- Molecular Malignancy Laboratory, Haematopathology and Oncology Diagnostic Service (HODS), Addenbrooke’s Hospital, Cambridge University Hospitals NHS Foundation Trust, Box 234, Hills Road, Cambridge, CB2 0QQ UK
| | - Elisabeth M. C. Dequeker
- Department of Public Health and Primary Care, Biomedical Quality Assurance Research Unit, University of Leuven, Kapucijnenvoer 35 block d, 1st floor, box 7001, 3000 Leuven, Belgium
| | - Patricia J. T. A. Groenen
- Department of Pathology, Radboud University Medical Centre Nijmegen, Geert Grooteplein Zuid 10, 6525 GA Nijmegen, The Netherlands
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14
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Horna P, Shi M, Olteanu H, Johansson U. Emerging Role of T-cell Receptor Constant β Chain-1 (TRBC1) Expression in the Flow Cytometric Diagnosis of T-cell Malignancies. Int J Mol Sci 2021; 22:ijms22041817. [PMID: 33673033 PMCID: PMC7918842 DOI: 10.3390/ijms22041817] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2021] [Revised: 02/09/2021] [Accepted: 02/09/2021] [Indexed: 02/07/2023] Open
Abstract
T-cell clonality testing is integral to the diagnostic work-up of T-cell malignancies; however, current methods lack specificity and sensitivity, which can make the diagnostic process difficult. The recent discovery of a monoclonal antibody (mAb) specific for human TRBC1 will greatly improve the outlook for T-cell malignancy diagnostics. The anti-TRBC1 mAb can be used in flow cytometry immunophenotyping assays to provide a low-cost, robust, and highly specific test that detects clonality of immunophenotypically distinct T-cell populations. Recent studies demonstrate the clinical utility of this approach in several contexts; use of this antibody in appropriately designed flow cytometry panels improves detection of circulating disease in patients with cutaneous T-cell lymphoma, eliminates the need for molecular clonality testing in the context of large granular lymphocyte leukemia, and provides more conclusive results in the context of many other T-cell disorders. It is worth noting that the increased ability to detect discrete clonal T-cell populations means that identification of T-cell clones of uncertain clinical significance (T-CUS) will become more common. This review discusses this new antibody and describes how it defines clonal T-cells. We present and discuss assay design and summarize findings to date about the use of flow cytometry TRBC1 analysis in the field of diagnostics, including lymph node and fluid sample investigations. We also make suggestions about how to apply the assay results in clinical work-ups, including how to interpret and report findings of T-CUS. Finally, we highlight areas that we think will benefit from further research.
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Affiliation(s)
- Pedro Horna
- Division of Hematopathology, Mayo Clinic, Rochester, MN 55905, USA; (P.H.); (M.S.); (H.O.)
| | - Min Shi
- Division of Hematopathology, Mayo Clinic, Rochester, MN 55905, USA; (P.H.); (M.S.); (H.O.)
| | - Horatiu Olteanu
- Division of Hematopathology, Mayo Clinic, Rochester, MN 55905, USA; (P.H.); (M.S.); (H.O.)
| | - Ulrika Johansson
- SI-HMDS, University Hospitals Bristol and Weston NHS Foundation Trust, Bristol BS1 3NU, UK
- Correspondence:
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15
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[Clonality analysis in practice]. DER PATHOLOGE 2021; 42:241-251. [PMID: 33575888 DOI: 10.1007/s00292-021-00915-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 01/13/2021] [Indexed: 10/22/2022]
Abstract
Malignant lymphomas are derived from a common progenitor cell with a unique rearrangement of immunoglobulin or T‑cell receptor genes. Polymerase chain reaction (PCR)-based analyses allow detection of the clone and are an important adjunct for the diagnosis of difficult lymphoproliferations, e.g. for the discrimination of reactive versus malignant lesions. Further applications are detection of disease dissemination and evaluation of the clonal relationship of two lymphomas. However, clonality analysis is not a stand-alone test and must always be considered in context with clinical, histological and immunophenotypic data. For the correct use of clonality analysis, comprehensive knowledge of the biological basis, technical requirements and interpretation are needed in order to avoid incorrect conclusions.
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16
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Oon ML, Lim JQ, Lee B, Leong SM, Soon GST, Wong ZW, Lim EH, Li Z, Yeoh AEJ, Chen S, Ban KHK, Chung TH, Tan SY, Chuang SS, Kato S, Nakamura S, Takahashi E, Ho YH, Khoury JD, Au-Yeung RKH, Cheng CL, Lim ST, Chng WJ, Tripodo C, Rotzschke O, Ong CK, Ng SB. T-Cell Lymphoma Clonality by Copy Number Variation Analysis of T-Cell Receptor Genes. Cancers (Basel) 2021; 13:cancers13020340. [PMID: 33477749 PMCID: PMC7832336 DOI: 10.3390/cancers13020340] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2020] [Accepted: 01/11/2021] [Indexed: 11/30/2022] Open
Abstract
Simple Summary T-cells defend the human body from pathogenic invasion via specific recognition by T-cell receptors (TCRs). The TCR genes undergo recombination (rearrangement) in a myriad of possible ways to generate different TCRs that can recognize a wide diversity of foreign antigens. However, in patients with T-cell lymphoma (TCL), a particular T-cell becomes malignant and proliferates, resulting in a population of genetically identical cells with same TCR rearrangement pattern. To help diagnose patients with TCL, a polymerase chain reaction (PCR)-based assay is currently used to determine if neoplastic cells in patient samples are of T-cell origin and bear identical (monoclonal) TCR rearrangement pattern. Herein, we report the application of a novel segmentation and copy number computation algorithm to accurately identify different TCR rearrangement patterns using data from the whole genome sequencing of patient materials. Our approach may improve the diagnostic accuracy of TCLs and can be similarly applied to the diagnosis of B-cell lymphomas. Abstract T-cell lymphomas arise from a single neoplastic clone and exhibit identical patterns of deletions in T-cell receptor (TCR) genes. Whole genome sequencing (WGS) data represent a treasure trove of information for the development of novel clinical applications. However, the use of WGS to identify clonal T-cell proliferations has not been systematically studied. In this study, based on WGS data, we identified monoclonal rearrangements (MRs) of T-cell receptors (TCR) genes using a novel segmentation algorithm and copy number computation. We evaluated the feasibility of this technique as a marker of T-cell clonality using T-cell lymphomas (TCL, n = 44) and extranodal NK/T-cell lymphomas (ENKTLs, n = 20), and identified 98% of TCLs with one or more TCR gene MRs, against 91% detected using PCR. TCR MRs were absent in all ENKTLs and NK cell lines. Sensitivity-wise, this platform is sufficiently competent, with MRs detected in the majority of samples with tumor content under 25% and it can also distinguish monoallelic from biallelic MRs. Understanding the copy number landscape of TCR using WGS data may engender new diagnostic applications in hematolymphoid pathology, which can be readily adapted to the analysis of B-cell receptor loci for B-cell clonality determination.
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Affiliation(s)
- Ming Liang Oon
- Department of Pathology, National University Hospital, National University Health System, Singapore 119074, Singapore; (M.L.O.); (G.S.-T.S.); (Z.W.W.); (S.-Y.T.)
| | - Jing Quan Lim
- Lymphoma Genomic Translational Research Laboratory, Division of Cellular and Molecular Research, National Cancer Centre Singapore, Singapore 169610, Singapore;
- Cancer and Stem Cell Biology, Duke-NUS Medical School, Singapore 169857, Singapore
| | - Bernett Lee
- Singapore Immunology Network (SIgN), A*STAR (Agency for Science, Technology and Research), Singapore 138632, Singapore; (B.L.); (O.R.)
| | - Sai Mun Leong
- Department of Pathology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore 119074, Singapore;
| | - Gwyneth Shook-Ting Soon
- Department of Pathology, National University Hospital, National University Health System, Singapore 119074, Singapore; (M.L.O.); (G.S.-T.S.); (Z.W.W.); (S.-Y.T.)
| | - Zi Wei Wong
- Department of Pathology, National University Hospital, National University Health System, Singapore 119074, Singapore; (M.L.O.); (G.S.-T.S.); (Z.W.W.); (S.-Y.T.)
| | - Evelyn Huizi Lim
- Viva-NUS Centre for Translational Research in Acute Leukaemia, Department of Paediatrics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore 117597, Singapore; (E.H.L.); (Z.L.); (A.E.J.Y.)
| | - Zhenhua Li
- Viva-NUS Centre for Translational Research in Acute Leukaemia, Department of Paediatrics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore 117597, Singapore; (E.H.L.); (Z.L.); (A.E.J.Y.)
| | - Allen Eng Juh Yeoh
- Viva-NUS Centre for Translational Research in Acute Leukaemia, Department of Paediatrics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore 117597, Singapore; (E.H.L.); (Z.L.); (A.E.J.Y.)
- VIVA—University Children’s Cancer Centre, Khoo Teck Puat–National University Children’s Medical Institute, National University Hospital, National University Health System, Singapore 119074, Singapore
| | - Shangying Chen
- Department of Biochemistry, Yong Loo Lin School of Medicine, National University of Singapore, Singapore 117596, Singapore; (S.C.); (K.H.K.B.)
| | - Kenneth Hon Kim Ban
- Department of Biochemistry, Yong Loo Lin School of Medicine, National University of Singapore, Singapore 117596, Singapore; (S.C.); (K.H.K.B.)
| | - Tae-Hoon Chung
- Cancer Science Institute of Singapore, National University of Singapore, Singapore 117599, Singapore; (T.-H.C.); (W.-J.C.)
| | - Soo-Yong Tan
- Department of Pathology, National University Hospital, National University Health System, Singapore 119074, Singapore; (M.L.O.); (G.S.-T.S.); (Z.W.W.); (S.-Y.T.)
- Department of Pathology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore 119074, Singapore;
| | - Shih-Sung Chuang
- Department of Pathology, Chi-Mei Medical Center, Tainan 71004, Taiwan;
| | - Seiichi Kato
- Department of Pathology and Laboratory Medicine, Nagoya University Hospital, Nagoya 466-8560, Japan; (S.K.); (S.N.)
- Department of Pathology and Molecular Diagnostics, Aichi Cancer Center Hospital, Nagoya 464-0021, Japan
| | - Shigeo Nakamura
- Department of Pathology and Laboratory Medicine, Nagoya University Hospital, Nagoya 466-8560, Japan; (S.K.); (S.N.)
| | - Emiko Takahashi
- Department of Pathology, Aichi Medical University Hospital, Nagakute 480-1195, Japan;
| | - Yong-Howe Ho
- Department of Pathology, Tan Tock Seng Hospital, Singapore 308433, Singapore;
| | - Joseph D. Khoury
- Department of Hematopathology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA;
| | - Rex K. H. Au-Yeung
- Department of Pathology, Queen Mary Hospital, The University of Hong Kong, Hong Kong, China;
| | - Chee-Leong Cheng
- Department of Pathology, Singapore General Hospital, Singapore 169608, Singapore;
| | - Soon-Thye Lim
- Lymphoma Genomic Translational Research Laboratory, Division of Medical Oncology, National Cancer Centre Singapore, Singapore 169610, Singapore;
| | - Wee-Joo Chng
- Cancer Science Institute of Singapore, National University of Singapore, Singapore 117599, Singapore; (T.-H.C.); (W.-J.C.)
