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Yadav M, Uikey BN, Rathore SS, Gupta P, Kashyap D, Kumar C, Shukla D, Vijayamahantesh, Chandel AS, Ahirwar B, Singh AK, Suman SS, Priyadarshi A, Amit A. Role of cytokine in malignant T-cell metabolism and subsequent alternation in T-cell tumor microenvironment. Front Oncol 2023; 13:1235711. [PMID: 37746258 PMCID: PMC10513393 DOI: 10.3389/fonc.2023.1235711] [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: 06/06/2023] [Accepted: 08/14/2023] [Indexed: 09/26/2023] Open
Abstract
T cells are an important component of adaptive immunity and T-cell-derived lymphomas are very complex due to many functional sub-types and functional elasticity of T-cells. As with other tumors, tissues specific factors are crucial in the development of T-cell lymphomas. In addition to neoplastic cells, T- cell lymphomas consist of a tumor micro-environment composed of normal cells and stroma. Numerous studies established the qualitative and quantitative differences between the tumor microenvironment and normal cell surroundings. Interaction between the various component of the tumor microenvironment is crucial since tumor cells can change the microenvironment and vice versa. In normal T-cell development, T-cells must respond to various stimulants deferentially and during these courses of adaptation. T-cells undergo various metabolic alterations. From the stage of quiescence to attention of fully active form T-cells undergoes various stage in terms of metabolic activity. Predominantly quiescent T-cells have ATP-generating metabolism while during the proliferative stage, their metabolism tilted towards the growth-promoting pathways. In addition to this, a functionally different subset of T-cells requires to activate the different metabolic pathways, and consequently, this regulation of the metabolic pathway control activation and function of T-cells. So, it is obvious that dynamic, and well-regulated metabolic pathways are important for the normal functioning of T-cells and their interaction with the microenvironment. There are various cell signaling mechanisms of metabolism are involved in this regulation and more and more studies have suggested the involvement of additional signaling in the development of the overall metabolic phenotype of T cells. These important signaling mediators include cytokines and hormones. The impact and role of these mediators especially the cytokines on the interplay between T-cell metabolism and the interaction of T-cells with their micro-environments in the context of T-cells lymphomas are discussed in this review article.
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Affiliation(s)
- Megha Yadav
- Department of Forensic Science, Guru Ghasidas Vishwavidyalaya, Bilaspur, India
| | - Blessi N. Uikey
- Department of Forensic Science, Guru Ghasidas Vishwavidyalaya, Bilaspur, India
| | | | - Priyanka Gupta
- Department of Forensic Science, Guru Ghasidas Vishwavidyalaya, Bilaspur, India
| | - Diksha Kashyap
- Department of Forensic Science, Guru Ghasidas Vishwavidyalaya, Bilaspur, India
| | - Chanchal Kumar
- Department of Forensic Science, Guru Ghasidas Vishwavidyalaya, Bilaspur, India
| | - Dhananjay Shukla
- Department of Biotechnology, Guru Ghasidas Vishwavidyalaya, Bilaspur, India
| | - Vijayamahantesh
- Department of Immunology and Microbiology, University of Missouri, Columbia, SC, United States
| | - Arvind Singh Chandel
- Center for Disease Biology and Integrative Medicine, Faculty of Medicine, The University of Tokyo, Bunkyo, Japan
| | - Bharti Ahirwar
- Department of Pharmacy, Guru Ghasidas Vishwavidyalaya, Bilaspur, India
| | | | - Shashi Shekhar Suman
- Department of Zoology, Udayana Charya (UR) College, Lalit Narayan Mithila University, Darbhanga, India
| | - Amit Priyadarshi
- Department of Zoology, Veer Kunwar Singh University, Arrah, India
| | - Ajay Amit
- Department of Forensic Science, Guru Ghasidas Vishwavidyalaya, Bilaspur, India
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Ondrejka SL, Amador C, Climent F, Ng SB, Soma L, Zamo A, Dirnhofer S, Quintanilla-Martinez L, Wotherspoon A, Leoncini L, de Leval L. Follicular helper T-cell lymphomas: disease spectrum, relationship with clonal hematopoiesis, and mimics. A report of the 2022 EA4HP/SH lymphoma workshop. Virchows Arch 2023; 483:349-365. [PMID: 37500795 PMCID: PMC10541838 DOI: 10.1007/s00428-023-03607-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Revised: 06/30/2023] [Accepted: 07/17/2023] [Indexed: 07/29/2023]
Abstract
Follicular helper T-cell lymphomas (TFH lymphomas) were discussed in session V of the lymphoma workshop of the European Association for Haematopathology (EA4HP)/Society for Hematopathology (SH) 2022 meeting in Florence, Italy. The session focused on the morphologic spectrum of TFH lymphoma, including its three subtypes: angioimmunoblastic-type (AITL), follicular-type, and not otherwise specified (NOS). The submitted cases encompassed classic examples of TFH lymphoma and unusual cases such as those with early or indolent presentations, associated B-cell proliferations, or Hodgkin/Reed-Sternberg-like cells. The relationship between TFH lymphoma and clonal hematopoiesis was highlighted by several cases documenting divergent evolution of myeloid neoplasm and AITL from shared clonal mutations. The distinction between TFH lymphoma and peripheral T-cell lymphoma, not otherwise specified (PTCL, NOS), was stressed, and many challenging examples were presented. Various cases highlighted the difficulties of differentiating TFH lymphoma from other established types of lymphoma and reactive conditions. Cutaneous T-cell lymphoma expressing TFH markers, particularly when resulting in lymph node involvement, should be distinguished from TFH lymphomas. Additional immunophenotyping and next-generation sequencing studies were performed on various cases in this session, highlighting the importance of these technologies to our current understanding and classification of TFH lymphomas.
