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Key Words
- CHOP, cyclophosphamide, doxorubicin, vincristine, and prednisolone
- EBER, EBV-encoded RNA
- ENKL, extranodal nasal NK/T-cell lymphoma
- HPS, hemophagocytic syndrome
- LEP, lupus erythematosus panniculitis
- PCGDTL, primary cutaneous gamma-delta T-cell lymphoma
- SPTL, subcutaneous panniculitis-like T-cell lymphoma
- TCR, T-cell receptor
- cellulitis
- erythema
- extranodal nasal NK/T-cell lymphoma
- lupus erythematosus panniculitis
- primary cutaneous gamma-delta T-cell lymphoma
- subcutaneous panniculitis-like T-cell lymphoma
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Affiliation(s)
| | | | | | | | | | - Xiaohong Chen
- Correspondence to: Xiaohong Chen, MD, PhD, Department of Dermatology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China, 510080.
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Shen XZ, Yu SL, Liu F, Luo ZY. Familial aggregation of subcutaneous panniculitis-like T cell lymphoma: A case report of monozygotic twin brothers. Medicine (Baltimore) 2020; 99:e22629. [PMID: 33080699 PMCID: PMC7571882 DOI: 10.1097/md.0000000000022629] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
RATIONALE Subcutaneous panniculitis-like T-cell lymphoma (SPTCL) is a rare subtype of cutaneous lymphoma, which was first defined as a clinical entity in 1991 as a cytotoxic T-cell lymphoma preferentially infiltrating subcutaneous tissue. Herein, we report 2 patients of SPTCL who are a pair of twin brothers. PATIENT CONCERNS The disease afflicted the monozygotic twin brothers at different time with an interval period of 5 years. The older twin brother had disease onset at 27 years of age. In June 2012, he developed prolonged fever accompanied by subcutaneous nodules in the left upper arm and left chest due to unknown origin. The younger twin brother had disease onset at 32 years of age. In June 2017, the younger brother presented with repeated high fever for more than 10 days, accompanied by head distension. DIAGNOSIS On August 7, 2012, skin biopsy was performed on the lesion of left upper arm of the older twin brother, and then, a diagnosis of subcutaneous panniculitis-like T cell lymphoma (SPTCL) was made. On June 19, 2017, the younger twin brother underwent whole-body fluorine-18 fluorodeoxyglucose positron emission tomography/computed tomography for diagnosis. Soon afterwards, abdominal subcutaneous nodule resection and biopsy was performed on June 28, 2018, and the specimen was diagnosed as SPTCL. INTERVENTIONS For the older brother, a total of 14 systemic chemotherapy sessions were performed from August 16, 2012, to September 21, 2014. For the younger brother, a total of 9 systemic chemotherapy sessions were performed from July 14, 2017, to March 8, 2018, then he was switched to oral chemotherapy with chidamide twice a week for 6 months. OUTCOMES The older twin brother died in March 2015, the younger brother has recovered well and is no longer receiving any treatment LESSONS:: To the best of our knowledge, twin brothers both having this disease has never been previously reported. Moreover, some of the involved areas are also extremely rare detected by fluorine-18 fluorodeoxyglucose positron emission tomography/computed tomography at initial stage. It is beneficial to people to gain some new understanding for SPTCL by this special case and some extremely unusual involved sites in the younger twin brother.
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Affiliation(s)
| | - Shan-Lu Yu
- Department of Pathology, Shaoxing People's Hospital, the First Affiliated Hospital of Shaoxing University, Shaoxing, Zhejiang Province, China
| | - Fang Liu
- Department of Pathology, Shaoxing People's Hospital, the First Affiliated Hospital of Shaoxing University, Shaoxing, Zhejiang Province, China
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von Dücker L, Fleischer M, Stutz N, Thieme M, Witte M, Zillikens D, Sadik CD, Terheyden P. Primary Cutaneous Gamma-Delta T-Cell Lymphoma With Long-Term Indolent Clinical Course Initially Mimicking Lupus Erythematosus Profundus. Front Oncol 2020; 10:133. [PMID: 32140447 PMCID: PMC7042375 DOI: 10.3389/fonc.2020.00133] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2019] [Accepted: 01/24/2020] [Indexed: 11/27/2022] Open
Abstract
Primary Cutaneous Gamma-Delta (γδ) T-Cell Lymphoma (PCGDTCL) is a rare primary cutaneous lymphoma of aggressive nature. Only a few cases with an initially indolent course over years have been published. PCGDTCL can mimic diseases with benign behavior in their clinical and histopathological presentation, such as lupus erythematosus profundus, but also other lymphomas, for example subcutaneous panniculitis-like T-cell lymphoma. In our patient, the results of histopathological, immunofluorescence microscopy, and clinical examinations of early lesions first led to the diagnosis of lupus erythematosus profundus. Two years after this diagnosis and 6 years after the first clinical symptoms appeared, the disease progressed with erosive and ulcerating plaques and a PCGDTCL with hemophagocytic syndrome with an aggressive course was diagnosed. A distinct correlation of clinical, histopathological, immunohistochemical, and molecular-pathological examinations is needed to differentiate between the potentially malignant and benign diseases. Re-biopsies of different skin lesions in uncertain cases are strongly indicated. This case demonstrates that an indolent clinical phenotype can precede an aggressive clinical course in PCGDTCL.