- Department of Hematology-Oncology, National University Cancer Institute Singapore, National University Hospital, National University Health System, Singapore 119074, Singapore
| | - Claudio Tripodo
- Tumor Immunology Unit, University of Palermo School of Medicine, 90134 Palermo, Italy;
| | - Olaf Rotzschke
- Singapore Immunology Network (SIgN), A*STAR (Agency for Science, Technology and Research), Singapore 138632, Singapore; (B.L.); (O.R.)
| | - Choon Kiat Ong
- Lymphoma Genomic Translational Research Laboratory, Division of Cellular and Molecular Research, National Cancer Centre Singapore, Singapore 169610, Singapore;
- Cancer and Stem Cell Biology, Duke-NUS Medical School, Singapore 169857, Singapore
- Genome Institute of Singapore, A*STAR (Agency for Science, Technology and Research), Singapore 138632, Singapore
- Correspondence: (C.K.O.); (S.-B.N.); Tel.: +65-6436-8269 (C.K.O.); +65-6772-4709 (S-B.N.)
| | - Siok-Bian Ng
- Department of Pathology, National University Hospital, National University Health System, Singapore 119074, Singapore; (M.L.O.); (G.S.-T.S.); (Z.W.W.); (S.-Y.T.)
- Department of Pathology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore 119074, Singapore;
- Cancer Science Institute of Singapore, National University of Singapore, Singapore 117599, Singapore; (T.-H.C.); (W.-J.C.)
- Correspondence: (C.K.O.); (S.-B.N.); Tel.: +65-6436-8269 (C.K.O.); +65-6772-4709 (S-B.N.)
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17
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Mendoza H, Tormey CA, Rinder HM, Howe JG, Siddon AJ. The utility and limitations of B- and T-cell gene rearrangement studies in evaluating lymphoproliferative disorders. Pathology 2020; 53:157-165. [PMID: 33358756 DOI: 10.1016/j.pathol.2020.09.024] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Revised: 08/05/2020] [Accepted: 09/10/2020] [Indexed: 12/16/2022]
Abstract
A hallmark of lymphoid malignancies is the presence of a monoclonal lymphocyte population. Monoclonality of B- and T-cell populations can be established through immunoglobulin (IG) or T-cell receptor (TCR) gene rearrangement analysis, respectively. The biological rationale of IG and TCR gene rearrangement analysis is that due to the extensive combinatorial repertoire made possible by V(D)J recombination in lymphocytes, it is unlikely that any substantive lymphocyte population would share the same IG or TCR gene rearrangement pattern unless there is an underlying neoplastic or reactive origin. Modern IG and TCR gene rearrangement analysis is typically performed by polymerase chain reaction (PCR) using commercially available primer sets followed by gel capillary electrophoresis. This process is highly sensitive in the detection of nearly all lymphoid malignancies. Several pitfalls and limitations, both biological and technical, apply to IG/TCR gene rearrangement analysis, but these can be minimised with high quality controls, performance of assays in duplicate, and adherence to strict criteria for interpreting and reporting results. Next generation sequencing (NGS) will likely replace PCR based methods of IG/TCR gene rearrangement analysis but is not yet widespread due to the absence of standardised protocols and multicentre validation.
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Affiliation(s)
- Hadrian Mendoza
- Department of Laboratory Medicine, Yale School of Medicine, New Haven, CT, USA
| | | | - Henry M Rinder
- Department of Laboratory Medicine, Yale School of Medicine, New Haven, CT, USA; Hematology Section, Department of Internal Medicine, Yale School of Medicine, New Haven, CT, USA
| | - John G Howe
- Department of Laboratory Medicine, Yale School of Medicine, New Haven, CT, USA
| | - Alexa J Siddon
- Department of Laboratory Medicine, Yale School of Medicine, New Haven, CT, USA; Department of Pathology, Yale School of Medicine, New Haven, CT, USA.
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18
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Lay L, Stroup B, Payton JE. Validation and interpretation of IGH and TCR clonality testing by Ion Torrent S5 NGS for diagnosis and disease monitoring in B and T cell cancers. Pract Lab Med 2020; 22:e00191. [PMID: 33304977 PMCID: PMC7718169 DOI: 10.1016/j.plabm.2020.e00191] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2019] [Accepted: 11/17/2020] [Indexed: 01/02/2023] Open
Abstract
Cancers of B and T lymphocytes are the most common hematologic malignancies in the US. Molecular assays for assessing clonal rearrangements of the immunoglobulin receptor (IGH) and T-cell receptor (TCR), commonly referred to as B- and T-cell clonality, as well as determination of IGH somatic mutation status, enables improved diagnostic accuracy and disease monitoring. Here we describe validation of NGS LymphoTrack (IGH, TCRG, Invivoscribe, Inc) with Ion Torrent S5 sequencing, which employs a different sequencing chemistry and has not been previously reported for NGS clonality to our knowledge. We also demonstrate the concordance of clonality by LymphoTrack with S5 sequencing with other molecular methodologies and with clinical measurements of disease. We show that LymphoTrack with S5 sequencing identifies previously detected IGH and TCRG clonal sequences across matched biopsy specimens and clinical timepoints, enabling more precise and sensitive disease monitoring for B- and T-cell cancers compared to PCR fragment or capillary sequencing. In sum, our study demonstrates that the LymphoTrack assays with Ion Torrent S5 sequencing 1) can be used successfully for IGH and TCR clonality with reproducible results; 2) generates and quantifies clonal sequences to enable highly precise comparison of samples; 3) are substantially more sensitive than PCR fragment and return clonality results in specimens that failed PCR fragment assays; and 4) the TCRG assays are highly concordant with clinical and histopathologic diagnoses. Taken together, the LymphoTrack with Ion S5 NGS clonality assays offer a sensitive and precise method for diagnostic testing and disease monitoring in B- and T-cell cancers.
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Affiliation(s)
| | | | - Jacqueline E. Payton
- Washington University School of Medicine, St. Louis, MO, USA
- Corresponding author.
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19
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Ghosh T, Duncavage E, Mehta-Shah N, McGuire PA, Tenenbaum M, Myckatyn TM. A Cautionary Tale and Update on Breast Implant-Associated Anaplastic Large Cell Lymphoma (BIA-ALCL). Aesthet Surg J 2020; 40:1288-1300. [PMID: 31894234 DOI: 10.1093/asj/sjz377] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Breast implant-associated anaplastic large T-cell lymphoma (BIA-ALCL) was first recognized by the World Health Organization in 2016. The total number of cases worldwide continues to increase, with >800 cases confirmed through a combination of Food and Drug Administration data, verified reports, and registries. To date, 33 deaths have been reported. Typical presentation includes a late seroma containing monoclonal T cells that are CD30 positive and anaplastic lymphoma kinase negative. We present a review of the current literature and report on 3 cases of BIA-ALCL at our institution, which serve to illustrate our approach to diagnosis and management of this disease. In 2 cases, the diagnosis of BIA-ALCL was not initially confirmed due to an incomplete workup but was recognized upon explantation. The seroma fluid was sent for flow cytometry. Initially, the cells were reported as morphologically suspicious for malignancy with phenotypically normal T cells based on standard CD3+ T-cell gating. Subsequent cytology specimens were reported as consistent with recurrent adenocarcinoma. However, upon regating of flow-cytometry data, a population of CD30+, CD3- T cells was noted and the diagnosis of BIA-ALCL was confirmed by immunohistochemical stains of the excised breast capsule specimen. Given the increasing incidence of this disease, as plastic surgeons we must stay informed to order the correct workup to avoid misdiagnosis and be prepared to appropriately refer affected patients to centers with multidisciplinary teams experienced in the management of BIA-ALCL. LEVEL OF EVIDENCE: 4
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Affiliation(s)
- Trina Ghosh
- Division of Plastic and Reconstructive Surgery, Washington University in St Louis School of Medicine, St Louis, MO
| | - Eric Duncavage
- Department of Pathology and Immunology, Washington University in St Louis School of Medicine, St Louis, MO
| | - Neha Mehta-Shah
- Division of Hematology and Oncology, Washington University in St Louis School of Medicine, St Louis, MO
| | | | - Marissa Tenenbaum
- Division of Plastic and Reconstructive Surgery, Washington University in St Louis School of Medicine, St Louis, MO
| | - Terence M Myckatyn
- Division of Plastic and Reconstructive Surgery, Washington University in St Louis School of Medicine, St Louis, MO
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20
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Kim M, Park CJ. Minimal Residual Disease Detection in Pediatric Acute Lymphoblastic Leukemia. CLINICAL PEDIATRIC HEMATOLOGY-ONCOLOGY 2020. [DOI: 10.15264/cpho.2020.27.2.87] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Affiliation(s)
- Miyoung Kim
- Department of Laboratory Medicine, Hallym University Sacred Heart Hospital, Hallym University Medical Center, Hallym University College of Medicine, Anyang, Korea
| | - Chan-Jeoung Park
- Department of Laboratory Medicine, University of Ulsan College of Medicine and Asan Medical Center, Seoul, Korea
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21
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Schachter O, Tabibian-Keissar H, Debby A, Segal O, Baum S, Barzilai A. Evaluation of the polymerase chain reaction-based T-cell receptor β clonality test in the diagnosis of early mycosis fungoides. J Am Acad Dermatol 2020; 83:1400-1405. [PMID: 32526320 DOI: 10.1016/j.jaad.2020.05.110] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2019] [Revised: 05/19/2020] [Accepted: 05/25/2020] [Indexed: 11/17/2022]
Abstract
BACKGROUND T-cell receptor (TCR) clonality may help establish a diagnosis of mycosis fungoides (MF). Routine clonality analysis is performed by using a polymerase chain reaction TCR- gamma assay, yet with this method, 10% to 50% of T-cell lymphomas escape detection. TCR- beta gene rearrangement is an additional assay. Data about its efficacy are controversial. OBJECTIVE To evaluate the role of TCR-β assay in the diagnosis of early MF. METHODS A retrospective study of 61 skin biopsies, 20 from patients with MF, 30 from patients suspected to have early MF, and 11 from patients with chronic inflammatory skin disease. RESULTS Monoclonality was detected in 16 of 20 (80%) MF cases: 15 (75%) with TCR-β and 12 (60%) with TCR-γ assay. Of the 30 suspected cases of early MF, 14 showed monoclonality with TCR-β, and only 5 of 14 showed monoclonality with TCR-γ assay. None of the chronic inflammatory condition samples showed monoclonality. Therefore, TCR-β clonality assay was more sensitive than TCR-γ in early MF (83% vs 43%; P = .002). LIMITATIONS This was a retrospective, relatively small study. CONCLUSION TCR-β showed a higher sensitivity rate compared with TCR-γ in early-stage MF. The combined use of the TCR-β and TCR-γ clonality tests can significantly improve the diagnosis rate of early-stage MF.
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Affiliation(s)
- Orit Schachter
- Department of Dermatology and School of Continuing Medical Education, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | | | - Assaf Debby
- Department of Dermatology and School of Continuing Medical Education, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel; Institute of Pathology, Sheba Medical Center, Tel-Hashomer, Israel
| | - Oz Segal
- Department of Dermatology and School of Continuing Medical Education, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Sharon Baum
- Department of Dermatology and School of Continuing Medical Education, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Aviv Barzilai
- Department of Dermatology and School of Continuing Medical Education, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel; Institute of Pathology, Sheba Medical Center, Tel-Hashomer, Israel.