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Affiliation(s)
- Sarah L Ondrejka
- Pathology and Laboratory Medicine Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Catalina Amador
- Division of Hematopathology, Department of Pathology and Laboratory Medicine, University of Miami, Miami, FL, USA
| | - Fina Climent
- Pathology Department, Hospital Universitari de Bellvitge, IDIBELL, L'Hospitalet De Llobregat, Barcelona, Spain
| | - Siok-Bian Ng
- Department of Pathology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Lorinda Soma
- Department of Pathology, City of Hope National Medical Center, Duarte, CA, USA
| | - Alberto Zamo
- Institute of Pathology, University of Würzburg, Würzburg, Germany
| | - Stefan Dirnhofer
- Institute of Medical Genetics and Pathology, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Leticia Quintanilla-Martinez
- Institute of Pathology and Neuropathology, Eberhard Karls University of Tübingen and Comprehensive Cancer Center, University Hospital Tübingen, Tübingen, Germany
| | | | - Lorenzo Leoncini
- Department of Medical Biotechnology, University of Siena, Siena, Italy
| | - Laurence de Leval
- Institute of Pathology, Department of Laboratory Medicine and Pathology, Lausanne University Hospital and Lausanne University, Lausanne, Switzerland.
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3
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Li Y, Gao X, Kong LZ, Li J. Misdiagnosis of angioimmunoblastic T‑cell lymphoma: A case report. Oncol Lett 2023; 25:250. [PMID: 37153053 PMCID: PMC10161358 DOI: 10.3892/ol.2023.13836] [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: 11/14/2022] [Accepted: 04/14/2023] [Indexed: 05/09/2023] Open
Abstract
Angioimmunoblastic T-cell lymphoma (AITL) is a specific subtype of peripheral T-cell lymphoma that is challenging to diagnose due to the lack of specific pathological characteristics. This report describes the case of a 56-year-old man with Hodgkin lymphoma in whom the gene rearrangement results were positive for TCRβDB+Jβ1/2. Pathological and immunochemical examinations revealed a diagnosis of lymphoma that was a composite of AITL and focal classical Hodgkin lymphoma. Unfortunately, he died soon after the correct diagnosis was made. This case shows that a combination of immunohistochemistry and gene rearrangement analysis can increase the diagnostic accuracy for AITL. A review of the literature on the misdiagnosis of AITL indicates that this disease progresses rapidly with a high mortality rate. Our experience, in this case, highlights the need for early diagnosis.
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Affiliation(s)
- Yan Li
- Department of Hematology, Hebei General Hospital, Shijiazhuang, Hebei 050051, P.R. China
- Correspondence to: Dr Yan Li, Department of Hematology, Hebei General Hospital, 348 Heping West Road, Shijiazhuang, Hebei 050051, P.R. China, E-mail:
| | - Xiaohan Gao
- Department of Hematology, Hebei General Hospital, Shijiazhuang, Hebei 050051, P.R. China
| | - Ling-Zhijie Kong
- Department of Hematology, Hebei General Hospital, Shijiazhuang, Hebei 050051, P.R. China
- Department of Graduate School, Hebei North University, Zhangjiakou, Hebei 075000, P.R. China
| | - Jie Li
- Department of Hematology, Hebei General Hospital, Shijiazhuang, Hebei 050051, P.R. China
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Donzel M, Trecourt A, Balme B, Harou O, Mauduit C, Bachy E, Guesquières H, Fontaine J, Ortonne N, Perier-Muzet M, Dalle S, Traverse-Glehen A. Deciphering the spectrum of cutaneous lymphomas expressing TFH markers. Sci Rep 2023; 13:6500. [PMID: 37081015 PMCID: PMC10119163 DOI: 10.1038/s41598-023-33031-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2022] [Accepted: 04/06/2023] [Indexed: 04/22/2023] Open
Abstract
T-follicular helper (TFH) markers are expressed in the microenvironnement of marginal zone B-cell lymphoma (MZL), and in lymphomas arising from TFH-cells, sometimes making the differential diagnosis difficult. In the skin, the "TFH-spectrum" is poorly defined, going from primary cutaneous lymphoproliferative disorder with small/medium CD4+ T-cells (SMLPD) to cutaneous localizations of systemic angioimmunoblastic T-cell lymphoma (cAITL), and may pass through intermediate forms (primary cutaneous T-follicular helper derived lymphoma, not otherwise specified (PCTFHL,NOS)). We retrospectively analyzed 20 MZL, 13 SMLPD, 5 PCTFHL, and 11 cAITL clinically, histologically, and molecularly, to define tools to differentiate them. Characteristics that might favor the diagnosis of MZL over SMLPD are: multiple skin nodules (p < 0.001), nodular architecture (p < 0.01), residual germinal centers with follicular dendritic cell network (p < 0.001), monotypic plasma cells (p < 0.001), and few staining with PD1 (p = 0.016) or CXCL13 (p = 0.03). PCTFHL and cAITL presented as multiple (p < 0.01) lesions, in older patients (p < 0.01), with systemic symptoms and/or biological alterations (p < 0.01). Immunophenotypic loss of T-cell markers (p < 0.001), BCL6 (p = 0.023) and/or CD10 staining (p = 0.08), and a higher proliferative index (≥ 30%, p = 0.039) favoured these diagnoses over SMLPD. Pathogenic variants were observed by genomic sequencing in 47% of MZL (TNFAIP3 (32%), EP300 (21%), NOTCH2 (16%), KMT2D (16%), CARD11 (10.5%)), 8% of SMLPD (TET2), 40% of PCTFHL (SOCS1 (20%), ARID1A (20%)) and 64% of cAITL (TET2 (63.6%), RHOA (36.4%), NOTCH1 (9%)). This study characterizes the various clinical and histological features between cutaneous lymphomas expressing TFH markers and highlights the value of the interest of screening for genomic mutations in difficult cases.