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Affiliation(s)
- Laura von Dücker
- Department of Dermatology, Allergy, and Venereology, University of Lübeck, Lübeck, Germany
| | - Mariella Fleischer
- Department of Dermatology, Allergy, and Venereology, University of Lübeck, Lübeck, Germany
| | - Nathalie Stutz
- Department of Dermatology, Allergy, and Venereology, University of Lübeck, Lübeck, Germany
| | - Markus Thieme
- Department of Dermatology, Allergy, and Venereology, University of Lübeck, Lübeck, Germany
| | - Mareike Witte
- Department of Dermatology, Allergy, and Venereology, University of Lübeck, Lübeck, Germany
| | - Detlef Zillikens
- Department of Dermatology, Allergy, and Venereology, University of Lübeck, Lübeck, Germany
| | - Christian D Sadik
- Department of Dermatology, Allergy, and Venereology, University of Lübeck, Lübeck, Germany
| | - Patrick Terheyden
- Department of Dermatology, Allergy, and Venereology, University of Lübeck, Lübeck, Germany
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Hematopoietic stem cell transplantation for subcutaneous panniculitis-like T-cell lymphoma: single center experience in an Asian population. Int J Hematol 2018; 109:187-196. [PMID: 30547418 DOI: 10.1007/s12185-018-02568-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2018] [Revised: 11/27/2018] [Accepted: 11/29/2018] [Indexed: 10/27/2022]
Abstract
Subcutaneous panniculitis-like T-cell lymphoma (SPTL) is a rare form of cytotoxic T-cell lymphoma. It is believed that SPTL in patients without hemophagocytic syndrome (HPS) follows an indolent course; in contrast, SPTL in patients with HPS has been associated with unfavorable survival. To provide more clinical data on SPTL in Asian populations and to identify optimal therapeutic strategies for SPTL, we assessed the clinicopathological features and long-term follow-up data of 10 Taiwanese SPTL patients diagnosed at a single center. Our study demonstrates a group of patients with high incidence of HPS (50%), rather aggressive courses, and early progression. A total of eight patients underwent hematopoietic stem cell transplant (HSCT), including one autologous HSCT and seven allogeneic HSCT. Seven of eight patients receiving HSCT achieved durable remission and maintained in remission for over 30 months (range 30-132 months). There was no difference in 3-year survival of patients with HPS (80%) compared with patients without HPS (80%). Of long-term survivors in the HPS group, three of four received HSCT (autologous HSCT, n = 1; allogeneic HSCT, n = 2). Our study indicated that HSCT is a curative option for eligible SPTL patients with HPS.
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Relapsed subcutaneous panniculitis-like T cell lymphoma: role of haploidentical hematopoietic stem cell transplant. Ann Hematol 2017; 96:2125-2126. [PMID: 28879427 DOI: 10.1007/s00277-017-3119-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2017] [Accepted: 08/19/2017] [Indexed: 10/18/2022]
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Rezania D, Cualing HD, Ayala E. The Diagnosis, Management, and Role of Hematopoietic Stem Cell Transplantation in Aggressive Peripheral T-Cell Neoplasms. Cancer Control 2017; 14:151-9. [PMID: 17387300 DOI: 10.1177/107327480701400208] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Background Peripheral T-cell neoplasms (PTCNs) comprise a group of uncommon and heterogeneous lymphoid malignancies. They are more difficult to diagnose and treat and have a worse prognosis than B-cell lymphomas. Although PTCNs initially show a significant degree of chemosensitivity, the outcome of treatment with conventional dose chemotherapy remains poor. Methods We reviewed the literature on the diagnosis, treatment, and collective transplant reports regarding PTCNs. Results The correct diagnosis of peripheral T-cell lymphoma requires a combination of clinical presentation, morphology, immunophenotype, and molecular study. While no specific treatment other than conventional dose chemotherapy is currently available for aggressive PTCN, histone acetylase inhibitors and monoclonal antibodies such as anti-CD7 and anti-CD52 are being studied in T-cell malignancies. The role of autologous and allogeneic transplantation is being investigated for high-risk, relapsed, and refractory PTCNs with some promising results. Conclusions Access to hematopathology expertise in a tertiary care setting may lead to earlier and more accurate diagnoses of these diseases. PTCNs comprise a heterogeneous group of diseases with no widely accepted standard of care, and accurate determination of their histologic subtypes correlates with prognosis. Patients in first complete remission with poor risk features and patients with relapsed and refractory disease should be considered for bone marrow transplant due to the poor outcomes obtained with conventional chemotherapy.
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Affiliation(s)
- Dorna Rezania
- Blood and Marrow Transplant Program, H. Lee Moffitt Cancer Center & Research Institute, 12902 Magnolia Drive, Tampa, FL 33612, USA
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Rezania D, Sokol L, Cualing HD. Classification and Treatment of Rare and Aggressive Types of Peripheral T-Cell/Natural Killer-Cell Lymphomas of the Skin. Cancer Control 2017; 14:112-23. [PMID: 17387296 DOI: 10.1177/107327480701400204] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Background The classification of cutaneous lymphomas has been contentious. Two major competing classifications were the World Health Organization (WHO) and the European Organization for Research and Treatment of Cancer (EORTC). The principal authors met for a consensus meeting resulted in a combined classification called WHO-EORTC Classification of Cutaneous Lymphoma. Methods We review the classification of “mature” or peripheral T-cell lymphoma (PTCL) with high predilection to the skin as published by the WHO-EORTC. We also highlight new information and changes from the previous classifications of cutaneous PTCL according to the WHO classification or the EORTC classification. Finally, the salient findings are compared with similar-looking nodal PTCLs with a high frequency of skin involvement. Results This review focuses on a rare group of cutaneous PTCLs other than mycosis fungoides or its variants. Changes from the previous classifications are discussed, and the rare group of nodal PTCLs with high predilection to the skin are presented. The salient findings, diagnostic features, and treatments are included, along with summary tables and clinical-histopathologic images. Conclusions This review may serve as a guide for hematologists, oncologists and dermatologists in the diagnosis and management of these rare, aggressive, and often difficult to diagnose lymphomas. Although cutaneous lymphomas are morphologically identical to systemic lymphomas, the former behave differently, require divergent management, and should be recognized as separate entities. The consensus WHO-EORTC classification presents unified terminology and definitions to promote conformity in diagnosing and treating these cases, to foster a multidisciplinary approach to these often-obscure diseases, and to lead to more advances in identifying molecular targets specific to these entities.
