Death Receptor Apoptosis Signaling Mediated by FADD in CD30-Positive Lymphoproliferative Disorders Involving the Skin

Increased Expression of Phosphorylated FADD in Anaplastic Large Cell and Other T-Cell Lymphomas

FAS-associated protein with death domain (FADD) is a major adaptor protein involved in extrinsic apoptosis, embryogenesis, and lymphocyte homeostasis. Although abnormalities of the FADD/death receptor apoptotic pathways have been established in tumorigenesis, fewer studies have analyzed the expression and role of phosphorylated FADD (pFADD). Our identification of FADD as a lymphoma-associated autoantigen in T-cell lymphoma patients raises the possibility that pFADD, with its correlation with cell cycle, may possess role(s) in human T-cell lymphoma development. This immunohistochemical study investigated pFADD protein expression in a range of normal tissues and lymphomas, particularly T-cell lymphomas that require improved therapies. Whereas pFADD was expressed only in scattered normal T cells, it was detected at high levels in T-cell lymphomas (eg, 84% anaplastic large cell lymphoma and 65% peripheral T cell lymphomas, not otherwise specified). The increased expression of pFADD supports further study of its clinical relevance and role in lymphomagenesis, highlighting phosphorylation of FADD as a potential therapeutic target.

Primary cutaneous anaplastic CD30 + large-cell lymphoma that completely regressed after incisional skin biopsy

We describe a 48-year-old woman with three erythematous nodules localized on the left forearm, with 2 months evolution. Histological and immunohistochemical examination revealed a CD30(+) large-cell lymphoma. Systemic involvement was not detected. The tumor regressed spontaneously within a week, after the incisional skin biopsy. In control skin biopsy, there was not any histological feature of lymphoma. No reactivation or any symptom of systemic disease was observed during the 10-month follow-up period.

Apoptosis in spermatocytic and usual seminomas: a light microscopic and immunohistochemical study

Despite its alarming appearance, spermatocytic seminoma virtually never metastasizes. We hypothesized that this paradox may at least be partially related to increased apoptosis compared to metastasizing germ cell tumors since high expression of proapoptotic factors correlates with indolent behavior in other tumor systems, notably CD30-positive cutaneous lymphoma, another neoplasm where phenotype and behavior do not match. We therefore compared apoptosis and apoptotic regulators in 17 spermatocytic seminomas (2 with sarcoma) and 18 usual seminomas by light microscopy and using immunostains for caspase-3, p53, bcl-2, bcl-xL, FADD, FAS and survivin. We found significantly greater numbers of apoptotic cells and activated caspase-3-positive cells in spermatocytic seminoma compared to usual seminoma (P<0.01). There was over a 10-fold range in apoptotic cells in usual seminoma but only a 4-fold variation in spermatocytic seminoma. Spermatocytic seminoma had decreased p53 expression compared to usual seminoma, with marked variation in bcl-2 expression and increased FADD. The two sarcomas in spermatocytic seminoma, however, showed decreased apoptosis and caspase-3 reactivity, with upregulation of p53 and bcl-2 and decreased FADD expression. We conclude that apoptosis, caspase-3 and FADD expression are increased in spermatocytic seminoma compared to usual seminoma. Apoptotic parameters are decreased in sarcomatous transformation of spermatocytic seminoma. The increased apoptosis of spermatocytic seminoma, possibly mediated by FAS independent activation of the death receptor pathway, may provide some insight into its excellent prognosis. The variation in apoptosis of usual seminomas merits investigation as a prognostic parameter.

Differences in survivin location and Bcl-2 expression in CD30+ lymphoproliferative disorders of the skin compared with systemic anaplastic large cell lymphomas: an immunohistochemical study

BACKGROUND

Cutaneous CD30+ lymphoproliferative disorders (LPDs) are a spectrum of disease associated with a favourable prognosis. Systemic anaplastic large cell lymphoma (ALCL), although morphologically and phenotypically similar, differs in clinical presentation and has a less favourable biological behaviour. Dysregulation of apoptosis, the process regulating cell population by programmed death, can explain the differences among these disorders.

OBJECTIVES

We investigated the expression of two inhibitors of apoptosis, survivin and Bcl-2 protein, in serial skin lesion samples from CD30+ LPDs compared with systemic ALCL.

METHODS

Immunohistochemical analysis with antibodies against anaplastic lymphoma kinase (ALK)-1 protein, survivin and Bcl-2 protein was performed in 10 cutaneous CD30+ LPDs (five lymphomatoid papulosis, five ALCL) and 18 systemic ALCLs. Reverse transcription-polymerase chain reaction studies for ALK and ALK/nucleophosmin were also performed.

RESULTS

Cutaneous CD30+ LPDs shared a heterogeneous expression of cytoplasmic survivin with all systemic ALCLs, and of Bcl-2 with systemic ALK- ALCLs; however, they differ from systemic ALK- ALCLs because they lack nuclear survivin (P = 0.045), and from systemic ALK+ ALCLs by a higher expression of Bcl-2 (P = 0.045) and a lack of ALK-1. Overall, coexpression of Bcl-2 and nuclear survivin in CD30+ LPDs was associated with a less favourable disease survival.

CONCLUSIONS

The different patterns of expression of Bcl-2 and survivin in CD30+ LPDs might have an impact on their different biological and clinical behaviour. Moreover, nuclear localization of survivin, similarly to ALK, may be a useful marker for predicting a systemic form of ALCL with cutaneous presentation.

The New World Health Organization–European Organization for Research and Treatment of Cancer Classification of Cutaneous Lymphomas

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.