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Affiliation(s)
- Marie Donzel
- Institut de Pathologie multisites, Hospices Civils de Lyon, Hôpital Lyon Sud, 165 Chemin du Grand Revoyet, 69310, Lyon, Pierre-Bénite, France.
| | - Alexis Trecourt
- Institut de Pathologie multisites, Hospices Civils de Lyon, Hôpital Lyon Sud, 165 Chemin du Grand Revoyet, 69310, Lyon, Pierre-Bénite, France
| | - Brigitte Balme
- Institut de Pathologie multisites, Hospices Civils de Lyon, Hôpital Lyon Sud, 165 Chemin du Grand Revoyet, 69310, Lyon, Pierre-Bénite, France
| | - Olivier Harou
- Institut de Pathologie multisites, Hospices Civils de Lyon, Hôpital Lyon Sud, 165 Chemin du Grand Revoyet, 69310, Lyon, Pierre-Bénite, France
| | - Claire Mauduit
- Institut de Pathologie multisites, Hospices Civils de Lyon, Hôpital Lyon Sud, 165 Chemin du Grand Revoyet, 69310, Lyon, Pierre-Bénite, France
| | - Emmanuel Bachy
- Hospices Civils de Lyon, Cancer Research Center of Lyon, INSERM U1052, CNRS UMR 5286, CLB, UCBL, Université Lyon 1, Lyon, France
- Hospices Civils de Lyon, Service d'Hématologie, Hôpital Lyon Sud, Lyon, France
| | - Hervé Guesquières
- Hospices Civils de Lyon, Cancer Research Center of Lyon, INSERM U1052, CNRS UMR 5286, CLB, UCBL, Université Lyon 1, Lyon, France
- Hospices Civils de Lyon, Service d'Hématologie, Hôpital Lyon Sud, Lyon, France
| | - Juliette Fontaine
- Institut de Pathologie multisites, Hospices Civils de Lyon, Hôpital Lyon Sud, 165 Chemin du Grand Revoyet, 69310, Lyon, Pierre-Bénite, France
| | - Nicolas Ortonne
- Biological Immunology, APHP Henri Mondor Hospital, Paris Est Creteil University (UPEC) and INSERM U955 Team Ortonne (NFL), Créteil, France
- Department of Dermatology, APHP Henri Mondor Hospital, Créteil, France
| | - Marie Perier-Muzet
- Hospices Civils de Lyon, Service de Dermatologie, Hôpital Lyon Sud, Lyon, France
| | - Stéphane Dalle
- Hospices Civils de Lyon, Cancer Research Center of Lyon, INSERM U1052, CNRS UMR 5286, CLB, UCBL, Université Lyon 1, Lyon, France
- Hospices Civils de Lyon, Service de Dermatologie, Hôpital Lyon Sud, Lyon, France
| | - Alexandra Traverse-Glehen
- Institut de Pathologie multisites, Hospices Civils de Lyon, Hôpital Lyon Sud, 165 Chemin du Grand Revoyet, 69310, Lyon, Pierre-Bénite, France
- Hospices Civils de Lyon, Cancer Research Center of Lyon, INSERM U1052, CNRS UMR 5286, CLB, UCBL, Université Lyon 1, Lyon, France
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Marques-Piubelli ML, Amador C, Vega F. Pathologic and molecular insights in nodal T-follicular helper cell lymphomas. Front Oncol 2023; 13:1105651. [PMID: 36793612 PMCID: PMC9923156 DOI: 10.3389/fonc.2023.1105651] [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: 11/22/2022] [Accepted: 01/13/2023] [Indexed: 01/31/2023] Open
Abstract
T-follicular helper (TFH) cells are one of the T-cell subsets with a critical role in the regulation of germinal center (GC) reactions. TFH cells contribute to the positive selection of GC B-cells and promote plasma cell differentiation and antibody production. TFH cells express a unique phenotype characterized by PD-1hi, ICOShi, CD40Lhi, CD95hi, CTLAhi, CCR7lo, and CXCR5hi . Three main subtypes of nodal TFH lymphomas have been described: 1) angioimmunoblastic-type, 2) follicular-type, and 3) not otherwise specified (NOS). The diagnosis of these neoplasms can be challenging, and it is rendered based on a combination of clinical, laboratory, histopathologic, immunophenotypic, and molecular findings. The markers most frequently used to identify a TFH immunophenotype in paraffin-embedded tissue sections include PD-1, CXCL13, CXCR5, ICOS, BCL6, and CD10. These neoplasms feature a characteristic and similar, but not identical, mutational landscape with mutations in epigenetic modifiers (TET2, DNMT3A, IDH2), RHOA, and T-cell receptor signaling genes. Here, we briefly review the biology of TFH cells and present a summary of the current pathologic, molecular, and genetic features of nodal lymphomas. We want to highlight the importance of performing a consistent panel of TFH immunostains and mutational studies in TCLs to identify TFH lymphomas.