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Affiliation(s)
- Dorna Rezania
- Hematopathology and Laboratory Medicine Program, H. Lee Moffitt Cancer Center & Research Institute, 12902 Magnolia Drive, Tampa, FL 33612, USA
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Bhatt VR, Giri S, Verma V, Manandhar S, Pathak R, Bociek RG, Vose JM, Armitage JO. Survival of Subcutaneous Panniculitis-Like T-Cell Lymphoma and Peripheral T-Cell Lymphoma Not Otherwise Specified: A Propensity-Matched Analysis of the Surveillance, Epidemiology, and End Results Database. CLINICAL LYMPHOMA MYELOMA & LEUKEMIA 2016; 16:373-8. [DOI: 10.1016/j.clml.2016.04.015] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/12/2015] [Revised: 04/20/2016] [Accepted: 04/26/2016] [Indexed: 10/21/2022]
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Ali L, Young MR, Bayerl MG, Helm KF, Clarke LE. Gamma-delta T-cell lymphoma arising in a long-standing cutaneous plaque. J Cutan Pathol 2015; 42:987-991. [PMID: 26265373 DOI: 10.1111/cup.12591] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2011] [Revised: 12/29/2011] [Accepted: 11/11/2012] [Indexed: 11/30/2022]
Abstract
The precise classification and characterization of primary cutaneous gamma-delta T-cell lymphoma (PCGD-TCL) has been hindered by clinical and morphologic features that overlap with other lymphomas, especially subcutaneous panniculitis-like T cell lymphoma (SPTCL). The recent World Health Organization/European Organization for Research and Treatment of Cancer (WHO/EORTC) classification distinguishes the more aggressive PCGD-TCL from the usually indolent SPTCL, however. We report a 30-year-old woman with an indurated violaceous plaque on the left cheek that had been present for several years. Biopsies showed a dense lymphocytic infiltrate involving the subcutis and dermis that consisted mostly of small and medium-sized lymphocytes, some with irregular nuclear contours and dense chromatin. These cells were positive for TIA-1, TCR-gamma and CD8, but negative for beta-F1 and granzyme-B. Staging with positron emission tomography-computed tomography (PET/CT), CBC and bone marrow with flow cytometry identified lymphadenopathy as well as blood and marrow involvement by an abnormal TCRgd-positive T-cell proliferation (Ann Arbor Stage IV). The patient's history of a long-standing lesion in this case is unusual, in that gamma-delta T-cell lymphomas are typically rapidly progressive neoplasms. As such, it raises the possibility of 'transformation' of a long-standing inflammatory process into an overt lymphoma.
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Affiliation(s)
- Liaqat Ali
- Department of Pathology, The Penn State Hershey Medical Center, Hershey, PA, USA.,Department of Dermatology, The Penn State Hershey Medical Center, Hershey, PA, USA
| | - Michelle R Young
- Department of Pathology, The William Beaumont Hospital, Royal Oak, MI, USA
| | - Michael G Bayerl
- Department of Pathology, The Penn State Hershey Medical Center, Hershey, PA, USA
| | - Klaus F Helm
- Department of Pathology, The Penn State Hershey Medical Center, Hershey, PA, USA.,Department of Dermatology, The Penn State Hershey Medical Center, Hershey, PA, USA
| | - Loren E Clarke
- Department of Pathology, The Penn State Hershey Medical Center, Hershey, PA, USA.,Department of Dermatology, The Penn State Hershey Medical Center, Hershey, PA, USA
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Nagai K, Nakano N, Iwai T, Iwai A, Tauchi H, Ohshima K, Ishii E. Pediatric subcutaneous panniculitis-like T-cell lymphoma with favorable result by immunosuppressive therapy: a report of two cases. Pediatr Hematol Oncol 2014; 31:528-33. [PMID: 24684413 DOI: 10.3109/08880018.2014.896062] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Subcutaneous panniculitis-like T-cell lymphoma (SPTL) is a rare type of skin lymphoma. Histopathology mimicking a lobular panniculitis makes it difficult to distinguish SPTL from benign autoimmune disease. We present cases of a 10-year-old female and an 11-year-old male with SPTL showing recurrent panniculitis and systemic manifestations. Initially, antibiotics and steroids were administered to treat infectious disease and benign panniculitis. However, they experienced recurrent fever and erythema nodosum. Additional immunohistochemistry and T-cell receptor (TCR) gene rearrangement analyses were performed, enabling the establishment of an SPTL diagnosis. The affected patients were given immunosuppressive therapy with favorable results.
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Affiliation(s)
- Kozo Nagai
- Department of Hematology and Oncology, Shikoku Medical Center for Children and Adults , Kagawa , Japan
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Levine BD, Seeger LL, James AW, Motamedi K. Subcutaneous panniculitis-like T-cell lymphoma: MRI features and literature review. Skeletal Radiol 2014; 43:1307-11. [PMID: 24719040 DOI: 10.1007/s00256-014-1879-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2013] [Revised: 03/18/2014] [Accepted: 03/20/2014] [Indexed: 02/02/2023]
Abstract
Subcutaneous panniculitis-like T-cell lymphoma (SPTCL) represents a rare subclassification of peripheral T-cell lymphoma (PTCL). We present a case of a 21-year-old female who presented with a 1-month history of pain in the left buttock and hip, tender left inguinal lymph nodes, fevers, and night sweats. Percutaneous core needle biopsy was diagnostic for SPTCL with CD8+ cells positive for cytotoxic granules. Magnetic resonance imaging (MRI) features of SPTCL with a review of the literature are discussed.
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Affiliation(s)
- Benjamin D Levine
- Department of Radiological Sciences, UCLA-Santa Monica Medical Center and Orthopedic Hospital, 1250 16th Street, Suite 2340, Santa Monica, CA, 90404, USA,
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Takahashi Y, Takata K, Kato S, Sato Y, Asano N, Ogino T, Hashimoto K, Tashiro Y, Takeuchi S, Masunari T, Hiramatsu Y, Maeda Y, Tanimoto M, Yoshino T. Clinicopathological analysis of 17 primary cutaneous T-cell lymphoma of the γδ phenotype from Japan. Cancer Sci 2014; 105:912-23. [PMID: 24815502 PMCID: PMC4317912 DOI: 10.1111/cas.12439] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2014] [Revised: 04/24/2014] [Accepted: 05/02/2014] [Indexed: 11/30/2022] Open
Abstract
Primary cutaneous γδ T-cell lymphoma (PCGD-TCL) is an aggressive lymphoma consisting of clonal proliferation of mature activated γδ T-cells of a cytotoxic phenotype. Because primary cutaneous γδ T-cell lymphoma is a rare disease, there are few clinicopathological studies. In addition, T-cell receptor (TCR) γδ cells are typically immunostained in frozen sections or determined by TCRβ negativity. We retrospectively analyzed 17 primary cutaneous T-cell lymphomas of the γδ phenotype (CTCL-γδ) in a clinicopathological and molecular study using paraffin-embedded sections. Among 17 patients, 11 had CTCL-γδ without subcutaneous panniculitis-like T-cell lymphoma (SPTCL) features and six had CTCL-γδ with SPTCL features. Immunophenotypically, some significant differences were found in CD8 and CD56 positivity between our patient series of CTCL-γδ patients with SPTCL features and SPTCL-γδ patients described in the previous literature. A univariate analysis of 17 CTCL-γδ patients showed that being more than 60 years old, presence of visceral organ involvement, and small-to-medium cell size were poor prognostic factors. In addition, the 5-year overall survival rate was 42.4% for the CTCL-γδ patients without SPTCL features and 80.0% for those with SPTCL features. Consequently, there was a strikingly significant difference in overall survival among SPTCL, CTCL-γδ with SPTCL features and CTCL-γδ without SPTCL features (P = 0.0005). Our data suggests that an indolent subgroup may exist in CTCL-γδ. Studies on more cases, including those from other countries, are warranted to delineate the clinicopathological features and the significance in these rare lymphomas.