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22
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Berg H, Otteson GE, Corley H, Shi M, Horna P, Jevremovic D, Olteanu H. Flow cytometric evaluation of
TRBC1
expression in tissue specimens and body fluids is a novel and specific method for assessment of
T‐cell
clonality and diagnosis of
T‐cell
neoplasms. CYTOMETRY PART B-CLINICAL CYTOMETRY 2020; 100:361-369. [DOI: 10.1002/cyto.b.21881] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/18/2019] [Revised: 03/31/2020] [Accepted: 04/07/2020] [Indexed: 11/09/2022]
Affiliation(s)
- Holly Berg
- Division of Hematopathology, Department of Pathology and Laboratory Medicine Mayo Clinic Rochester Minnesota USA
| | - Gregory E. Otteson
- Division of Hematopathology, Department of Pathology and Laboratory Medicine Mayo Clinic Rochester Minnesota USA
| | - Heidi Corley
- Division of Hematopathology, Department of Pathology and Laboratory Medicine Mayo Clinic Rochester Minnesota USA
| | - Min Shi
- Division of Hematopathology, Department of Pathology and Laboratory Medicine Mayo Clinic Rochester Minnesota USA
| | - Pedro Horna
- Division of Hematopathology, Department of Pathology and Laboratory Medicine Mayo Clinic Rochester Minnesota USA
| | - Dragan Jevremovic
- Division of Hematopathology, Department of Pathology and Laboratory Medicine Mayo Clinic Rochester Minnesota USA
| | - Horatiu Olteanu
- Division of Hematopathology, Department of Pathology and Laboratory Medicine Mayo Clinic Rochester Minnesota USA
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23
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Marsilio S, Newman SJ, Estep JS, Giaretta PR, Lidbury JA, Warry E, Flory A, Morley PS, Smoot K, Seeley EH, Powell MJ, Suchodolski JS, Steiner JM. Differentiation of lymphocytic-plasmacytic enteropathy and small cell lymphoma in cats using histology-guided mass spectrometry. J Vet Intern Med 2020; 34:669-677. [PMID: 32100916 PMCID: PMC7096630 DOI: 10.1111/jvim.15742] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2019] [Accepted: 02/14/2020] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Differentiation of lymphocytic-plasmacytic enteropathy (LPE) from small cell lymphoma (SCL) in cats can be challenging. HYPOTHESIS/OBJECTIVE Histology-guided mass spectrometry (HGMS) is a suitable method for the differentiation of LPE from SCL in cats. ANIMALS Forty-one cats with LPE and 52 cats with SCL. METHODS This is a retrospective clinicopathologic study. Duodenal tissue samples of 17 cats with LPE and 22 cats with SCL were subjected to HGMS, and the acquired data were used to develop a linear discriminate analysis (LDA) machine learning algorithm. The algorithm was subsequently validated using a separate set of 24 cats with LPE and 30 cats with SCL. Cases were classified as LPE or SCL based on a consensus by an expert panel consisting of 5-7 board-certified veterinary specialists. Histopathology, immunohistochemistry, and clonality testing were available for all cats. The panel consensus classification served as a reference for the calculation of test performance parameters. RESULTS Relative sensitivity, specificity, and accuracy of HGMS were 86.7% (95% confidence interval [CI]: 74.5%-98.8%), 91.7% (95% CI: 80.6%-100%), and 88.9% (95% CI: 80.5%-97.3%), respectively. Comparatively, the clonality testing had a sensitivity, specificity, and accuracy of 85.7% (95% CI: 72.8%-98.7%), 33.3% (95% CI: 14.5%-52.2%), and 61.5% (95% CI: 48.3%-74.8%) relative to the panel decision. CONCLUSIONS AND CLINICAL IMPORTANCE Histology-guided mass spectrometry was a reliable technique for the differentiation of LPE from SCL in duodenal formalin-fixed paraffin-embedded samples of cats and might have advantages over tests currently considered state of the art.
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Affiliation(s)
- Sina Marsilio
- Department of Veterinary Medicine and EpidemiologyUC Davis School of Veterinary MedicineDavisCalifornia
- Gastrointestinal Laboratory, Department of Small Animal Clinical Sciences, College of Veterinary Medicine and Biomedical Sciences, Texas A&M UniversityCollege StationTexas
| | | | | | - Paula R. Giaretta
- Department of Veterinary PathobiologyTexas A&M UniversityCollege StationTexas
| | - Jonathan A. Lidbury
- Gastrointestinal Laboratory, Department of Small Animal Clinical Sciences, College of Veterinary Medicine and Biomedical Sciences, Texas A&M UniversityCollege StationTexas
| | - Emma Warry
- Department of Small Animal Clinical SciencesCollege of Veterinary Medicine and Biomedical Sciences, Texas A&M UniversityCollege StationTexas
| | - Andi Flory
- Veterinary Specialty HospitalSan DiegoCalifornia
| | - Paul S. Morley
- Veterinary Education, Research, and Outreach Center, Texas A&M UniversityCanyonTexas
| | - Katy Smoot
- New River VDL, LLCMorgantownWest VirginiaUSA
| | | | | | - Jan S. Suchodolski
- Gastrointestinal Laboratory, Department of Small Animal Clinical Sciences, College of Veterinary Medicine and Biomedical Sciences, Texas A&M UniversityCollege StationTexas
| | - Jörg M. Steiner
- Gastrointestinal Laboratory, Department of Small Animal Clinical Sciences, College of Veterinary Medicine and Biomedical Sciences, Texas A&M UniversityCollege StationTexas
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24
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Breast implant-associated anaplastic large cell lymphoma: A comprehensive review. Cancer Treat Rev 2020; 84:101963. [PMID: 31958739 DOI: 10.1016/j.ctrv.2020.101963] [Citation(s) in RCA: 44] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2019] [Revised: 12/28/2019] [Accepted: 01/05/2020] [Indexed: 12/12/2022]
Abstract
Breast implant-associated anaplastic large cell lymphoma (BIA-ALCL) is a recently recognized non-Hodgkin lymphoma of T-cell origin. Despite the low incidence of this new disease, the increasing use of breast implants for cosmetic or post-mastectomy reconstruction purposes places BIA-ALC as an emerging and compelling medical challenge. The real BIA-ALCL pathogenesis has not been fully uncovered so far, while different putative causal factors have been proposed. Breast implants with textured surfaces seem to be associated with nearly all cases of BIA-ALCL, while the real the risk of disease development has not been well estimated so far. Late onset, persistent seroma around breast implant represents the classical clinical presentation. Most of the BIA-ALCL patients presents with localized disease, which confers an excellent prognosis. Unlike other non-Hodgkin lymphomas, surgical excision of the mass has a key role in the treatment. For patients with advanced and disseminated diseases, the treatment did not differ from other types of T-cell lymphoma. For these reasons, BIA-ALCL represents an emerging disease which requires multidisciplinary team approach to well define diagnostic workup and treatment for each patient. This review article aims to summarize available data on BIA-ALCL. First, we will outline available data on BIA-ALCL epidemiology, pathogenesis, diagnostic work-up, and treatment. Second, we will point out the potential psychological implications as well as the risk of perception distortion for women with breast implants, especially for those with previous breast cancer. Lastly, we will summarize the current national recommendations regarding textured breast implants and discuss the diagnostic-therapeutic algorithm for BIA-ALCL management.
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25
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Sidorova YV, Sychevskaya KA, Chernova NG, Julhakyan HL, Smirnova SJ, Ryzhikova NV, Gorodetskiy VR, Naumova EV, Sudarikov AB. High Incidence of Clonal CD8+ T-cell Proliferation in Non-malignant Conditions May Reduce the Significance of T-cell Clonality Assay for Differential Diagnosis in Oncohematology. CLINICAL LYMPHOMA MYELOMA & LEUKEMIA 2020; 20:203-208. [PMID: 32046930 DOI: 10.1016/j.clml.2019.12.021] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/06/2019] [Revised: 12/26/2019] [Accepted: 12/31/2019] [Indexed: 01/23/2023]
Abstract
Polymerase chain reaction (PCR) analysis of rearranged T-cell receptor (TCR) genes is a valuable diagnostic tool for differential diagnosis of T-cell large granular lymphocytic (T-LGL) leukemia and reactive lymphocytosis. Age-related narrowing of T-cells repertoire and expansion of immune or autoimmune clones may lead to false-positive results. The objective of this study was to evaluate the specificity and positive predictive value of PCR-based clonality assessment for a differential diagnostics of T-LGL leukemia. Rearrangements of TCRG and TCRB genes using the BIOMED-2 protocol were assessed in healthy individuals including the elderly (n = 62) and patients with rheumatic diseases (n = 14), transitory reactive CD8+ lymphocytosis (n = 17), and T-LGL leukemia (n = 42). Monoclonal TCRG/TCRB rearrangements in blood were identified in 11.3%/4.8% (7/3 of 62) of healthy individuals; 21.4%/14.3% (3/2 of 14) of patients with rheumatic diseases, and 17.6%/11.8% (3/2 of 17) of patients with reactive lymphocytosis. Immunomagnetic selection of lymphocytes in healthy individuals (31 of 33) revealed that clonal T-cells belong to CD8+ and CD57+ population. No clonal Vβ-Jβ TCRB rearrangements were found in the control group, only Dβ-Jβ TCRB and TCRG. Given the high detectability (96.7%) of Vβ-Jβ TCRB monoclonal rearrangements in patients with αβ-T-LGL leukemia, this marker had the greatest specificity and positive predictive value (100%; 99.2%). The presence of clonal CD8+CD57+ cells in blood is common for healthy individuals and patients with reactive conditions and may not associate with any malignancy. Different specificity of TCRG/ Dβ-Jβ TRB/ Vβ-Jβ TCRB PCR reactions should be taken into account for T-cell clonality data interpretation.
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Affiliation(s)
| | | | | | | | | | | | - Vadim R Gorodetskiy
- V. A. Nasonova Scientific and Research Institute of Rheumatology, Moscow, Russia
| | - Elena V Naumova
- Department of Clinical Laboratory Diagnostics, Russian Medical Academy of Postgraduate Continuous Education, Moscow, Russia
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26
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Acquired Pure Red Cell Aplasia and Acquired Amegakaryocytic Thrombocytopenia Associated With Clonal Expansion of T-Cell Large Granular Lymphocytes in a Patient With Lipopolysaccharide-responsive Beige-like Anchor (LRBA) Protein Deficiency. J Pediatr Hematol Oncol 2019; 41:e542-e545. [PMID: 30188351 DOI: 10.1097/mph.0000000000001292] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Acquired pure red cell aplasia and acquired amegakaryocytic thrombocytopenic purpura are rare in children. Similarly, clonal expansion of T-cell large granular lymphocytes is infrequently seen in pediatrics. Lipopolysaccharide-responsive beige-like anchor (LRBA) protein deficiency is a recently described immunodeficiency syndrome that has been associated with inflammatory bowel disease and autoimmune phenomena such as Evans syndrome. Here, we describe a patient with LRBA deficiency who developed acquired pure red cell aplasia and acquired amegakaryocytic thrombocytopenic purpura associated with expansion of clonal T-cell large granular lymphocytes. This has not been described in the literature previously and adds to the knowledge on the spectrum of manifestations of LRBA deficiency.