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Affiliation(s)
- Mario L Marques-Piubelli
- Department of Translational Molecular Pathology, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Catalina Amador
- Division of Hematopathology, Department of Pathology and Laboratory Medicine, University of Miami, Miami, FL, United States
| | - Francisco Vega
- Department of Hematopathology, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
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6
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Khalil S, Donthi D, Gru AA. Cutaneous Reactive B-cell Lymphoid Proliferations. J Cutan Pathol 2022; 49:898-916. [PMID: 35656820 DOI: 10.1111/cup.14264] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Revised: 05/14/2022] [Accepted: 05/23/2022] [Indexed: 11/28/2022]
Abstract
Cutaneous lymphoid hyperplasia (CLH), also known as cutaneous pseudolymphoma, is a spectrum of benign conditions characterized by reactive B- and T-cell cutaneous lymphocytic infiltrates. B-cell lymphoid proliferations are a heterogenous group of non-neoplastic cutaneous diseases that must be histopathologically distinguished from cutaneous B-cell lymphomas. These proliferations can be observed as reactive phenomena to infections, medications, allergens, neoplasms, and more. Further, there are many inflammatory conditions that present with reactive B-cell infiltrates, including actinic prurigo, Zoon balanitis, Rosai-Dorfman, and cutaneous plasmacytosis. This review summarizes multiple cutaneous B-cell lymphoid proliferations within the major categories of reactive and disease-associated CLH. Further we discuss major discriminating features of atypical CLH and malignancy. Understanding the specific patterns of B-cell CLH is essential for the proper diagnosis and treatment of patients presenting with such lesions.
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Affiliation(s)
- Shadi Khalil
- Department of Dermatology, University of California San Diego
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Pesqué D, Marcantonio O, Vázquez I, Papaleo N, Sánchez-González B, Gallardo F, Colomo L, Pujol RM. Cutaneous Involvement of Angioimmunoblastic T-Cell Lymphoma Masquerading as B-Cell Reactive Lymphoid Hyperplasia. Am J Dermatopathol 2022; 44:e41-e45. [PMID: 34966050 DOI: 10.1097/dad.0000000000002110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
ABSTRACT A 59-year-old woman presented with a persistent eruption manifested as multiple agminated miliary facial papules. Histopathological examination showed prominent nodular dermal lymphoid infiltrates with hyperplastic follicles that were initially interpreted as B-cell reactive lymphoid hyperplasia. Several years later, an additional biopsy showed a dense perifollicular infiltrate with reactive primary and secondary follicles. Accompanying T cells corresponded to CD3/CD4/PD1/CXCL13-positive cells and scattered Epstein-Barr virus-positive B cells were identified by in situ hybridization. A monoclonal T-cell population was demonstrated by TCRγ and TCRβ Polymerase Chain Reaction amplification, as well as a minor abnormal circulating T-cell population by flow cytometry (0.62% of the white blood cells, CD4+CD3s-CD7-). A biopsy specimen from an enlarged right supraclavicular lymph node disclosed nodal involvement by angioimmunoblastic T-cell lymphoma. The observation of B-cell dermal nodular infiltrates with well-demarcated lymphoid aggregates forming primary lymphoid follicles may lead to overlook the T-cell component in some cases of angioimmunoblastic T-cell lymphoma. In such cases, a careful assessment of the apparently minor T-cell component is important to establish a correct diagnosis.
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Affiliation(s)
| | | | - Ivonne Vázquez
- Pathology, Hospital del Mar-Institut Mar d'Investigacions Mèdiques, Universitat Autònoma de Barcelona (UAB), Barcelona, Spain
- Department of Pathology, Universitat Pompeu Fabra, Barcelona, Spain; and
| | - Natalia Papaleo
- Pathology, Hospital del Mar-Institut Mar d'Investigacions Mèdiques, Universitat Autònoma de Barcelona (UAB), Barcelona, Spain
- Department of Pathology, Universitat Pompeu Fabra, Barcelona, Spain; and
| | - Blanca Sánchez-González
- Department of Hematology, Hospital del Mar-Institut Mar d'Investigacions Mèdiques, Universitat Autònoma de Barcelona (UAB), Barcelona, Spain
| | | | - Luis Colomo
- Pathology, Hospital del Mar-Institut Mar d'Investigacions Mèdiques, Universitat Autònoma de Barcelona (UAB), Barcelona, Spain
- Department of Pathology, Universitat Pompeu Fabra, Barcelona, Spain; and
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Gru AA, Bacchi CE, Pulitzer M, Bhagat G, Kempf W, Robson A, Plaza JA, Pincus L, Raghavan S, Xu M, Vencato da Silva T, Salavaggione AL, Subtil A, Battistella M. Secondary skin involvement in classic Hodgkin lymphoma: Results of an international collaborative cutaneous lymphoma working group study of 25 patients. J Cutan Pathol 2021; 48:1367-1378. [PMID: 34089205 DOI: 10.1111/cup.14077] [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: 02/10/2021] [Revised: 04/18/2021] [Accepted: 06/01/2021] [Indexed: 11/27/2022]
Abstract
BACKGROUND Cutaneous involvement by classic Hodgkin lymphoma (CHL) is an extraordinarily rare phenomenon in the current era. To date, no single large case series of cutaneous involvement by Hodgkin lymphoma has ever been reported in the literature. METHODS A comprehensive search for cases designated "skin" and "Hodgkin" was performed at different institutions between 1990 and 2020. Twenty-five cases were identified, and each case was independently reviewed by at least three board-certified dermatopathologists and/or hematopathologists. RESULTS All cases represented examples of systemic CHL with secondary skin dissemination. A single lesion, usually a tumor, nodule or infiltrative plaque was observed in 56% of cases and multiple lesions were present in 28% of cases. Most patients (86%-12/14) had a diagnosis of stage IV disease at first diagnosis. The interval between the clinical (first) diagnosis of HL and the development of skin lesions ranged between 6 and 108 months (average 33.75 months). Comprehensive histopathologic evaluation of these cases (at the initial diagnosis) revealed a diagnosis of classic HL not otherwise specified (NOS) in 60% of cases (15/25), nodular sclerosis type in 24% (6/25), mixed cellularity in 12% (3/25), and lymphocyte depleted in 4% (1/25). CONCLUSIONS We provide documentation of a large series of CHL with secondary skin involvement in association with CHL with additional clinical, morphologic, and immunophenotypic features.