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Affiliation(s)
- Yuka Takahashi
- Department of Pathology, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama, Japan
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Gao J, Gauerke SJ, Martinez-Escala ME, Guitart J, Nelson BP, Chadburn A, Peterson LC. Bone marrow involvement by subcutaneous panniculitis-like T-cell lymphoma: a report of three cases. Mod Pathol 2014; 27:800-7. [PMID: 24201122 DOI: 10.1038/modpathol.2013.191] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2013] [Accepted: 09/03/2013] [Indexed: 11/09/2022]
Abstract
Subcutaneous panniculitis-like T-cell lymphoma is a rare subtype of cutaneous T-cell lymphoma. Virtually all cases are confined to the subcutaneous adipose tissue. In this report, we describe the first small series of subcutaneous panniculitis-like T-cell lymphoma (three patients) with bone marrow involvement. All patients presented with skin or soft tissue nodules, fever, and constitutional symptoms, and were diagnosed with subcutaneous panniculitis-like T-cell lymphoma based on the characteristic morphologic and immunophenotypic features of the subcutaneous lesions. Bone marrow core biopsies in these cases showed focal involvement by lymphoma with pathologic features similar to those seen in the diagnostic biopsies. Our observations suggest bone marrow involvement by subcutaneous panniculitis-like T-cell lymphoma does occur, and can be identified histologically and confirmed using standard immunohistochemistry. Our findings raise awareness of bone marrow involvement in this rare entity. However, the incidence and significance of bone marrow involvement in subcutaneous panniculitis-like T-cell lymphoma requires further evaluation.
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Affiliation(s)
- Juehua Gao
- Department of Pathology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Steve J Gauerke
- Department of Pathology, Portsmouth Naval Medical Center, Portsmouth, VA, USA
| | - Maria E Martinez-Escala
- Department of Dermatology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Joan Guitart
- Department of Dermatology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Beverly P Nelson
- Department of Pathology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Amy Chadburn
- Department of Pathology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - LoAnn C Peterson
- Department of Pathology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
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Schlaak M, Pickenhain J, Theurich S, Skoetz N, von Bergwelt‐Baildon M, Kurschat P. Allogeneic stem cell transplantation versus conventional therapy for advanced primary cutaneous T-cell lymphoma. Cochrane Database Syst Rev 2013; 2013:CD008908. [PMID: 23986525 PMCID: PMC7156921 DOI: 10.1002/14651858.cd008908.pub3] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND Primary cutaneous T-cell lymphomas (CTCL) belong to the group of non-Hodgkin lymphomas and usually run an indolent course. However, some patients progress to advanced tumour or leukaemic stages. To date, there is no cure for those cases. In the last few years, several publications reported durable responses in some patients following allogeneic stem cell transplantation (alloSCT). This is an update of a Cochrane review first published in 2011 and updated in 2013. OBJECTIVES To compare the efficacy and safety of conventional therapies with allogeneic stem cell transplantation in patients with advanced primary cutaneous T-cell lymphomas. SEARCH METHODS We searched the Cochrane Central Register of Controlled Trials (CENTRAL, Issue 1), MEDLINE (1950 to January 2013), Internet-databases of ongoing trials, conference proceedings of the American Society of Clinical Oncology (ASCO, 2009 to July 2013) and the American Society of Hematology (ASH, 2009 to July 2013). We also contacted members of the European Organisation for Research and Treatment of Cancer (EORTC) Cutaneous Lymphoma Task Force to check for ongoing study activities. We handsearched citations from identified trials and relevant review articles. In addition, we handsearched randomised controlled trials from the European Group for Blood and Marrow Transplantation (EBMT) and International Conference on Cutaneous T-cell Lymphoma, ASCO and ASH up to July 2013. SELECTION CRITERIA Trials eligible for inclusion were genetically randomised controlled trials (RCTs) comparing alloSCT plus conditioning therapy (regardless of agents) with conventional therapy as treatment for advanced CTCL. DATA COLLECTION AND ANALYSIS Two review authors would have extracted data from eligible studies and assessed their quality. The primary outcome measure was overall survival; secondary outcomes were time to progression, response rate, treatment-related mortality, adverse events and quality of life. MAIN RESULTS We did not identify any randomised controlled trials from the updated search in January 2013. In 2011, we found 2077 citations but none were relevant genetically or non-genetically randomised controlled trials. All 41 studies that were thought to be potentially suitable were excluded after full text screening for being non-randomised, not including CTCL or being review articles. AUTHORS' CONCLUSIONS We planned to report evidence from genetically or non-genetically randomised controlled trials comparing conventional therapy and allogeneic stem cell transplantation. However, we did not identify any randomised controlled trials addressing this question. Nevertheless, prospective genetically randomised controlled trials need to be initiated to evaluate the precise role of alloSCT in advanced CTCL.