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27
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Staber PB, Herling M, Bellido M, Jacobsen ED, Davids MS, Kadia TM, Shustov A, Tournilhac O, Bachy E, Zaja F, Porkka K, Hoermann G, Simonitsch-Klupp I, Haferlach C, Kubicek S, Mayerhoefer ME, Hopfinger G, Jaeger U, Dearden C. Consensus criteria for diagnosis, staging, and treatment response assessment of T-cell prolymphocytic leukemia. Blood 2019; 134:1132-1143. [PMID: 31292114 PMCID: PMC7042666 DOI: 10.1182/blood.2019000402] [Citation(s) in RCA: 65] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2019] [Accepted: 06/26/2019] [Indexed: 12/18/2022] Open
Abstract
T-cell prolymphocytic leukemia (T-PLL) is a rare, mature T-cell neoplasm with a heterogeneous clinical course. With the advent of novel treatment options that will potentially change the management of patients with T-PLL, it has become necessary to produce consensus guidelines for the design and conduct of clinical trials. The T-PLL International Study group (TPLL-ISG) set out to define standardized criteria for diagnosis, treatment indication, and evaluation of response. These criteria will facilitate comparison of results from clinical trials in T-PLL, and will thus support clinical decision making, as well as the approval of new therapeutics by healthcare authorities.
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Affiliation(s)
- Philipp B Staber
- Division of Hematology and Hemostaseology, Department of Internal Medicine I, Medical University of Vienna, Vienna, Austria
| | - Marco Herling
- Department of Internal Medicine, Center for Integrated Oncology Aachen-Bonn-Cologne-Duesseldorf, and
- Excellence Cluster for Cellular Stress Response and Aging-Associated Diseases, University of Cologne, Cologne, Germany
- Center for Molecular Medicine, University of Cologne, Cologne, Germany
| | - Mar Bellido
- Hematology Department, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Eric D Jacobsen
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA
| | - Matthew S Davids
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA
| | - Tapan Mahendra Kadia
- Department of Leukemia, The University of Texas, MD Anderson Cancer Center, Houston, TX
| | - Andrei Shustov
- Seattle Cancer Care Alliance, University of Washington, Seattle, WA
| | | | - Emmanuel Bachy
- Department of Hematology, Hospices Civils de Lyon, Lyon, France
| | - Francesco Zaja
- S.C. Ematologia Azienda Sanitaria Universitaria Integrata, Trieste, Italy
| | - Kimmo Porkka
- Department of Hematology, Helsinki University Hospital Comprehensive Cancer Center, Helsinki, Finland
| | - Gregor Hoermann
- Central Institute of Medical and Chemical Laboratory Diagnostics, University Hospital Innsbruck, Innsbruck, Austria
- Department of Laboratory Medicine and
| | | | | | - Stefan Kubicek
- CeMM Research Center for Molecular Medicine of the Austrian Academy of Sciences, Vienna, Austria
- Christian Doppler Laboratory for Chemical Epigenetics and Anti-Infectives, CeMM Research Center for Molecular Medicine of the Austrian Academy of Sciences, Vienna, Austria
| | - Marius E Mayerhoefer
- Department of Biomedical Imaging and Image-Guided Therapy, Medical University of Vienna, Vienna, Austria
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Georg Hopfinger
- Division of Blood and Marrow Transplantation, Department of Medicine I, Medical University of Vienna, Vienna, Austria; and
| | - Ulrich Jaeger
- Division of Hematology and Hemostaseology, Department of Internal Medicine I, Medical University of Vienna, Vienna, Austria
| | - Claire Dearden
- The Royal Marsden Hospital, NHS Foundation Trust, London, United Kingdom
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Liu X, He H, Li Y, Huang Y, Li G, Yu Q, Li W, Li D. The application of antigen receptor gene rearrangement of BIOMED-2 in the pathologic diagnosis of 348 cases with non-Hodgkin lymphoma in a single institution in Southwest of China. Pathol Res Pract 2019; 215:152615. [PMID: 31562020 DOI: 10.1016/j.prp.2019.152615] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2019] [Revised: 08/12/2019] [Accepted: 08/23/2019] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To explore the clinical value of immunoglobulin (Ig) and T cell receptor (TCR) gene rearrangement in the diagnosis of non-Hodgkin lymphoma. METHODS Using the standardized BIOMED-2 multiplex PCR strategy to detect IgH, IgK and TCR in 272 cases of mature B-cell lymphoma, 55 cases of mature T-cell lymphoma, 21 cases of extranodal NK/ T-cell lymphoma, nasal type, and 20 cases of lymphoid tissue reactive hyperplasia. RESULTS Among all mature B-cell lymphomas, the sensitivity of Ig gene rearrangement was 91.18% (248/272), IgH and IgK gene rearrangement was 76.47% (208/272) and 75.00% (204/272), respectively, meanwhile the sensitivity of TCRγ rearrangement was 3.68% (10/272). In the 55 cases of mature T-cell lymphoma, the sensitivity of the detection of TCRγ was 76.36% (44/55), at the same time the sensitivity of Ig gene rearrangement was 14.55% (8/55), IgH and IgK gene rearrangement was 7.27% (4/55) and 12.73% (7/55), respectively. In 21 cases of extranodal NK/T cell lymphoma, nasal type, and 20 cases of reactive lymphoid hyperplasia, no gene rearrangement was found in the samples of IgH, IgK and TCR. The sensitivity of gene rearrangement in Ig/TCR in B and T-cell lymphoma was significantly different from that in the control group (P < 0.05). CONCLUSION The Ig/TCR gene rearrangement of BIOMED-2 multiplex PCR strategy has important auxiliary value in the diagnosis of B/T-cell non-Hodgkin lymphoma respectively, however, a few B-cell lymphomas may company TCR gene rearrangement as well as a few T-cell lymphomas may accompany Ig gene rearrangement, it must be comprehensively judged with the combination of morphology, immunohistochemistry and clinical features.
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Affiliation(s)
- Xueni Liu
- Department of Pathology, College of Basic Medicine, Chongqing Medical University, Chongqing, China
| | - Hong He
- Department of Internal Medicine, The First Affiliated Hospital, Chongqing Medical University, Chongqing, China
| | - Yuanxin Li
- Department of Pathology, College of Basic Medicine, Chongqing Medical University, Chongqing, China
| | - Ying Huang
- Department of Pathology, College of Basic Medicine, Chongqing Medical University, Chongqing, China
| | - Gang Li
- Molecular Medical Laboratory, Chongqing Medical University, Chongqing, China
| | - Qiubo Yu
- Molecular Medical Laboratory, Chongqing Medical University, Chongqing, China
| | - Wenwen Li
- Department of Pathology, College of Basic Medicine, Chongqing Medical University, Chongqing, China
| | - Dan Li
- Department of Pathology, College of Basic Medicine, Chongqing Medical University, Chongqing, China.
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Rout ED, Burnett RC, Yoshimoto JA, Avery PR, Avery AC. Assessment of immunoglobulin heavy chain, immunoglobulin light chain, and T-cell receptor clonality testing in the diagnosis of feline lymphoid neoplasia. Vet Clin Pathol 2019; 48 Suppl 1:45-58. [PMID: 31478220 DOI: 10.1111/vcp.12767] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2019] [Revised: 05/14/2019] [Accepted: 06/12/2019] [Indexed: 12/31/2022]
Abstract
BACKGROUND Differentiation between neoplastic and reactive lymphocytic proliferations can be challenging in cats. PCR for antigen receptor rearrangements (PARR) testing is a useful diagnostic tool to assess clonality of a lymphoid population. Previous feline PARR studies evaluated clonality of complete immunoglobulin heavy chain V-D-J (IGH-VDJ) and T-cell receptor gamma (TRG) gene rearrangements. OBJECTIVES We aimed to evaluate the sensitivity and specificity of feline PARR primers targeting complete IGH-VDJ and TRG rearrangements, as well as incomplete IGH-DJ, kappa deleting element (Kde), and immunoglobulin lambda light chain (IGL) gene rearrangements in defined feline neoplasms and nonneoplastic controls. METHODS Fluorescently labeled PCR primers were designed to amplify complete IGH-VDJ, incomplete IGH-DJ, Kde, IGL, and TRG gene rearrangements in two multiplexed PCR reactions, and PCR products were analyzed by fragment analysis. Fresh tissue samples from 12 flow cytometrically confirmed B-cell lymphomas, 26 cytologically confirmed gastric and renal lymphomas of presumed B-cell origin, 30 flow cytometrically confirmed T-cell leukemias, and 11 negative control cats were tested. RESULTS Using four immunoglobulin primer sets (IGH-VDJ, IGH-DJ, Kde, and IGL), clonal immunoglobulin rearrangements were detected in 87% (33/38) of the presumed B-cell neoplasms. The IGH-VDJ reaction alone only detected clonality in 50% (19/38) of these cases. TRG rearrangements were clonal in 97% (29/30) of the T-cell leukemia cases. All negative control samples had polyclonal immunoglobulin and TRG rearrangements. CONCLUSIONS The PARR assay developed in this study is useful for assessing clonality in feline lymphoid neoplasms. Clonality assessment of incomplete IGH-DJ, Kde, and IGL rearrangements helped identify clonal B-cell neoplasms not detected with complete IGH-VDJ PARR alone.
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Affiliation(s)
- Emily D Rout
- Department of Microbiology, Immunology and Pathology, College of Veterinary Medicine and Biomedical Sciences, Colorado State University, Fort Collins, Colorado
| | - Robert C Burnett
- Department of Microbiology, Immunology and Pathology, College of Veterinary Medicine and Biomedical Sciences, Colorado State University, Fort Collins, Colorado
| | - Janna A Yoshimoto
- Department of Microbiology, Immunology and Pathology, College of Veterinary Medicine and Biomedical Sciences, Colorado State University, Fort Collins, Colorado
| | - Paul R Avery
- Department of Microbiology, Immunology and Pathology, College of Veterinary Medicine and Biomedical Sciences, Colorado State University, Fort Collins, Colorado
| | - Anne C Avery
- Department of Microbiology, Immunology and Pathology, College of Veterinary Medicine and Biomedical Sciences, Colorado State University, Fort Collins, Colorado
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Standardized next-generation sequencing of immunoglobulin and T-cell receptor gene recombinations for MRD marker identification in acute lymphoblastic leukaemia; a EuroClonality-NGS validation study. Leukemia 2019; 33:2241-2253. [PMID: 31243313 PMCID: PMC6756028 DOI: 10.1038/s41375-019-0496-7] [Citation(s) in RCA: 148] [Impact Index Per Article: 29.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2019] [Accepted: 02/20/2019] [Indexed: 01/09/2023]
Abstract
Amplicon-based next-generation sequencing (NGS) of immunoglobulin (IG) and T-cell receptor (TR) gene rearrangements for clonality assessment, marker identification and quantification of minimal residual disease (MRD) in lymphoid neoplasms has been the focus of intense research, development and application. However, standardization and validation in a scientifically controlled multicentre setting is still lacking. Therefore, IG/TR assay development and design, including bioinformatics, was performed within the EuroClonality-NGS working group and validated for MRD marker identification in acute lymphoblastic leukaemia (ALL). Five EuroMRD ALL reference laboratories performed IG/TR NGS in 50 diagnostic ALL samples, and compared results with those generated through routine IG/TR Sanger sequencing. A central polytarget quality control (cPT-QC) was used to monitor primer performance, and a central in-tube quality control (cIT-QC) was spiked into each sample as a library-specific quality control and calibrator. NGS identified 259 (average 5.2/sample, range 0–14) clonal sequences vs. Sanger-sequencing 248 (average 5.0/sample, range 0–14). NGS primers covered possible IG/TR rearrangement types more completely compared with local multiplex PCR sets and enabled sequencing of bi-allelic rearrangements and weak PCR products. The cPT-QC showed high reproducibility across all laboratories. These validated and reproducible quality-controlled EuroClonality-NGS assays can be used for standardized NGS-based identification of IG/TR markers in lymphoid malignancies.