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Affiliation(s)
- Alejandro A Gru
- Department of Pathology, University of Virginia, Charlottesville, Virginia, USA
| | | | - Melissa Pulitzer
- Department of Pathology, Memorial Sloan-Kettering Cancer Center, New York, New York, USA
| | - Govind Bhagat
- Department of Pathology, Columbia University, New York, New York, USA
| | - Werner Kempf
- Kempf und Pfaltz Histologische Diagnostik, Zurich, Switzerland.,Department of Dermatology, University Hospital Zurich, Zurich, Switzerland
| | - Alistair Robson
- Institute of Oncology, Lisbon, Portugal, Portugal and LDPath London, London, UK
| | - Jose A Plaza
- Department of Pathology, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Laura Pincus
- Department of Dermatology, University of California San Francisco, San Francisco, California, USA
| | - Shyam Raghavan
- Department of Pathology, University of Virginia, Charlottesville, Virginia, USA
| | - Mina Xu
- Department of Pathology, Yale University, New Haven, Connecticut, USA
| | | | | | - Antonio Subtil
- Department of Pathology, Royal Jubilee Hospital, Victoria, British Columbia, Canada
| | - Maxime Battistella
- Pathology Department, Université de Paris, Hôpital Saint-Louis, Paris, France
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Gibson SE, Swerdlow SH. How I Diagnose Primary Cutaneous Marginal Zone Lymphoma. Am J Clin Pathol 2020; 154:428-449. [PMID: 32808967 DOI: 10.1093/ajcp/aqaa116] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
OBJECTIVES Primary cutaneous marginal zone lymphoma (PCMZL) is 1 of the 3 major subtypes of primary cutaneous B-cell lymphoma. The diagnosis of PCMZL may be challenging, as the differential diagnosis includes benign cutaneous lymphoproliferations as well as other primary or secondary cutaneous B-cell or T-cell lymphomas. This review describes our approach to the diagnosis of PCMZL. METHODS Two cases are presented that illustrate how we diagnose each of the 2 subtypes of PCMZL. The clinicopathologic features of PCMZL and the ways in which these cases can be distinguished from both benign and other neoplastic entities are emphasized. RESULTS A definitive diagnosis of PCMZL requires the incorporation of histologic and immunophenotypic features, molecular genetic studies in some cases, and just as importantly, clinical findings. Emerging data suggest that the heavy chain class-switched cases may be more like a clonal chronic lymphoproliferative disorder. CONCLUSIONS The 2 subtypes of PCMZL create different diagnostic challenges and require the use of a multiparameter approach. Although very indolent, it is important to distinguish PCMZLs from reactive proliferations, because they frequently recur and may require antineoplastic therapies. It is also critical to distinguish PCMZLs from other B- or T-cell lymphomas so that patients are properly evaluated and not overtreated.
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Vroobel KM, O’Connor S, Cunningham D, Wren D, Sharma B, Wotherspoon A, Attygalle AD. Florid T follicular helper cell hyperplasia associated with extranodal marginal zone lymphoma: a diagnostic pitfall which may mimic T cell lymphoma. Histopathology 2019; 75:287-290. [DOI: 10.1111/his.13858] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Affiliation(s)
| | - Simon O’Connor
- Haematological Diagnostic Malignancy Service The Royal Marsden Hospital SuttonUK
| | - David Cunningham
- Gastrointestinal and Lymphoma Unit The Royal Marsden Hospital LondonUK
| | - Dorte Wren
- Department of Molecular Genetics The Royal Marsden Hospital LondonUK
| | | | | | - Ayoma D Attygalle
- Department of Cellular Pathology The Royal Marsden Hospital LondonUK
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11
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Magro CM, Ruan J, Grossman M, Hedayat AA. Monoclonal plasma cell infiltrates in the setting of cutaneous follicular helper T cell lymphoproliferative disorders. Ann Diagn Pathol 2019; 40:94-104. [PMID: 31077877 DOI: 10.1016/j.anndiagpath.2019.04.013] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2019] [Accepted: 04/25/2019] [Indexed: 11/17/2022]
Abstract
There is a growing recognition that some primary cutaneous T cell lymphomas of the skin exhibit a follicular helper T cell phenotype best exemplified by primary cutaneous CD4+ small/medium sized pleomorphic T cell lymphoma. The follicular helper T cells is an evolutionary function in a common TH1 cell under the influence of other cell types most notably monocyte derived dendritic cells but also plasma cells. In addition, the skin defines a characteristic organ site of involvement for angioimmunoblastic T-cell lymphoma (AITL); the first recognized form of follicular helper T cell lymphoma. One of the hallmarks of the follicular helper T cell lymphomas a significant degree of post germinal center B cell hyperplasia. We encountered 7 cases of primary cutaneous follicular helper T cell and four cases of AITL, in which the biopsies contained a light chain restricted plasma cell infiltrate in the skin. There were no features that suggested an atypical or more aggressive clinical course in association with the identification of this light chain restricted plasmacytic infiltrates except one case of AITL in whom a diffuse large cell B cell lymphoma subsequently developed. There was no association with Epstein-Barr virus (EBV) infection light chain restricted plasma cell infiltrate in any of the eleven cases. The basis of these infiltrates is likely a reciprocal functional one reflecting the role of follicular helper T cells in the induction of B cell hyperplasia and the role of plasma cells as a countercheck balance controlling the extent of follicular helper T cell hyperplasia. B cell clonality, plasma cell atypia and blastic B cell transformation can occur without implying a malignant transformation.