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Affiliation(s)
- Max Schlaak
- University Hospital of CologneDepartment of Dermatology and VenerologyKerpener Str. 62CologneGermany50924
| | - Juliane Pickenhain
- University Hospital of CologneDepartment of Dermatology and VenerologyKerpener Str. 62CologneGermany50924
| | - Sebastian Theurich
- University Hospital of CologneDepartment I of Internal Medicine, Stem Cell Transplantation ProgramKerpener Str. 62CologneGermany50924
| | - Nicole Skoetz
- University Hospital of CologneCochrane Haematological Malignancies Group, Department I of Internal MedicineKerpener Str. 62CologneGermany50924
| | - Michael von Bergwelt‐Baildon
- University Hospital of CologneDepartment I of Internal Medicine, Stem Cell Transplantation ProgramKerpener Str. 62CologneGermany50924
| | - Peter Kurschat
- University Hospital of CologneDepartment of Dermatology and VenerologyKerpener Str. 62CologneGermany50924
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Schlaak M, Pickenhain J, Theurich S, Skoetz N, von Bergwelt-Baildon M, Kurschat P. Allogeneic stem cell transplantation versus conventional therapy for advanced primary cutaneous T-cell lymphoma. Cochrane Database Syst Rev 2012; 1:CD008908. [PMID: 22258991 DOI: 10.1002/14651858.cd008908.pub2] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
BACKGROUND Primary cutaneous T-cell lymphomas (CTCL) belong to the group of non-Hodgkin lymphomas and usually run an indolent course. However, some patients progress to advanced tumour or leukaemic stages. Up to now, no curative treatment has been established for those cases. In the last few years, several publications have reported durable responses in some patients following allogeneic stem cell transplantation (alloSCT). OBJECTIVES To compare the efficacy and safety of conventional therapies with allogeneic stem cell transplantation in patients with advanced primary cutaneous T-cell lymphomas. SEARCH METHODS The search strategy included the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE (1950 to May 2011), Internet-databases of ongoing trials (www.controlled-trials.com; www.clinicaltrials.gov), conference proceedings of the American Society of Clinical Oncology (ASCO, 2009 to present) and the American Society of Hematology (ASH, 2009 to present). We also contacted members of the European Organisation for Research and Treatment of Cancer (EORTC) Cutaneous Lymphoma Task Force to check for ongoing study activities. We handsearched citations from identified trials and relevant review articles. In addition, randomised controlled trials from the European Group for Blood and Marrow Transplantation (EBMT) and International Conference on Cutaneous T-cell Lymphoma, ASCO and ASH up to 2010 were handsearched. SELECTION CRITERIA Genetically randomised controlled trials (RCT) comparing alloSCT plus conditioning therapy regardless of agents with conventional therapy as treatment for advanced CTCL were eligible to be included. DATA COLLECTION AND ANALYSIS From eligible studies data would have been extracted by two review authors and assessed for quality. Primary outcome measures were overall survival, secondary criteria were time to progression, response rate, treatment-related mortality, adverse events and quality of life. MAIN RESULTS We found 2077 citations but none were relevant genetically or non-genetically randomised controlled trials. All 41 studies that were thought to be potentially suitable were excluded after full text screening for being non-randomised, not including CTCL or being review articles. AUTHORS' CONCLUSIONS We planned to report evidence from genetically or non-genetically randomised controlled trials comparing conventional therapy and allogeneic stem cell transplantation. However, no randomised trials addressing this question were identified. Nevertheless, prospective genetically randomised controlled trials need to be initiated to evaluate the precise role of alloSCT in advanced CTCL.
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Affiliation(s)
- Max Schlaak
- Department ofDermatology andVenerology,UniversityHospital ofCologne,Cologne,Germany.
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Jung HR, Yun SY, Choi JH, Bae SH, Ryoo HM, Kum YS. Cyclosporine in Relapsed Subcutaneous Panniculitis-like T-Cell Lymphoma after Autologous Hematopoietic Stem Cell Transplantation. Cancer Res Treat 2011; 43:255-9. [PMID: 22247712 PMCID: PMC3253869 DOI: 10.4143/crt.2011.43.4.255] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2010] [Accepted: 09/12/2010] [Indexed: 11/21/2022] Open
Abstract
Subcutaneous panniculitis-like T-cell lymphoma (SPTCL) is a rare T-cell lymphoma characterized by involvement of the subcutaneous tissue of neoplastic T lymphocytes. SPTCL with hemophagocytic syndrome (HPS) is associated with an aggressive clinical course and treatment of SPTCL with HPS is not well established. Cyclophosphamide, doxorubicin, vincristine, prednisolone (CHOP) therapy is not successful in most patients suffering from SPTCL with HPS. The role of high dose chemotherapy followed by hematopoietic stem cell transplantation (HSCT) remains controversial. We report a case of relapsed SPTCL after CHOP chemotherapy and salvage chemotherapy followed by autologous HSCT, which had rapid improvement within weeks after cyclosporine and prednisolone. Immunosuppressive therapy may be an important and successful treatment option in SPTCL patients, even though they may have clinically aggressive disease.
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Affiliation(s)
- Hye Ryun Jung
- Division of Hematology/Oncology, Department of Internal Medicine, Daegu Catholic University Hospital, Catholic University of Daegu School of Medicine, Daegu, Korea
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Mehta N, Wayne AS, Kim YH, Hale GA, Alvarado CS, Myskowski P, Jaffe ES, Busam KJ, Pulitzer M, Zwerner J, Horwitz S. Bexarotene is active against subcutaneous panniculitis-like T-cell lymphoma in adult and pediatric populations. CLINICAL LYMPHOMA MYELOMA & LEUKEMIA 2011; 12:20-5. [PMID: 22001256 DOI: 10.1016/j.clml.2011.06.016] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/27/2011] [Revised: 06/30/2011] [Accepted: 06/30/2011] [Indexed: 01/02/2023]
Abstract
INTRODUCTION Subcutaneous panniculitis-like T-cell lymphoma (SPTL-AB) and cutaneous gamma/delta T-cell lymphoma (CGD-TCL) are rare T-cell lymphomas with varying clinical courses. There is no standard treatment, although chemotherapy and hematopoietic stem cell transplantation are commonly used. We describe results using bexarotene for children and adults with these disorders. METHODS We identified 15 patients (12 adults, 3 children) who were treated with bexarotene between 2000 and 2010 from the Memorial Sloan-Kettering Cancer Center lymphoma database, the Stanford Cancer Center Registry, and the National Cancer Institute (NCI) pediatric lymphoma database. There were 8 females and 7 males, with a median age of 45 years (range, 3 years to 85 years). All patients had stage IV disease. Two of 15 and 4 of 15 patients had documented CGD-TCL and SPTL-AB, respectively; others were presumed to have SPTL-AB. Bexarotene was administered at flat doses corresponding to 91 to 339 mg/m(2)/d. Two of 15 patients received concurrent denileukin diftitox. Two children received bexarotene as maintenance therapy and were not evaluable for response. RESULTS Among those treated with bexarotene alone, the overall response rate (ORR) was 82% (6/11 complete response [CR], 3/11 partial response [PR]). One of the 2 patients treated with concomitant denileukin diftitox responded for an ORR of 10/13 (77%), including 54% CR and 23% PR. Median progression-free survival was 38.4 months; median duration of response was 26.3 months. Six patients developed hypothyroidism and 9 developed hyperlipidemia; one patient developed dose-limiting hypertriglyceridemia. One pediatric patient developed insulin-dependent diabetes mellitus. CONCLUSIONS In this retrospective series, bexarotene showed a high response rate in SPTL-AB and CGD-TCL. It was generally well-tolerated with durable responses; therefore, bexarotene represents a promising therapy for children and adults with these disorders.