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31
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A New and Simple TRG Multiplex PCR Assay for Assessment of T-cell Clonality: A Comparative Study from the EuroClonality Consortium. Hemasphere 2019; 3:e255. [PMID: 31723840 PMCID: PMC6746026 DOI: 10.1097/hs9.0000000000000255] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2018] [Accepted: 04/11/2019] [Indexed: 11/25/2022] Open
Abstract
Supplemental Digital Content is available in the text T-cell Receptor Gamma (TRG) rearrangements are commonly used to detect clonal lymphoproliferations in hematopathology, since they are rearranged in virtually all T lymphocytes and have a relatively limited recombinatorial repertoire, which reduces the risk of false negative results, at the cost of potential false positivity. We developed an initial one-tube, 2-fluorochrome EuroClonality TRG PCR multiplex (TRG-1T-2F) which was compared to the original 2-tube, 2-fluorochrome EuroClonality/BIOMED-2 TRG PCR (TRG-2T-2F) and a commercial Invivoscribe one-tube, one-fluorochrome kit (IVS-1T-1F) on a series of 239 samples, including both T-cell malignancies and reactive cases. This initial assay yielded discrepant results between the 10 participating EuroClonality laboratories when using 2 fluorochromes, leading to adoption of a final single color EuroClonality strategy (TRG-1T-1F). Compared to TRG-2T-2F, both TRG-1T-1F and IVS-1T-1F demonstrated easier interpretation and a lower risk of false positive from minor peaks in dispersed repertoires. Both generate smaller fragments and as such are likely to be better adapted to analysis of formalin-fixed paraffin-embedded (FFPE) tissue samples. Their differential performance was mainly explained by (i) superposition of biallelic rearrangements with IVS-1T-1F, due to more extensive overlapping of the repertoires and (ii) intentional omission of the TRGJP primer in TRG-1T-1F, in order to avoid the potential risk of confusion of consensus TRG V9-JP normal rearrangements with a pathological clone.
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Shi M, Jevremovic D, Otteson GE, Timm MM, Olteanu H, Horna P. Single Antibody Detection of T-Cell Receptor αβ Clonality by Flow Cytometry Rapidly Identifies Mature T-Cell Neoplasms and Monotypic Small CD8-Positive Subsets of Uncertain Significance. CYTOMETRY PART B-CLINICAL CYTOMETRY 2019; 98:99-107. [PMID: 30972977 DOI: 10.1002/cyto.b.21782] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/04/2019] [Revised: 03/07/2019] [Accepted: 03/26/2019] [Indexed: 02/01/2023]
Abstract
BACKGROUND The diagnosis of T-cell neoplasms is often challenging, due to overlapping features with reactive T-cells and limitations of currently available T-cell clonality assays. The description of an antibody specific for one of two mutually exclusive T-cell receptor (TCR) β-chain constant regions (TRBC1) provide an opportunity to facilitate the detection of clonal TCRαβ T-cells based on TRBC-restriction. METHODS Twenty patients with mature T-cell neoplasms and 44 patients without evidence of T-cell neoplasia were studied. Peripheral blood (51), bone marrow (10), and lymph node (3) specimens were evaluated by 9-color flow cytometry including TRBC1 (CD2/CD3/CD4/CD5/CD7/CD8/CD45/TCRγδ/TRBC1 and/or CD2/CD3/CD4/CD5/CD7/CD8/CD26/CD45/TRBC1). Monophasic TRBC1 expression on any immunophenotypically distinct CD4-positive or CD8-positive/TCRγδ-negative T-cell subset was considered indicative of clonality. RESULTS Monophasic (clonal) TRBC1 expression was identified on immunophenotypically abnormal T-cells from all 20 patients with T-cell malignancies (100% sensitivity), including 17 cases with either >97% or <3% TRBC1-positive events, and three cases with monophasic homogenous TRBC1-dim expression. All immunophenotypically distinct CD4-positive and CD8-positive/TCRγδ-negative T-cell subsets from 44 patients without T-cell malignancies showed the expected mixture of TRBC1-positive and TRBC-1-negative subpopulations (non-clonal), except for seven patients (16%) with very small CD8-positive T-cell subsets exhibiting a monophasic (clonal) pattern. CONCLUSION Inclusion of a single anti-TRBC1 antibody into a diagnostic T-cell flow cytometry panel facilitates the rapid identification of T-cell neoplasms, in addition to small monotypic CD8-positive subsets of uncertain significance. © 2019 International Clinical Cytometry Society.
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Affiliation(s)
- Min Shi
- Division of Hematopathology, Mayo Clinic, Rochester, Minnesota
| | | | | | - Michael M Timm
- Division of Hematopathology, Mayo Clinic, Rochester, Minnesota
| | - Horatiu Olteanu
- Division of Hematopathology, Mayo Clinic, Rochester, Minnesota
| | - Pedro Horna
- Division of Hematopathology, Mayo Clinic, Rochester, Minnesota
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Achieving Reliable Diagnosis in Late Breast Implant Seromas: From Reactive to Anaplastic Large Cell Lymphoma. Plast Reconstr Surg 2019; 143:15S-22S. [PMID: 30817552 DOI: 10.1097/prs.0000000000005565] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Late onset of fluid collection surrounding breast implants may represent a serious issue when considering the possibility of breast implant-associated anaplastic large cell lymphoma, a newly recognized type of T-cell malignancy. However, many other factors, including trauma and infections, may be implicated in the formation of non-neoplastic periprosthetic delayed effusions. An appropriate management of late seromas, consisting of ultrasound-guided fluid drainage, cultures, cytology, and immunocytochemical and T-cell clonality studies, should be performed to achieve a correct and prompt diagnosis of breast implant-associated anaplastic large cell lymphoma. Criticisms in the diagnosis of late peri-implant effusions are here discussed in detail.
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Qayyum S, Bullock GC, Swerdlow SH, Brower R, Nikiforova M, Aggarwal N. Diagnostic Utility of Isolated Tube C Positivity in T-Cell Receptor β Testing Using BIOMED-2 Primers. Am J Clin Pathol 2019; 151:386-394. [PMID: 30534953 DOI: 10.1093/ajcp/aqy157] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
OBJECTIVES T-cell receptor (TCR) gene rearrangement studies are widely used for assessing T-cell clonality. The frequency and significance of clonal peaks restricted to TCR β (TCRB) tube C are uncertain. We retrospectively reviewed 80 TCR studies performed on bone marrow/peripheral blood. METHODS TCRB and TCR γ (TCRG) analyses were performed using BIOMED-2 primers. A peak was considered clonal or atypical if it was reproducible and 5× or more or 3× to 5× polyclonal background, respectively. RESULTS TCRB analysis demonstrated 12 (15%) of 80 cases with one to four isolated peaks in tube C (>3×) with polyclonal pattern in tubes A and B. TCRG analysis was monoclonal in two cases (both definite T-cell neoplasms), polyclonal in four, and oligoclonal in six. Of the 10 cases without clone in TCRG, six had autoimmune disorder and none had T-cell neoplasm. CONCLUSIONS Peaks restricted to TCRB tube C in the TCR analysis may be misleading, as it is often not indicative of an overt T-cell neoplasm.
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Affiliation(s)
- Sohail Qayyum
- Department of Pathology, University of Pittsburgh School of Medicine, Pittsburgh, PA
| | - Grant C Bullock
- Department of Pathology, University of Pittsburgh School of Medicine, Pittsburgh, PA
| | - Steven H Swerdlow
- Department of Pathology, University of Pittsburgh School of Medicine, Pittsburgh, PA
| | - Raven Brower
- Department of Pathology, University of Pittsburgh School of Medicine, Pittsburgh, PA
| | - Marina Nikiforova
- Department of Pathology, University of Pittsburgh School of Medicine, Pittsburgh, PA
| | - Nidhi Aggarwal
- Department of Pathology, University of Pittsburgh School of Medicine, Pittsburgh, PA
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Boone E, Heezen KC, Groenen PJTA, Langerak AW. PCR GeneScan and Heteroduplex Analysis of Rearranged Immunoglobulin or T-Cell Receptor Genes for Clonality Diagnostics in Suspect Lymphoproliferations. Methods Mol Biol 2019; 1956:77-103. [PMID: 30779031 DOI: 10.1007/978-1-4939-9151-8_4] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Assessment of the presence of clonal lymphoproliferations via polymerase chain reaction (PCR)-based analysis of rearranged immunoglobulin (IG) or T-cell receptor (TR) genes is a valuable method in the diagnosis of suspect lymphoproliferative disorders. Additionally, this methodology can be used for evaluating dissemination of lymphoma cells and for studying the clonal relationship between multiple (different locations) or consecutive (over time) lymphomas. Here we describe an integrated approach to assess clonality via analysis of Ig heavy chain (IGH), Ig kappa (IGK), TCR beta (TRB), and TCR gamma (TRG) gene rearrangements, based on the standardized multiplex PCRs as originally developed by the European BIOMED-2 consortium. The described protocol covers the pre-analytical phase of DNA isolation (from formalin-fixed paraffin-embedded and fresh tissues, body fluids, peripheral blood, and bone marrow), the analytical phase of PCR GeneScan and heteroduplex analysis, and the post-analytical interpretation of the obtained profiles, following established guidelines.
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Affiliation(s)
- Elke Boone
- Laboratory for Molecular Diagnostics, Department of Laboratory Medicine, AZ Delta Hospital, Roeselare, Belgium
| | - Kim C Heezen
- Laboratory Medical Immunology, Department of Immunology, Erasmus MC, Rotterdam, Netherlands
| | | | - Anton W Langerak
- Laboratory Medical Immunology, Department of Immunology, Erasmus MC, Rotterdam, Netherlands.