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Affiliation(s)
- Cynthia M Magro
- Weill Cornell Medicine- New York Presbyterian Hospital, Department of Dermatopathology, 1300 York Avenue, New York, NY 10065, United States of America.
| | - Jia Ruan
- Weill Cornell Medicine- New York Presbyterian Hospital, Hematology/Oncology, 1300 York Avenue, New York, NY 10065, United States of America
| | - Marc Grossman
- Department of Dermatology, Yale University School of Medicine, New Haven, CT, United States of America; Department of Dermatology, Donald and Barbara Zucker School of Medicine, At New Hyde Park, N.Y., United States of America
| | - Amin A Hedayat
- Weill Cornell Medicine- New York Presbyterian Hospital, Department of Dermatopathology, 1300 York Avenue, New York, NY 10065, United States of America; Memorial Sloan Kettering Cancer Center, Section of Dermatopathology, 1275 York Avenue, New York, NY 10065, United States of America
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12
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Oishi N, Sartori-Valinotti JC, Bennani NN, Wada DA, He R, Cappel MA, Feldman AL. Cutaneous lesions of angioimmunoblastic T-cell lymphoma: Clinical, pathological, and immunophenotypic features. J Cutan Pathol 2019; 46:637-644. [PMID: 30980412 DOI: 10.1111/cup.13475] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2018] [Revised: 03/22/2019] [Accepted: 04/09/2019] [Indexed: 12/24/2022]
Abstract
BACKGROUND Angioimmunoblastic T-cell lymphoma (AITL) is a systemic peripheral T-cell lymphoma with a follicular helper T-cell (TFH ) immunophenotype that frequently involves the skin. However, the histopathology of cutaneous involvement by AITL has not been fully established. METHODS We reviewed the clinicopathological features of 19 patients seen at our institution with AITL involving the skin. Pan-T-cell and TFH marker expression was evaluated by immunohistochemistry. Epstein-Barr virus (EBV) was detected using in situ hybridization (ISH) for Epstein-Barr virus-encoded small RNA (EBER). T-cell receptor (TCR) gene rearrangement was evaluated by PCR. RESULTS AITL affected both trunk and extremities in 15/19 cases (79%). Perivascular infiltration by small and/or medium-sized lymphocytes was seen in 18/19 (95%). Granulomatous inflammation was identified in 4/19 (21%). Aberrant loss of CD2, CD5, or CD7 was identified in 1/18 (6%), 2/18 (11%), or 7/19 (37%) cases, respectively. Seventeen of eighteen evaluable cases (95%) expressed 2 to 3 TFH markers: PD-1 in 19/19 (100%), BCL6 in 94% (17/18), and CD10 in 37% (7/19). EBV-positive cells were detected in 3/18 (17%) with varying density. Clonal TCR gene rearrangement was identified in 9/11 (82%). CONCLUSIONS Cutaneous involvement by AITL shows relatively non-specific histopathological features. However, an immunohistochemical panel including TFH markers and EBER ISH is useful in differential diagnosis.