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Affiliation(s)
- Neha Mehta
- Department of Medicine, New York Presbyterian-Weil Cornell Medical Center, 1275 York Avenue, New York, NY 10021, USA
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Radiological and clinical features of subcutaneous panniculitis-like T-cell lymphoma. J Comput Assist Tomogr 2011; 35:394-401. [PMID: 21586937 DOI: 10.1097/rct.0b013e3182106585] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
OBJECTIVE To retrospectively analyze computed tomography (CT) and clinical findings of patients with subcutaneous panniculitis-like T-cell lymphoma (SPTCL). MATERIALS AND METHODS The CT findings were retrospectively assessed in 8 patients (6 men, 2 women; age range, 23-60 years; mean age, 39.8 years) with pathologically proven SPTCL. The tumor location, number, distribution, size, and morphological characteristics on CT were evaluated, as were maximum standardized uptake values on positron emission tomography. We also evaluated patient symptoms, laboratory findings, immunophenotype, involvement of bone marrow, treatment, and outcomes. RESULTS All 8 patients had multiple (range, 4 to numerous) soft tissue lesions involving subcutaneous fat tissue of the chest, abdominal wall, back, and buttock. Lesions varied in size (range, 0.5-10 cm) and showed reticular (n = 1), nodular (n = 4), and diffuse infiltrative (n = 3) patterns. Three patients had lesions involving the entire thickness of fat tissue, 3 had partial lesions, and 2 had variable lesions. Skin thickening was mild in 4 patients, moderate in 2, and severe in 2; fascia thickening was mild in 3 patients, moderate in one, severe in one, and variable in 2. In 7 patients, lesions were accompanied by engorged supplying vessels. At onset, maximum standardized uptake values varied from 1.2 to 4.7, decreasing to 0.0 to 4.2. Five patients had αβ type and one had γδ type. Clinical outcome varied: two remain alive with disease, two had no disease, and one died. CONCLUSIONS The SPTCL is characterized by multiple, nodular, or diffuse soft tissue lesions involving subcutaneous fat tissue, accompanied by engorged vessels and skin and fascial thickening. Patients vary in presentation and in treatment outcomes.
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MIURA T, KAWAKAMI Y, SATO M, OHTSUKA M, YAMAMOTO T. Hemophagocytic syndrome occurred in a patient with subcutaneous panniculitis-like T-cell lymphoma without overt skin lesion: Successful treatment with steroid pulse therapy. J Dermatol 2011; 38:1113-1115. [DOI: 10.1111/j.1346-8138.2010.01178.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
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Caudron A, Bouaziz J, Battistella M, Sibon D, Lok C, Leclech C, Ortonne N, Molinier-Frenkel V, Bagot M. Two Atypical Cases of Cutaneous Gamma/Delta T-Cell Lymphomas. Dermatology 2011; 222:297-303. [DOI: 10.1159/000327932] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2010] [Accepted: 03/29/2011] [Indexed: 11/19/2022] Open
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Soylu S, Gül Ü, Kiliç A, Heper AO, Kuzu I, Gönen Minareci B. A case with an indolent course of subcutaneous panniculitis-like T-cell lymphoma demonstrating Epstein-Barr virus positivity and simulating dermatitis artefacta. Am J Clin Dermatol 2010; 11:147-50. [PMID: 20141236 DOI: 10.2165/11311060-000000000-00000] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Abstract
Subcutaneous panniculitis-like T-cell lymphoma (SPTCL) is a rare form of cytotoxic T-cell lymphoma. The disease has a poor prognosis in patients with the complication of hemophagocytic syndrome, especially in those with Epstein-Barr virus (EBV) positivity. A 20-year-old woman presented with multiple, itchy, purplish nodules and excoriations on both of her upper limbs. The histopathologic, immunohistochemical staining, and clonal T-cell receptor gene rearrangement examinations of skin lesions revealed the diagnosis of SPTCL. In situ hybridization performed for EBV was positive. There were no findings suggesting systemic involvement of SPTCL, or hemophagocytic syndrome. The lesions improved with systemic corticosteroid therapy and radiotherapy, with no recurrence. We present a patient with a protracted course of SPTCL in whom EBV positivity was demonstrated. This apparent conflict may be explained by geographic and ethnic variations in EBV infection. Further studies may shed light on the real relationship between EBV-RNA and the course of SPTCL.
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Rojnuckarin P, Nakorn TN, Assanasen T, Wannakrairot P, Intragumtornchai T. Cyclosporin in subcutaneous panniculitis-like T-cell lymphoma. Leuk Lymphoma 2009; 48:560-3. [PMID: 17454599 DOI: 10.1080/10428190601078456] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Subcutaneous panniculitis-like T-cell lymphoma (SPTCL) is a rare form of hematologic malignancy characterized by lesions in subcutaneous fat associated with systemic symptoms. The standard treatment of the disease, currently, is not established, but CHOP or CHOP-like regimens are usually given. We report, herein, 4 cases of SPTCL diagnosed by histopathology and immunohistochemistry who were refractory to CHOP and/or ESHAP and/or fludarabine-based regimen, but showed rapid improvement within weeks after oral cyclosporin 4 mg/kg/day. Three sustained complete remission for the durations of 8 - 9 months off-treatments. T-cell receptor gene rearrangement revealed polyclonality in 3 cases and monoclonality in 1 case. Our data suggest the benefit of incorporating cyclosporin into the treatment regimen for SPTCL.