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Nollet F, Vanhouteghem K, Vermeire S, Maelbrancke E, Emmerechts J, Devos H, Cauwelier B. Evaluation of next-generation sequencing-based clonality analysis of T-cell receptor gamma gene rearrangements based on a new interpretation algorithm. Int J Lab Hematol 2018; 41:242-249. [PMID: 30537135 DOI: 10.1111/ijlh.12954] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2018] [Revised: 10/23/2018] [Accepted: 11/01/2018] [Indexed: 12/20/2022]
Abstract
INTRODUCTION T-cell receptor gene (TRG) rearrangement profiling is an essential component of the workup at diagnosis of T-cell malignancies. TRG amplification by polymerase chain reaction (PCR) and analysis by capillary electrophoresis (PCR-CE) is mostly widely used but is hampered by a subjective interpretation of its results and possible false-positive interpretation of clonality. Several studies evaluated the advantage of TRG rearrangement analysis by Next Generation Sequencing (TRG-NGS), however few have proposed an adequate data interpretation algorithm. METHODS Eighty five fresh and 36 formalin-fixed paraffin embedded (FFPE) diagnostic samples suspected for a lymphoproliferative disorder were analyzed by PCR-CE and TRG NGS. Final clinical diagnosis was available for all fresh samples. Reproducibility, analytical specificity and sensitivity of the TRG NGS analysis was evaluated. RESULTS We propose a new interpretation algorithm for TRG NGS data analysis. PCR-CE and TRG NGS showed identical results in 66/85 (78%) of fresh samples. Sensitivities to detect T-cell malignancies were comparable (96% versus 92%, respectively). The analysis of FFPE material was significantly more successful by TRG NGS (34/36 cases) in respect to PCR-CE (16/36 cases), most likely due to the small size of the amplicons. CONCLUSION Assessment of T-cell clonality by TRG NGS has a significant added value in the diagnosis of T-cell disorders as an adjunct to PCR-CE, particularly in difficult to interpret cases or when analyzing FFPE samples.
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Affiliation(s)
- Friedel Nollet
- Department of Laboratory Medicine, AZ Sint-Jan Brugge-Oostende, Bruges, Belgium
| | | | - Stefanie Vermeire
- Department of Laboratory Medicine, AZ Sint-Jan Brugge-Oostende, Bruges, Belgium
| | - Ellen Maelbrancke
- Department of Laboratory Medicine, AZ Sint-Jan Brugge-Oostende, Bruges, Belgium
| | - Jan Emmerechts
- Department of Laboratory Medicine, AZ Sint-Jan Brugge-Oostende, Bruges, Belgium
| | - Helena Devos
- Department of Laboratory Medicine, AZ Sint-Jan Brugge-Oostende, Bruges, Belgium
| | - Barbara Cauwelier
- Department of Laboratory Medicine, AZ Sint-Jan Brugge-Oostende, Bruges, Belgium
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Kotrova M, Novakova M, Oberbeck S, Mayer P, Schrader A, Knecht H, Hrusak O, Herling M, Brüggemann M. Next-generation ampliconTRBlocus sequencing can overcome limitations of flow-cytometric Vβ expression analysis and confirms clonality in all T-cell prolymphocytic leukemia cases. Cytometry A 2018; 93:1118-1124. [DOI: 10.1002/cyto.a.23604] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2018] [Revised: 07/27/2018] [Accepted: 08/20/2018] [Indexed: 12/27/2022]
Affiliation(s)
- Michaela Kotrova
- Medical Department II, Unit for Hema-tological Diagnostics; University Hospital Schleswig-Holstein; Kiel Germany
| | - Michaela Novakova
- Medical Department II, Unit for Hema-tological Diagnostics; University Hospital Schleswig-Holstein; Kiel Germany
- CLIP-Childhood Leukaemia Investigation Prague, Department of Pediatric Hematology and Oncology, Second Faculty of Medicine; Charles University and University Hospital Motol; Prague Czech Republic
| | - Sebastian Oberbeck
- Department I of Internal Medicine, Center for Integrated Oncology (CIO) Köln-Bonn, Excellence Cluster for Cellular Stress Response and Aging-Associated Diseases (CECAD); Center for Molecular Medicine Cologne (CMMC), University of Cologne; Cologne Germany
| | - Petra Mayer
- Department I of Internal Medicine, Center for Integrated Oncology (CIO) Köln-Bonn, Excellence Cluster for Cellular Stress Response and Aging-Associated Diseases (CECAD); Center for Molecular Medicine Cologne (CMMC), University of Cologne; Cologne Germany
| | - Alexandra Schrader
- Department I of Internal Medicine, Center for Integrated Oncology (CIO) Köln-Bonn, Excellence Cluster for Cellular Stress Response and Aging-Associated Diseases (CECAD); Center for Molecular Medicine Cologne (CMMC), University of Cologne; Cologne Germany
| | - Henrik Knecht
- Medical Department II, Unit for Hema-tological Diagnostics; University Hospital Schleswig-Holstein; Kiel Germany
| | - Ondrej Hrusak
- CLIP-Childhood Leukaemia Investigation Prague, Department of Pediatric Hematology and Oncology, Second Faculty of Medicine; Charles University and University Hospital Motol; Prague Czech Republic
| | - Marco Herling
- Department I of Internal Medicine, Center for Integrated Oncology (CIO) Köln-Bonn, Excellence Cluster for Cellular Stress Response and Aging-Associated Diseases (CECAD); Center for Molecular Medicine Cologne (CMMC), University of Cologne; Cologne Germany
| | - Monika Brüggemann
- Medical Department II, Unit for Hema-tological Diagnostics; University Hospital Schleswig-Holstein; Kiel Germany
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Mehta-Shah N, Clemens MW, Horwitz SM. How I treat breast implant-associated anaplastic large cell lymphoma. Blood 2018; 132:1889-1898. [PMID: 30209119 PMCID: PMC6536699 DOI: 10.1182/blood-2018-03-785972] [Citation(s) in RCA: 48] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2018] [Accepted: 08/22/2018] [Indexed: 11/20/2022] Open
Abstract
Breast implant-associated anaplastic large cell lymphoma (BIA-ALCL) is a recently described form of T-cell non-Hodgkin lymphoma now formally recognized by the World Health Organization classification of lymphoid neoplasms. The disease most often presents with a delayed seroma around the breast implant, almost exclusively with a textured surface, and manifests with breast pain, swelling or asymmetry, capsular contracture, but can also present with a breast mass, and lymph node involvement. The prognosis of BIA-ALCL is favorable compared with many other subtypes of systemic T-cell lymphoma; however, unlike other non-Hodgkin lymphomas, complete surgical excision for localized disease is an important part of the management of these patients. In this paper, we share our recommendations for a multidisciplinary team approach to the diagnosis, workup, and treatment of BIA-ALCL in line with consensus guidelines by the National Comprehensive Cancer Network.
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Affiliation(s)
- Neha Mehta-Shah
- Division of Oncology, Department of Medicine, Washington University in St. Louis, St. Louis, MO
| | - Mark W Clemens
- Department of Plastic Surgery, MD Anderson Cancer Center, Houston, TX; and
| | - Steven M Horwitz
- Department of Medicine, Lymphoma Service, Memorial Sloan Kettering Cancer Center, New York, NY
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39
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Scarisbrick JJ, Hodak E, Bagot M, Stranzenbach R, Stadler R, Ortiz-Romero PL, Papadavid E, Knobler R, Quaglino P, Vermeer M. Developments in the understanding of blood involvement and stage in mycosis fungoides/Sezary syndrome. Eur J Cancer 2018; 101:278-280. [DOI: 10.1016/j.ejca.2018.06.013] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2018] [Accepted: 06/07/2018] [Indexed: 12/19/2022]
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40
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Kansal R, Grody WW, Zhou J, Dong L, Li X. The Value of T-Cell Receptor γ (TRG) Clonality Evaluation by Next-Generation Sequencing in Clinical Hematolymphoid Tissues. Am J Clin Pathol 2018; 150:193-223. [PMID: 29982316 DOI: 10.1093/ajcp/aqy046] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVES To evaluate feasibility of assessing T-cell receptor γ (TRG) clonality by next-generation sequencing (NGS) in hematolymphoid tissues. METHODS We evaluated TRG clonality using NGS and polymerase chain reaction (PCR) assays in blood, bone marrow, and formalin-fixed, paraffin-embedded tissues in 41 archived cases, including 21 benign cases with no history of any lymphoproliferative disorders (LPDs), 16 LPDs (nine mature T-cell neoplasms, seven mature B-cell neoplasms and immune dysregulation-associated LPDs), and four atypical LPDs from 22 females and 19 males with a median age of 58 (range, 9-87) years. RESULTS (1) NGS analyzed TRG sequence and peak ratios, and it had a greater sensitivity than PCR. (2) NGS identified small clones, including biallelic or monoallelic, and minimum clonal percentages (range, ~2.4% to ~69%) within all T cells. (3) We provide our strategy and criteria for evaluating NGS results. (4) We describe every case, with definitive evaluation of TRG clonality in 100% cases by NGS. CONCLUSIONS TRG clonality evaluation by NGS provides greater clinical utility than PCR.
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Affiliation(s)
- Rina Kansal
- Department of Pathology and Laboratory Medicine, University of California at Los Angeles
| | - Wayne W Grody
- Department of Pathology and Laboratory Medicine, University of California at Los Angeles
| | - Jamie Zhou
- Department of Pathology and Laboratory Medicine, University of California at Los Angeles
| | - Ling Dong
- Department of Pathology and Laboratory Medicine, University of California at Los Angeles
| | - Xinmin Li
- Department of Pathology and Laboratory Medicine, University of California at Los Angeles
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Vonderheid E. Comment on B ratings for erythrodermic cutaneous T-cell lymphoma. Eur J Cancer 2018; 101:281-283. [PMID: 30017384 DOI: 10.1016/j.ejca.2018.06.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2018] [Accepted: 06/07/2018] [Indexed: 11/26/2022]
Affiliation(s)
- Eric Vonderheid
- Sydney Kimmel Cancer Center, Johns Hopkins Medical Institutes, Baltimore, MD, USA.
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Ramchandren R, Jazaerly T, Bluth MH, Gabali AM. Molecular Diagnosis of Hematopoietic Neoplasms. Clin Lab Med 2018; 38:293-310. [DOI: 10.1016/j.cll.2018.02.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Wang HW, Raffeld M. Molecular assessment of clonality in lymphoid neoplasms. Semin Hematol 2018; 56:37-45. [PMID: 30573043 DOI: 10.1053/j.seminhematol.2018.05.008] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2018] [Accepted: 05/08/2018] [Indexed: 02/03/2023]
Abstract
Molecular clonality assays in B- and T-cell lymphoproliferative disorders often provide critical information in establishing a diagnosis of a lymphoproliferative disorder. These assays rely on the unique genetic structures that serve as assay targets, created in the process of generating immunoglobulin and T-cell receptors during B- and T-cell development. Molecular clonality assays are generally used when flow cytometry or immunohistochemistry has not sufficiently clarified the benign or malignant nature of a lymphoid proliferation. Additionally, since molecular clonality assays are tumor specific, they allow the clinician to distinguish recurrences from second tumors, and have the sensitivity to monitor minimal residual disease. In this review, we discuss the principles underlying these tests, the current approaches to clonality testing, some of the pitfalls in their interpretation, and the future applications of next generation sequencing technology to clonality testing.
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Affiliation(s)
- Hao-Wei Wang
- Hematopathology Section, Laboratory of Pathology, National Cancer Institute, National Institutes of Health, Bethesda, MD
| | - Mark Raffeld
- Molecular Diagnostics Section, Laboratory of Pathology, National Cancer Institute, National Institutes of Health, Bethesda, MD.