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Affiliation(s)
- Naoki Oishi
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota.,Department of Pathology, University of Yamanashi, Yamanashi, Japan
| | | | - N Nora Bennani
- Division of Hematology, Mayo Clinic, Rochester, Minnesota
| | - David A Wada
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota.,Department of Dermatology, Mayo Clinic, Rochester, Minnesota
| | - Rong He
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota
| | - Mark A Cappel
- Department of Dermatology, Mayo Clinic, Jacksonville, Florida
| | - Andrew L Feldman
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota
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13
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An Immune Suppression-associated EBV-positive Anaplastic Large Cell Lymphoma With a BRAF V600E Mutation. Am J Surg Pathol 2019; 43:140-146. [DOI: 10.1097/pas.0000000000001174] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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14
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Szablewski V, Dereure O, René C, Tempier A, Durand L, Alame M, Cacheux V, Costes-Martineau V. Cutaneous localization of angioimmunoblastic T-cell lymphoma may masquerade as B-cell lymphoma or classical Hodgkin lymphoma: A histologic diagnostic pitfall. J Cutan Pathol 2018; 46:102-110. [PMID: 30370547 DOI: 10.1111/cup.13382] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2018] [Revised: 09/12/2018] [Accepted: 10/22/2018] [Indexed: 01/21/2023]
Abstract
BACKGROUND We report the cases of three patients presenting skin lesions whose biopsies showed nodular polymorphic infiltrates consisting of lymphocytes, plasma cells, histiocytes, eosinophils, B blasts, and Hodgkin Reed-Sternberg (HRS)-like cells. Two of them were initially diagnosed as classical Hodgkin lymphoma (cHL), on the other hand, the last one as a B-cell lymphoma. All patients have been treated for angioimmunoblastic T-cell lymphoma (AITL). METHODS We performed a second review of the skin biopsies with further immunophenotypic molecular analyses. Scrupulous observation revealed, in the background of the three cases, atypical small to medium-sized lymphocytes carrying a CD3+, CD4+ T-cell phenotype and expressing PD1 and CXCL13 follicular helper T-cell markers. The two lesions initially diagnosed as cHL showed scattered HRS-like cells with CD30+, CD15+, PAX5+, CD20-, Epstein Barr Virus (EBV) + classical phenotype. The case initially diagnosed as B-cell lymphoma showed a diffuse B-cell proliferation associated with small B-cell and medium to large-sized B blasts that were positive for EBV. CONCLUSION Those cases highlighted that atypical T-cells may be obscured by B-cell proliferation mimicking cHL or B-cell lymphoma in cutaneous localization of AITL and confirmed the requirement of collecting clinical information before performing a diagnosis.
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Affiliation(s)
- Vanessa Szablewski
- Département de Biopathologie, CHU Montpellier, Hôpital Gui De Chauliac, Montpellier, France.,Université Montpellier 1, Faculté de Médecine, Montpellier, France
| | - Olivier Dereure
- Université Montpellier 1, Faculté de Médecine, Montpellier, France.,Département de Dermatologie, CHU Montpellier, Hôpital Saint-Eloi, Montpellier
| | - Céline René
- Université Montpellier 1, Faculté de Médecine, Montpellier, France.,Département d'Immunologie, CHU Montpellier, Hôpital Saint Eloi, Montpellier, France
| | - Ariane Tempier
- Département de Biopathologie, CHU Montpellier, Hôpital Gui De Chauliac, Montpellier, France.,Université Montpellier 1, Faculté de Médecine, Montpellier, France
| | - Luc Durand
- Département de Biopathologie, CHU Montpellier, Hôpital Gui De Chauliac, Montpellier, France.,MEDIPATH, Grabels, France
| | - Melissa Alame
- Université Montpellier 1, Faculté de Médecine, Montpellier, France.,Département d'Hématologie Biologique, CHU Montpellier, Hôpital Saint Eloi, Montpellier, France
| | - Valère Cacheux
- Université Montpellier 1, Faculté de Médecine, Montpellier, France.,Département d'Hématologie Biologique, CHU Montpellier, Hôpital Saint Eloi, Montpellier, France
| | - Valérie Costes-Martineau
- Département de Biopathologie, CHU Montpellier, Hôpital Gui De Chauliac, Montpellier, France.,Université Montpellier 1, Faculté de Médecine, Montpellier, France
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15
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Zhu W, He QY, Lu C, Fu CY, Zhou JH, Liu S, Tao YG, Xiao DS. Detection of immunoglobulin and T-cell receptor gene rearrangements in angioimmunoblastic T-cell lymphoma. INTERNATIONAL JOURNAL OF CLINICAL AND EXPERIMENTAL PATHOLOGY 2018; 11:2642-2653. [PMID: 31938379 PMCID: PMC6958285] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 01/08/2018] [Accepted: 02/12/2018] [Indexed: 06/10/2023]
Abstract
Objective: To assess the value of immunoglobulin and T-cell receptor gene rearrangements in the diagnosis and differential diagnosis of angioimmunoblastic T-cell lymphoma. Methods: We selected 55 cases of angioimmunoblastic T-cell lymphoma confirmed by histopathology and 15 cases of reactive lymph node hyperplasia. Using the IdentiClone gene rearrangement detection kit, BIOMED-2 primer system, and GeneScanning analysis, we tested for immunoglobulin and T-cell receptor gene rearrangements. Results: Among all 55 angioimmunoblastic T-cell lymphoma cases, 1 (2%) displayed the first type of angioimmunoblastic T-cell lymphoma, which has an intact lymphoid follicle structure. Five cases (9%) displayed the second type, which has an intact segmental lymphatic follicular structure. Forty-nine cases (89%) displayed the third type, which is characterized by a complete obliteration of the lymphatic follicular structure. Fifty-two cases (95%) had tumor cells that were positive for CD3, 50 cases (91%) were positive for CD4, 33 cases (60%) were positive for Bcl-6, 20 cases (36%) were positive for CD10, 44 cases (80%) were positive for CXCL13 to different degrees, and 53 cases (96%) showed a strong positive expression of CD21. Ki67 expression intensity was 30-80% in tumor T cells. Clonal gene rearrangements were identified in 48 of the 55 angioimmunoblastic T-cell lymphoma cases (87%), of which 30 (55%) displayed IG gene rearrangements, including IGHA (7 cases; 13%), IGHB (6 cases; 11%), IGHC (2 cases; 4%), IGKA (22 cases; 40%), IGKB (6 cases; 11%), and IGL (20 cases; 36%). TCR gene rearrangements were observed in 32 cases (58%), including TCRBA (6 cases; 11%), TCRBB (5 cases; 9%), TCRBC (10 cases; 18%), TCRD (7 cases; 13%), TCRGA (22 cases; 40%), and TCRGB (16 cases; 29%). IG and TCR gene rearrangements were concurrently observed in 14 cases (25%). Immunoglobulin or TCR clonal gene rearrangements were not detected in the 15 cases of reactive hyperplasia. Conclusions: Angioimmunoblastic T-cell lymphomas may be positive for immunoglobulin or T-cell receptor clone gene rearrangements or may express double rearrangements. The assessment of clonal gene rearrangements is valuable for the diagnosis and differential diagnosis of angioimmunoblastic T-cell lymphoma.