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Affiliation(s)
- Ponlapat Rojnuckarin
- Department of Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailland
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Ichii M, Hatanaka K, Imakita M, Ueda Y, Kishino BI, Tamaki T. Successful treatment of refractory subcutaneous panniculitis-like T-cell lymphoma with allogeneic peripheral blood stem cell transplantation from HLA-mismatched sibling donor. Leuk Lymphoma 2009; 47:2250-2. [PMID: 17071503 DOI: 10.1080/10428190600783619] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Hagiwara M, Takata K, Shimoyama Y, Yamamoto K, Takahashi E, Asano N, Iwase Y, Okazaki Y, Tamada Y, Yoshino T, Tomita Y, Nakamura S. Primary cutaneous T-cell lymphoma of unspecified type with cytotoxic phenotype: clinicopathological analysis of 27 patients. Cancer Sci 2009; 100:33-41. [PMID: 19018763 PMCID: PMC11158474 DOI: 10.1111/j.1349-7006.2008.01000.x] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2008] [Revised: 08/31/2008] [Accepted: 09/01/2008] [Indexed: 11/27/2022] Open
Abstract
The objective of our study was to investigate the clinicopathological features of the currently ill-defined subtype of primary cutaneous T-cell lymphoma of unspecified type (CTCLU) with a cytotoxic phenotype and no Epstein-Barr virus (EBV) association. A series of 27 patients with CTCLU (median age 49 years; range 25-87 years; 18 men) was reviewed. Performance status scores above 1 (7%), clinical stages above 2 (15%), B symptoms (26%), extracutaneous involvement (30%), and a fatal course within 1 year of diagnosis (19%) were observed infrequently. The International Prognostic Index was high or high to intermediate in 11%, and the Prognostic Index for Peripheral T-cell Lymphoma unspecified was above group 2 in 22%. Notably, the rates of spontaneous regression and T-cell receptor gene rearrangements by polymerase chain reaction analysis were seen in 26 and 17% of our cases, respectively. Histologically, 22 patients had subcutaneous involvement of whom eight showed a lethal clinical course, and five patients without subcutaneous involvement were all survivors. Immunophenotypical and morphological features allowed us to subclassify our cases according to the following four categories: (1) epidermotropic CD8+ T-cell lymphoma (n=5); (2) cutaneous gamma/delta T-cell lymphoma (n=8); (3) cutaneous alpha/beta pleomorphic T-cell lymphoma (n=8); and (4) cutaneous medium/large pleomorphic T-cell lymphoma, not otherwise specified (n=6). All four of these groups of lymphomas exhibited a relatively favorable clinical course compared to previous reports. However, epidermotropic CD8+ T-cell lymphoma appeared to be unique with a higher ratio (80%) of spontaneous regression, a lower ratio (40%) of subcutaneous involvement, and a more favorable clinical course than the other three subcategories.
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Affiliation(s)
- Masahiro Hagiwara
- Department of Dermatology, Nagoya Graduate School of Medicine, and Department of Pathology and Clinical Laboratories, Nagoya University Hospital, Showa-ku, Nagoya 466-8550, Japan.
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Gallardo F, Pujol RM. Subcutaneous Panniculitic-Like T-Cell Lymphoma and Other Primary Cutaneous Lymphomas with Prominent Subcutaneous Tissue Involvement. Dermatol Clin 2008; 26:529-40, viii. [DOI: 10.1016/j.det.2008.05.008] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
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Clinicopathological Characterization and Genomic Aberrations in Subcutaneous Panniculitis-Like T-Cell Lymphoma. J Invest Dermatol 2008; 128:2304-9. [DOI: 10.1038/jid.2008.6] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Vidulich K, Jones D, Duvic M. Cutaneous γ/δ T-Cell Lymphoma Treated with Radiation and Denileukin Diftitox. ACTA ACUST UNITED AC 2008; 8:55-8. [DOI: 10.3816/clm.2008.n.005] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
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Chim CS, Loong F, Ng WK, Kwong YL. Use of fludarabine-containing chemotherapeutic regimen results in durable complete remission of subcutaneous panniculitis-like T-cell lymphoma. Am J Clin Dermatol 2008; 9:396-8. [PMID: 18973407 DOI: 10.2165/0128071-200809060-00007] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Abstract
Subcutaneous panniculitis-like T-cell lymphoma (SPTCL) is a rare lymphoma. The optimal therapy for SPTCL is undefined and the results of treatment with anthracycline-containing chemotherapy for aggressive cases have remained poor. A 27-year-old woman with multifocal and aggressive CD8+ SPTCL was treated with the purine analog fludarabine in combination with mitoxantrone and dexamethasone (FND). The patient achieved complete remission after one course of treatment. After completion of six courses of FND, the patient has remained in remission for more than 3 years. FND may be an effective treatment for aggressive SPTCL.
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Subcutaneous panniculitis-like T-cell lymphoma: definition, classification, and prognostic factors: an EORTC Cutaneous Lymphoma Group Study of 83 cases. Blood 2007; 111:838-45. [PMID: 17934071 DOI: 10.1182/blood-2007-04-087288] [Citation(s) in RCA: 400] [Impact Index Per Article: 23.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
In the WHO classification, subcutaneous panniculitis-like T-cell lymphoma (SPTL) is defined as a distinct type of T-cell lymphoma with an aggressive clinical behavior. Recent studies suggest that distinction should be made between SPTL with an alpha/beta T-cell phenotype (SPTL-AB) and SPTL with a gammadelta T-cell phenotype (SPTL-GD), but studies are limited. To better define their clinicopathologic features, immunophenotype, treatment, and survival, 63 SPTL-ABs and 20 SPTL-GDs were studied at a workshop of the EORTC Cutaneous Lymphoma Group. SPTL-ABs were generally confined to the subcutis, had a CD4-, CD8+, CD56-, betaF1+ phenotype, were uncommonly associated with a hemophagocytic syndrome (HPS; 17%), and had a favorable prognosis (5-year overall survival [OS]: 82%). SPTL-AB patients without HPS had a significantly better survival than patients with HPS (5-year OS: 91% vs 46%; P<.001). SPTL-GDs often showed (epi)dermal involvement and/or ulceration, a CD4-, CD8-, CD56+/-, betaF1- T-cell phenotype, and poor prognosis (5-year OS: 11%), irrespective of the presence of HPS or type of treatment. These results indicate that SPTL-AB and SPTL-GD are distinct entities, and justify that the term SPTL should further be used only for SPTL-AB. SPTL-ABs without associated HPS have an excellent prognosis, and multiagent chemotherapy as first choice of treatment should be questioned.
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Aguilera P, Mascaró JM, Martinez A, Esteve J, Puig S, Campo E, Estrach T. Cutaneous γ/δ T-cell lymphoma: A histopathologic mimicker of lupus erythematosus profundus (lupus panniculitis). J Am Acad Dermatol 2007; 56:643-7. [PMID: 17367613 DOI: 10.1016/j.jaad.2006.08.029] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2006] [Revised: 07/24/2006] [Accepted: 08/01/2006] [Indexed: 10/23/2022]
Abstract
In the newly revised World Health Organization (WHO)-European Organization for Research and Treatment of Cancer (EORTC) consensus classification for cutaneous lymphomas, cutaneous gamma/delta T-cell lymphoma (CGD-TCL) has been included as a provisional entity. This type of lymphomas, when involving the subcutaneous fat, can mimic both clinically and histologically other more indolent conditions, such as subcutaneous panniculitic T-cell lymphomas (SPTCL) and lupus erythematosus profundus (LEP), and multiple biopsies may be needed to obtain a correct diagnosis. A good correlation of the clinical data with the histopathology and immunohistochemistry are required for diagnosis. Herein, we describe a patient whose initial histopathologic findings ressembled LEP but presented an aggressive clinical course. A new biopsy was performed during the follow-up, and a final diagnosis of CGD-TCL was made.