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Ultrasensitive automated RNA in situ hybridization for kappa and lambda light chain mRNA detects B-cell clonality in tissue biopsies with performance comparable or superior to flow cytometry. Mod Pathol 2018; 31:385-394. [PMID: 29052600 PMCID: PMC5843495 DOI: 10.1038/modpathol.2017.142] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2017] [Revised: 08/30/2017] [Accepted: 08/31/2017] [Indexed: 12/17/2022]
Abstract
The assessment of B-cell clonality is a critical component of the evaluation of suspected lymphoproliferative disorders, but analysis from formalin-fixed, paraffin-embedded tissues can be challenging if fresh tissue is not available for flow cytometry. Immunohistochemical and conventional bright field in situ hybridization stains for kappa and lambda are effective for evaluation of plasma cells but are often insufficiently sensitive to detect the much lower abundance of light chains present in B-cells. We describe an ultrasensitive RNA in situ hybridization assay that has been adapted for use on an automated immunohistochemistry platform and compare results with flow cytometry in 203 consecutive tissues and 104 consecutive bone marrows. Overall, in 203 tissue biopsies, RNA in situ hybridization identified light chain-restricted B-cells in 85 (42%) vs 58 (29%) by flow cytometry. Within 83 B-cell non-Hodgkin lymphomas, RNA in situ hybridization identified restricted B-cells in 74 (89%) vs 56 (67%) by flow cytometry. B-cell clonality could be evaluated in only 23/104 (22%) bone marrow cases owing to poor RNA preservation, but evaluable cases showed 91% concordance with flow cytometry. RNA in situ hybridization allowed for recognition of biclonal/composite lymphomas not identified by flow cytometry and highlighted unexpected findings, such as coexpression of kappa and lambda RNA in 2 cases and the presence of lambda light chain RNA in a T lymphoblastic lymphoma. Automated RNA in situ hybridization showed excellent interobserver reproducibility for manual evaluation (average K=0.92), and an automated image analysis system showed high concordance (97%) with manual evaluation. Automated RNA in situ hybridization staining, which can be adopted on commonly utilized immunohistochemistry instruments, allows for the interpretation of clonality in the context of the morphological features in formalin-fixed, paraffin-embedded tissues with a clinical sensitivity similar or superior to flow cytometry.
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Maciocia PM, Wawrzyniecka PA, Philip B, Ricciardelli I, Akarca AU, Onuoha SC, Legut M, Cole DK, Sewell AK, Gritti G, Somja J, Piris MA, Peggs KS, Linch DC, Marafioti T, Pule MA. Targeting the T cell receptor β-chain constant region for immunotherapy of T cell malignancies. Nat Med 2017; 23:1416-1423. [PMID: 29131157 DOI: 10.1038/nm.4444] [Citation(s) in RCA: 168] [Impact Index Per Article: 24.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2016] [Accepted: 10/18/2017] [Indexed: 12/19/2022]
Abstract
Mature T cell cancers are typically aggressive, treatment resistant and associated with poor prognosis. Clinical application of immunotherapeutic approaches has been limited by a lack of target antigens that discriminate malignant from healthy (normal) T cells. Unlike B cell depletion, pan-T cell aplasia is prohibitively toxic. We report a new targeting strategy based on the mutually exclusive expression of T cell receptor β-chain constant domains 1 and 2 (TRBC1 and TRBC2). We identify an antibody with unique TRBC1 specificity and use it to demonstrate that normal and virus-specific T cell populations contain both TRBC1+ and TRBC2+ compartments, whereas malignancies are restricted to only one. As proof of concept for anti-TRBC immunotherapy, we developed anti-TRBC1 chimeric antigen receptor (CAR) T cells, which recognized and killed normal and malignant TRBC1+, but not TRBC2+, T cells in vitro and in a disseminated mouse model of leukemia. Unlike nonselective approaches targeting the entire T cell population, TRBC-targeted immunotherapy could eradicate a T cell malignancy while preserving sufficient normal T cells to maintain cellular immunity.
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Affiliation(s)
| | | | - Brian Philip
- Cancer Institute, University College London, London, UK
| | - Ida Ricciardelli
- Institute of Child Health, University College London, London, UK
| | - Ayse U Akarca
- Cancer Institute, University College London, London, UK
| | | | - Mateusz Legut
- Division of Infection and Immunity, Cardiff University School of Medicine, Cardiff, UK
| | - David K Cole
- Division of Infection and Immunity, Cardiff University School of Medicine, Cardiff, UK
| | - Andrew K Sewell
- Division of Infection and Immunity, Cardiff University School of Medicine, Cardiff, UK
| | - Giuseppe Gritti
- Hematology and Bone Marrow Transplant Units, Papa Giovanni XXIII Hospital, Bergamo, Italy
| | - Joan Somja
- Department of Anatomy and Cellular Pathology, University of Liège, Liège, Belgium
| | - Miguel A Piris
- Department of Pathology, Fundación Jiménez Díaz, Centro de Investigación Biomédica en Red de Cáncer (CIBERONC), Madrid, Spain
| | - Karl S Peggs
- Cancer Institute, University College London, London, UK
| | - David C Linch
- Cancer Institute, University College London, London, UK
| | | | - Martin A Pule
- Cancer Institute, University College London, London, UK.,Autolus, Ltd., London, UK
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Idiopathic hypereosinophilia is clonal disorder? Clonality identified by targeted sequencing. PLoS One 2017; 12:e0185602. [PMID: 29088303 PMCID: PMC5663336 DOI: 10.1371/journal.pone.0185602] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2017] [Accepted: 09/15/2017] [Indexed: 12/25/2022] Open
Abstract
Idiopathic hypereosinophilia (IHE)/idiopathic hypereosinophilic syndrome (IHES) has been defined by a persistent elevation of the blood eosinophil count exceeding 1.5×103/μL, without evidence of reactive or clonal causes. While T-cell clonality assessment has been recommended for unexplained hypereosinophilia, this approach is not often applied to routine practice in the clinic. We hypothesized that the clonality would exist in a subset of IHE/IHES patients. We aimed to investigate the candidate mutations and T-cell clonality in IHE/IHES and to explore the role of mutations in eosinophil proliferation. We performed targeted capture sequencing for 88 genes using next-generation sequencing, T-cell receptor (TCR) gene rearrangement assays, and pathway network analysis in relation to eosinophil proliferation. By targeted sequencing, 140 variants in 59 genes were identified. Sixteen out of 30 patients (53.3%) harbored at least one candidate mutation. The most frequently affected genes were NOTCH1 (26.7%), SCRIB and STAG2 (16.7%), and SH2B3 (13.3%). Network analysis revealed that our 21 candidate genes (BIRC3, BRD4, CSF3R, DNMT3A, EGR2, EZH2, FAT4, FLT3, GATA2, IKZF, JAK2, MAPK1, MPL, NF1, NOTCH1, PTEN, RB1, RUNX1, TET2, TP53 and WT1) are functionally linked to the eosinophilopoietic pathway. Among the 21 candidate genes, five genes (MAPK1, RUNX1, GATA2, NOTCH1 and TP53) with the highest number of linkages were considered major genes. A TCR assay revealed that four patients (13.3%) had a clonal TCR rearrangement. NOTCH1 was the most frequently mutated gene and was shown to be a common node for eosinophilopoiesis in our network analysis, while the possibility of hidden T cell malignancy was indwelling in the presence of NOTCH1 mutation, though not revealed by aberrant T cell study. Collectively, these results provide new evidence that mutations affecting eosinophilopoiesis underlie a subset of IHE/IHES, and the candidate genes are inferred to act their potential roles in the eosinophilopoietic pathway.
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47
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Di Napoli A, Pepe G, Giarnieri E, Cippitelli C, Bonifacino A, Mattei M, Martelli M, Falasca C, Cox MC, Santino I, Giovagnoli MR. Cytological diagnostic features of late breast implant seromas: From reactive to anaplastic large cell lymphoma. PLoS One 2017; 12:e0181097. [PMID: 28715445 PMCID: PMC5513491 DOI: 10.1371/journal.pone.0181097] [Citation(s) in RCA: 67] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2017] [Accepted: 06/26/2017] [Indexed: 11/18/2022] Open
Abstract
Late breast implant seroma may be the presentation of a breast implant-associated anaplastic large cell lymphoma (BI-ALCL), which claims for a prompt recognition. However, BI-ALCL diagnosis on fine-needle aspiration (FNA) might be challenging for pathologists lacking experience with peri-implant breast effusions. Sixty-seven late breast implant seromas collected by FNA from 50 patients were evaluated by Papanicolaou smear stain and immunocytochemistry on cell blocks. A diagnostic algorithm based on the cellular composition, cell morphology and percentage of CD30+ cells was developed. Histological evaluation of the corresponding peri-prosthetic capsules was also performed. Most of the effusions (91% of the samples) were classified as reactive and 9% as BI-ALCL. In the BI-ALCL cases, medium-to-large atypical cells expressing CD30 represented more than 70% of the cellularity, whereas in in the reactive effusions CD30+ elements were extremely rare (<5%) and consisted of non-atypical elements. The reactive effusions were categorized into three patterns: i) acute infiltrate with prominent neutrophilic component (33% of the samples); ii) mixed infiltrate characterized by a variable number of neutrophils, lymphocytes and macrophages (30% of the samples); iii) chronic infiltrate composed predominantly of T lymphocytes or macrophages with only sporadic granulocytes (37% of the samples). The inflammatory cytological patterns were consistent with the histology of the corresponding capsules. Our results indicate that cytological analysis of late breast implant effusions, supported by the knowledge of the heterogeneous cytomorphological spectrum of late seromas, is a valuable approach for the early recognition of BI-ALCL.