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Affiliation(s)
- Wei Zhu
- Department of Pathology, Xiangya Hospital, Central South UniversityChangsha, Hunan, China
- Cancer Research Institute, School of Basic Medicine, Central South UniversityChangsha, Hunan, China
| | - Qiu-Yan He
- Department of Pathology, Xiangya Hospital, Central South UniversityChangsha, Hunan, China
- Cancer Research Institute, School of Basic Medicine, Central South UniversityChangsha, Hunan, China
| | - Can Lu
- Department of Pathology, Xiangya Hospital, Central South UniversityChangsha, Hunan, China
- Cancer Research Institute, School of Basic Medicine, Central South UniversityChangsha, Hunan, China
| | - Chun-Yan Fu
- Department of Pathology, Xiangya Hospital, Central South UniversityChangsha, Hunan, China
- Cancer Research Institute, School of Basic Medicine, Central South UniversityChangsha, Hunan, China
| | - Jian-Hua Zhou
- Department of Pathology, Xiangya Hospital, Central South UniversityChangsha, Hunan, China
- Cancer Research Institute, School of Basic Medicine, Central South UniversityChangsha, Hunan, China
| | - Shuang Liu
- Department of Pathology, School of Basic Medicine, Central South UniversityChangsha, Hunan, China
| | - Yong-Guang Tao
- Center for Medicine Research, Xiangya Hospital, Central South UniversityChangsha, Hunan, China
- Department of Pathology, School of Basic Medicine, Central South UniversityChangsha, Hunan, China
- Key Laboratory of Carcinogenesis and Cancer Invasion (Central South University), Ministry of EducationHunan, China
- Key Laboratory of Carcinogenesis (Central South University), Ministry of HealthHunan, China
| | - De-Sheng Xiao
- Department of Pathology, Xiangya Hospital, Central South UniversityChangsha, Hunan, China
- Cancer Research Institute, School of Basic Medicine, Central South UniversityChangsha, Hunan, China
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16
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Abstract
Primary cutaneous marginal zone lymphoma (CMZL) is one of the major primary B-cell lymphomas of skin. Two types are recognized: a more common class-chain switched CMZL, and a much less common IgM+ CMZL. The extremely indolent course, together with other features distinct from most other MALT lymphomas, has led some to question whether at least the class-switched cases should be considered an overt lymphoma.
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Affiliation(s)
- Steven H Swerdlow
- Division of Hematopathology, Department of Pathology, University of Pittsburgh School of Medicine, UPMC-Presbyterian, G-335, 200 Lothrop Street, Pittsburgh, PA 15213.
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17
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Suárez AE, Artiga M, Santonja C, Montes-Moreno S, De Pablo P, Requena L, Piris MA, Rodríguez-Pinilla SM. Angioimmunoblastic T-cell lymphoma with a clonal plasma cell proliferation that underwent immunoglobulin isotype switch in the skin, coinciding with cutaneous disease progression. J Cutan Pathol 2016; 43:1203-1210. [DOI: 10.1111/cup.12814] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2016] [Revised: 08/19/2016] [Accepted: 08/30/2016] [Indexed: 12/20/2022]
Affiliation(s)
- Ana E. Suárez
- Pathology Department; Hospital Universitario Fundación Jiménez Díaz; Madrid Spain
| | - M.J. Artiga
- Tumor Bank; Centro Nacional de Investigaciones Oncológicas; Madrid Spain
| | - Carlos. Santonja
- Pathology Department; Hospital Universitario Fundación Jiménez Díaz; Madrid Spain
| | | | - P. De Pablo
- Dermatology Department; Hospital del Tajo; Madrid Spain
| | - Luis Requena
- Dermatology Department; Hospital Universitario Fundación Jiménez Díaz; Madrid Spain
| | - Miguel A. Piris
- Pathology Department; Hospital Universitario Marqués de Valdecilla; Santander Spain
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18
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Santonja C, Soto C, Manso R, Requena L, Piris MA, Rodríguez-Pinilla SM. Primary cutaneous follicular helper T-cell lymphoma. J Cutan Pathol 2015; 43:164-70. [DOI: 10.1111/cup.12614] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2015] [Revised: 08/13/2015] [Accepted: 08/16/2015] [Indexed: 11/27/2022]
Affiliation(s)
| | - Carlos Soto
- Hematology Department; Fundación Jiménez Díaz; Madrid Spain
| | - Rebeca Manso
- Pathology Department; Fundación Jiménez Díaz; Madrid Spain
| | - Luis Requena
- Dermatology Department; Fundación Jiménez Díaz; Madrid Spain
| | - Miguel Angel Piris
- Pathology Department; Hospital Universitario Marqués de Valdecilla; Santander Spain
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