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MESH Headings
- Biopsy, Needle
- Diagnosis, Differential
- Disease Progression
- Follow-Up Studies
- Genes, T-Cell Receptor gamma/genetics
- Genetic Markers
- Humans
- Immunohistochemistry
- Lymphoma, T-Cell, Cutaneous/classification
- Lymphoma, T-Cell, Cutaneous/diagnosis
- Lymphoma, T-Cell, Cutaneous/pathology
- Male
- Middle Aged
- Panniculitis, Lupus Erythematosus/diagnosis
- Panniculitis, Lupus Erythematosus/pathology
- Risk Assessment
- World Health Organization
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Affiliation(s)
- Paula Aguilera
- Department of Dermatology, Hospital Clinic i Provincial de Barcelona, University of Barcelona, Spain.
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Rao DS, Said JW. Small Lymphoid Proliferations in Extranodal Locations. Arch Pathol Lab Med 2007; 131:383-96. [PMID: 17516741 DOI: 10.5858/2007-131-383-slpiel] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/04/2006] [Indexed: 11/06/2022]
Abstract
Abstract
Context.—Low-grade non-Hodgkin lymphomas frequently involve extranodal sites including the gastrointestinal tract, skin, and lung, either selectively or as part of widespread dissemination. Differentiation from inflammatory or infectious conditions requires knowledge of specific histologic characteristics of the various entities as well as ancillary techniques.
Objective.—To describe the key features and provide diagnostic clues to the identification of specific extranodal low-grade lymphomas of T-cell and B-cell types including small lymphocytic lymphoma, follicular lymphoma, mantle cell lymphoma, extranodal marginal zone B-cell lymphomas of mucosal-associated lymphoid tissue, and hairy cell leukemia. Histologic and cytologic features are highlighted, as well as appropriate integration of results of ancillary diagnostic studies including flow cytometry, immunohistochemistry, molecular features, and cytogenetics.
Data Sources.—The published literature as well as personal experience from a specialized hematopathology practice at a large university medical center.
Conclusions.—Correct identification of extranodal low-grade lymphomas and differentiation from hyperplastic and inflammatory or infectious processes require the ability to distinguish each of the specific entities discussed. Ancillary studies are often indispensable in reaching a correct diagnosis.
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Affiliation(s)
- Dinesh S Rao
- Center for Health Sciences, UCLA, Department of Pathology and Laboratory Medicine, 10833 Le Conte Ave, Los Angeles, CA 90095, USA
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Tzeng HE, Teng CL, Yang Y, Young JH, Chou G. Occult Subcutaneous Panniculitis-like T-cell Lymphoma with Initial Presentations of Cellulitis-like Skin Lesion and Fulminant Hemophagocytosis. J Formos Med Assoc 2007; 106:S55-9. [PMID: 17493898 DOI: 10.1016/s0929-6646(09)60354-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Hemophagocytic syndrome (HPS) may be primary or secondary to malignancies, infections, autoimmune diseases, or drugs. In most cases, HPS occurs at the same time as the diagnosis of underlying malignancy or when it relapses. In rare situations, the neoplastic disease can be occult, even for more than a decade. Were port the case of a 28-year-old woman admitted because of HPS. Treatment with etoposide for fulminant HPS was effective. Four months later, she was admitted again because of newly developed subcutaneous nodules and cellulitis-like skin lesions over her legs. Excisional biopsy of subcutaneous nodule showed subcutaneous panniculitis-like T-cell lymphoma. After etoposide, solumedrol, cytosine arabinoside, and cisplatin regimen chemotherapy, both skin lesions and subcutaneous nodules disappeared. In conclusion, for patients presenting with HPS and cellulitis-like skin lesions, occult lymphoma should be considered, which might not be diagnosed for months, even years. Adequate treatment, including steroid and chemotherapy against malignant lymphoma, should be started as soon as possible for patients with fulminant HPS because of its fatal course.
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Affiliation(s)
- Huey-En Tzeng
- Division of Hematology/Oncology, Taichung Veterans General Hospital, Taichung, Taiwan
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Pérez-Persona E, Mateos-Mazón JJ, López-Villar O, Arcos MJ, Encinas C, Graciani IF, Ocio EM, Sánchez-Guijo FM, Caballero MD. Complete remission of subcutaneous panniculitic T-cell lymphoma after allogeneic transplantation. Bone Marrow Transplant 2006; 38:821-2. [PMID: 17057727 DOI: 10.1038/sj.bmt.1705527] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Ko CJ. The New World Health Organization–European Organization for Research and Treatment of Cancer Classification of Cutaneous Lymphomas. ACTA ACUST UNITED AC 2006; 22:259-77. [PMID: 17249305 DOI: 10.1016/j.yadr.2006.09.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
The WHO-EORTC classification of cutaneous lymphomas is a good start to unifying nomenclature, a necessity before coherent consensus diagnoses can be made. There are three provisional diagnoses in this new classification that are not covered in detail in this review because they are rare diseases that still require further study for definitive classification. Much remains to be elucidated about cutaneous lymphomas, but understanding of the major entities within the new classification is an important first step in understanding these diverse diseases.
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Affiliation(s)
- Christine J Ko
- Yale University, 15 York Street, LMP 5031, New Haven, CT 06510, USA.
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Abstract
AbstractThe mature T/natural killer (NK) lymphoma/leukemias represent 5–15% of all non-Hodgkin lymphoma. These diseases have a geographic variation, with more nodal disease in North America and Europe, including peripheral T cell lymphomas, unspecified, anaplastic large cell lymphoma, and angioimmunoblastic T cell lymphoma; and more extranodal disease in Asia due to Epstein-Barr virus–related nasal NK/T lymphoma and human T-cell leukemia virus (HTLV)-1–associated adult T cell leukemia/lymphoma. The prognosis in most peripheral T/NK neoplasms is poor, with 5-year survival less than 30%. Progress has been slow due to the rarity of the diseases, geographic variation, relative chemoresistance, and lack of randomized trials. There is no consensus about optimal therapy in T/NK neoplasms, and recommendations are based on anecdotal reports, small series, and phase II trials. In this review, topics include the question of CHOP as standard therapy, prognostic factors, disease-adapted therapy, novel approaches, monoclonal antibody therapy, and stem cell transplantation.
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