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MESH Headings
- Adult
- Aged
- Antigens, CD/metabolism
- Antigens, Differentiation, Myelomonocytic/metabolism
- Breast Implantation
- Breast Neoplasms/pathology
- CD3 Complex/metabolism
- Female
- Gene Rearrangement
- Humans
- Ki-1 Antigen/metabolism
- Klebsiella oxytoca/isolation & purification
- Lymphocytes/cytology
- Lymphocytes/metabolism
- Lymphoma, Large-Cell, Anaplastic/pathology
- Macrophages/cytology
- Macrophages/metabolism
- Middle Aged
- Neutrophils/cytology
- Neutrophils/metabolism
- Pseudomonas aeruginosa/isolation & purification
- Receptors, Antigen, T-Cell, gamma-delta/genetics
- Receptors, Antigen, T-Cell, gamma-delta/metabolism
- Seroma/diagnosis
- Seroma/microbiology
- Serratia marcescens/isolation & purification
- Staphylococcus aureus/isolation & purification
- Young Adult
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Affiliation(s)
- Arianna Di Napoli
- Department of Clinical and Molecular Medicine, Sapienza University, Pathology Unit, Sant'Andrea Hospital, Roma, Italy
- * E-mail:
| | - Giuseppina Pepe
- Department of Clinical and Molecular Medicine, Sapienza University, Pathology Unit, Sant'Andrea Hospital, Roma, Italy
| | - Enrico Giarnieri
- Department of Clinical and Molecular Medicine, Sapienza University, Cytology Unit, Sant'Andrea Hospital, Roma, Italy
| | - Claudia Cippitelli
- Department of Clinical and Molecular Medicine, Sapienza University, Pathology Unit, Sant'Andrea Hospital, Roma, Italy
| | | | - Mauro Mattei
- Breast Unit, Sant’Andrea Hospital, Sapienza University, Roma, Italy
| | - Maurizio Martelli
- Department of Cellular Biotechnologies and Hematology, Sapienza University, Policlinico Umberto I, Rome, Italy
| | - Carlo Falasca
- Department of Clinical and Molecular Medicine, Sapienza University, Cytology Unit, Sant'Andrea Hospital, Roma, Italy
| | | | - Iolanda Santino
- Department of Clinical and Molecular Medicine, Sapienza University, Microbiology Unit, Sant'Andrea Hospital, Roma, Italy
| | - Maria Rosaria Giovagnoli
- Department of Clinical and Molecular Medicine, Sapienza University, Cytology Unit, Sant'Andrea Hospital, Roma, Italy
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48
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Villarese P, Lours C, Trinquand A, Le Noir S, Belhocine M, Lhermitte L, Cieslak A, Tesio M, Petit A, LeLorch M, Spicuglia S, Ifrah N, Dombret H, Langerak AW, Boissel N, Macintyre E, Asnafi V. TCRα rearrangements identify a subgroup of NKL-deregulated adult T-ALLs associated with favorable outcome. Leukemia 2017; 32:61-71. [PMID: 28592888 DOI: 10.1038/leu.2017.176] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2016] [Revised: 05/16/2017] [Accepted: 05/25/2017] [Indexed: 12/18/2022]
Abstract
T-cell acute lymphoblastic leukemia (T-ALL) results from leukemic transformation of T-cell precursors arrested at specific differentiation stages, including an 'early-cortical' thymic maturation arrest characterized by expression of cytoplasmic TCRβ but no surface T-cell receptor (TCR) and frequent ectopic expression of the TLX1/3 NK-like homeotic proteins (NKL). We designed a TCRα VJC PCR to identify clonal TCRα rearrangements in 32% of 127 T-ALLs, including 0/52 immature/TCRγδ lineage cases and 41/75 (55%) TCRαβ lineage cases. Amongst the latter, TCRα rearrangements were not identified in 30/54 (56%) of IMβ/pre-αβ early-cortical T-ALLs, of which the majority (21/30) expressed TLX1/3. We reasoned that the remaining T-ALLs might express other NKL proteins, so compared transcript levels of 46 NKL in T-ALL and normal thymic subpopulations. Ectopic overexpression of 10 NKL genes, of which six are unreported in T-ALL (NKX2-3, BARHL1, BARX2, EMX2, LBX2 and MSX2), was detectable in 17/104 (16%) T-ALLs. Virtually all NKL overexpressing T-ALLs were TCRα unrearranged and ectopic NKL transcript expression strongly repressed Eα activity, suggesting that ectopic NKL expression is the major determinant in early-cortical thymic T-ALL maturation arrest. This immunogenetic T-ALL subtype, defined by TCRβ VDJ but no TCRα VJ rearrangement, is associated with a favorable outcome in GRAALL-treated adult T-ALLs.
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Affiliation(s)
- P Villarese
- Université Paris Descartes Sorbonne Cité, Institut Necker Enfants-Malades (INEM), Institut National de Recherche Médicale (INSERM) U1151, Paris, France.,Laboratory of Onco-Hematology, Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Necker Enfants-Malades, Paris, France
| | - C Lours
- Université Paris Descartes Sorbonne Cité, Institut Necker Enfants-Malades (INEM), Institut National de Recherche Médicale (INSERM) U1151, Paris, France.,Laboratory of Onco-Hematology, Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Necker Enfants-Malades, Paris, France
| | - A Trinquand
- Université Paris Descartes Sorbonne Cité, Institut Necker Enfants-Malades (INEM), Institut National de Recherche Médicale (INSERM) U1151, Paris, France.,Laboratory of Onco-Hematology, Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Necker Enfants-Malades, Paris, France
| | - S Le Noir
- Université Paris Descartes Sorbonne Cité, Institut Necker Enfants-Malades (INEM), Institut National de Recherche Médicale (INSERM) U1151, Paris, France
| | - M Belhocine
- Université Paris Descartes Sorbonne Cité, Institut Necker Enfants-Malades (INEM), Institut National de Recherche Médicale (INSERM) U1151, Paris, France.,Laboratory of Onco-Hematology, Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Necker Enfants-Malades, Paris, France.,Aix Marseille Univ, INSERM, TAGC UMR1090, Marseille, France
| | - L Lhermitte
- Université Paris Descartes Sorbonne Cité, Institut Necker Enfants-Malades (INEM), Institut National de Recherche Médicale (INSERM) U1151, Paris, France.,Laboratory of Onco-Hematology, Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Necker Enfants-Malades, Paris, France
| | - A Cieslak
- Université Paris Descartes Sorbonne Cité, Institut Necker Enfants-Malades (INEM), Institut National de Recherche Médicale (INSERM) U1151, Paris, France
| | - M Tesio
- Université Paris Descartes Sorbonne Cité, Institut Necker Enfants-Malades (INEM), Institut National de Recherche Médicale (INSERM) U1151, Paris, France
| | - A Petit
- Department of Hematology and Oncologie Pédiatrique, Hôpital Trousseau Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France
| | - M LeLorch
- Laboratory of Cytogenetics, Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Necker Enfants-Malades, Paris, France
| | - S Spicuglia
- Aix Marseille Univ, INSERM, TAGC UMR1090, Marseille, France
| | - N Ifrah
- Department of Hematology, Centre Hospitalier, Angers, France
| | - H Dombret
- University Paris 7, Hôpital Saint-Louis, AP-HP, Department of Hematology and Institut Universitaire d'Hématologie, Paris, France
| | - A W Langerak
- Department of Immunology, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
| | - N Boissel
- University Paris 7, Hôpital Saint-Louis, AP-HP, Department of Hematology and Institut Universitaire d'Hématologie, Paris, France
| | - E Macintyre
- Université Paris Descartes Sorbonne Cité, Institut Necker Enfants-Malades (INEM), Institut National de Recherche Médicale (INSERM) U1151, Paris, France
| | - V Asnafi
- Université Paris Descartes Sorbonne Cité, Institut Necker Enfants-Malades (INEM), Institut National de Recherche Médicale (INSERM) U1151, Paris, France.,Laboratory of Onco-Hematology, Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Necker Enfants-Malades, Paris, France
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49
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Jeon YK, Yoon SO, Paik JH, Kim YA, Shin BK, Kim HJ, Cha HJ, Kim JE, Huh J, Ko YH. Molecular Testing of Lymphoproliferative Disorders: Current Status and Perspectives. J Pathol Transl Med 2017; 51:224-241. [PMID: 28535584 PMCID: PMC5445208 DOI: 10.4132/jptm.2017.04.09] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2017] [Accepted: 04/09/2017] [Indexed: 12/13/2022] Open
Abstract
Molecular pathologic testing plays an important role for the diagnosis, prognostication and decision of treatment strategy in lymphoproliferative disease. Here, we briefly review the molecular tests currently used for lymphoproliferative disease and those which will be implicated in clinical practice in the near future. Specifically, this guideline addresses the clonality test for B- and T-cell proliferative lesions, molecular cytogenetic tests for malignant lymphoma, determination of cell-of-origin in diffuse large B-cell lymphoma, and molecular genetic alterations incorporated in the 2016 revision of the World Health Organization classification of lymphoid neoplasms. Finally, a new perspective on the next-generation sequencing for diagnostic, prognostic, and therapeutic purpose in malignant lymphoma will be summarized.
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Affiliation(s)
- Yoon Kyung Jeon
- Corresponding Author Yoon Kyung Jeon, MD, PhD Department of Pathology, Seoul National University Hospital, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul 03080, Korea Tel: +82-2-2072-1347 Fax: +82-2-743-5530 E-mail:
| | - Sun Och Yoon
- Department of Pathology, Yonsei University College of Medicine, Seoul, Korea
| | - Jin Ho Paik
- Department of Pathology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Young A Kim
- Department of Pathology, SMG-SNU Boramae Medical Center, Seoul National University College of Medicine, Seoul, Korea
| | - Bong Kyung Shin
- Department of Pathology, Korea University Guro Hospital, Korea University School of Medicine, Seoul, Korea
| | - Hyun-Jung Kim
- Department of Pathology, Inje University Sanggye Paik Hospital, Seoul, Korea
| | - Hee Jeong Cha
- Department of Pathology, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Korea
| | - Ji Eun Kim
- Department of Pathology, SMG-SNU Boramae Medical Center, Seoul National University College of Medicine, Seoul, Korea
| | - Jooryung Huh
- Department of Pathology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Young-Hyeh Ko
- Department of Pathology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - The Hematopathology Study Group of the Korean Society of Pathologists
- Department of Pathology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
- Department of Pathology, Yonsei University College of Medicine, Seoul, Korea
- Department of Pathology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
- Department of Pathology, SMG-SNU Boramae Medical Center, Seoul National University College of Medicine, Seoul, Korea
- Department of Pathology, Korea University Guro Hospital, Korea University School of Medicine, Seoul, Korea
- Department of Pathology, Inje University Sanggye Paik Hospital, Seoul, Korea
- Department of Pathology, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Korea
- Department of Pathology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
- Department of Pathology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - The Molecular Pathology Study Group of Korean Society of Pathologists
- Department of Pathology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
- Department of Pathology, Yonsei University College of Medicine, Seoul, Korea
- Department of Pathology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
- Department of Pathology, SMG-SNU Boramae Medical Center, Seoul National University College of Medicine, Seoul, Korea
- Department of Pathology, Korea University Guro Hospital, Korea University School of Medicine, Seoul, Korea
- Department of Pathology, Inje University Sanggye Paik Hospital, Seoul, Korea
- Department of Pathology, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Korea
- Department of Pathology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
- Department of Pathology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
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50
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Zhang L, Van den Bergh M, Sokol L. CD4-Positive T-Cell Large Granular Lymphocytosis Mimicking Sezary Syndrome in a Patient With Mycosis Fungoides. Cancer Control 2017; 24:207-212. [PMID: 28441377 DOI: 10.1177/107327481702400215] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
A white woman aged 65 years presented with a macular, nonscaly, nonpruritic, erythematous lesion on her right breast. Test results revealed histological features similar to lichenoid dermatitis and early-phase primary cutaneous T-cell lymphoma with a subtype of mycosis fungoides (MF). Despite topical therapy with steroids, her skin disease continued to progress, so she underwent polymerase chain reaction and gene mutation testing. Two missense mutations were detected. The overall findings supported a diagnosis of co-occurring, CD4-positive large granular lymphocytosis and stage IA MF. The patient continued to receive topical steroids and maintenance phototherapy, and her skin lesions completely resolved after 14 weeks of therapy. Approximately 5 years after her initial presentation, she was free of symptoms, cytopenia, and no skin lesions were present. CD4-positive, large granular lymphocytosis was persistent. This patient case - to our knowledge, the first of its kind - posed dilemmas of a diagnostic and therapeutic nature. Correctly staging the lymphoma helped to aid the diagnosis and can help prevent patients similar to the one in this case from receiving unnecessary therapy.
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Affiliation(s)
- Ling Zhang
- Hematopathology & Laboratory Medicine Program, Moffitt Cancer Center, Tampa, FL.
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