1
|
Song B, Ning X, Guo L, Liu W, Jin H. Comparative Proteomics Analysis Reveals Distinct Molecular Phenotype and Biomarkers in Patients with Erythrodermic Atopic Dermatitis and Erythrodermic Psoriasis. Inflammation 2024:10.1007/s10753-024-02078-3. [PMID: 38877357 DOI: 10.1007/s10753-024-02078-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2024] [Revised: 06/03/2024] [Accepted: 06/03/2024] [Indexed: 06/16/2024]
Abstract
Erythrodermic atopic dermatitis (EAD) and erythrodermic psoriasis (EP) are rare yet debilitating inflammatory skin disorders that propose challenges in diagnosis and discovering effective therapeutic targets. Despite their clinical and histological similarities, the underlying molecular mechanisms and systemic biomarkers of these diseases are substantially unclear. In this study, we sought to investigate the differential serum proteome of EP and EAD patients and identify biomarkers for these two subtypes of erythroderma. We recruited 14 EAD patients, 14 EP patients and 14 healthy controls. Serum samples were collected and analyzed using the Olink high-throughput platform to assess the levels of 269 inflammation-/immune response-/cardiovascular-related biomarkers. Both EAD and EP patients exhibited enhanced immune activation and dysregulated cardiovascular profiles compared to healthy controls. EAD demonstrated a more pronounced inflammation tone, characterized by Th1/Th2/Th22/IL-1-dominant patterns, as well as increased TNF superfamily, Th17, and apoptosis markers. Conversely, EP displayed inflammation with Th1/Th17/TNF-skewing and mild Th2 upregulation, along with notable increases in epidermal-development markers. Disease severity in EAD was strongly correlated with apoptosis/Th2 markers, while correlated with Th17 markers in EP. Furthermore, a panel of eight markers (IL-17A/IL-17C/PI3/CCL20/SH2D1A/SIRT2/DFFA/IL-13) was identified that effectively discriminated between EP and EAD, with an Area Under the Curve greater than 0.8. Our study comprehensively characterizes the circulating molecular profiles in EAD and EP patients, providing insights into the similarities and complexities of their inflammation phenotypes. The identified serum biomarkers have the potential to differentiate between EP and EAD, which could aid in the diagnosis and guiding tailored therapeutics.
Collapse
Affiliation(s)
- Biao Song
- Department of Dermatology, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China
- State Key Laboratory for Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Beijing, 100730, China
- National Clinical Research Center for Dermatologic and Immunologic Diseases, Beijing, China
| | - Xin Ning
- Department of Dermatology, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China
- State Key Laboratory for Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Beijing, 100730, China
- National Clinical Research Center for Dermatologic and Immunologic Diseases, Beijing, China
| | - Lan Guo
- Department of Dermatology, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China
- State Key Laboratory for Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Beijing, 100730, China
- National Clinical Research Center for Dermatologic and Immunologic Diseases, Beijing, China
| | - Weida Liu
- State Key Laboratory for Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Beijing, 100730, China
- Medical Research Center, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, 100730, China
| | - Hongzhong Jin
- Department of Dermatology, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China.
- State Key Laboratory for Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Beijing, 100730, China.
- National Clinical Research Center for Dermatologic and Immunologic Diseases, Beijing, China.
| |
Collapse
|
2
|
Fernandez-Flores A, Cassarino D. CD30 in Cutaneous Pathology. Am J Dermatopathol 2023; 45:593-607. [PMID: 37625801 DOI: 10.1097/dad.0000000000002422] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/27/2023]
Abstract
ABSTRACT The discovery of CD30 as a diagnostic marker was essential in the identification of not only some lymphomas but also many other solid tumors and benign reactive conditions. Many CD30+ cutaneous disorders and tumors have been categorized since the identification of the marker. With the design of targeted therapies against CD30+ tumoral cells, the interest in CD30 determination was not only diagnostic but also mainly therapeutic. In this article, we explore the historical aspects of the discovery of CD30 and examine the main CD30-related cutaneous pathology, susceptible of anti-CD30 modern treatments.
Collapse
Affiliation(s)
- Angel Fernandez-Flores
- Dermatopathologist, Department of Histopathology, University Hospital El Bierzo, Ponferrada, Spain
- Department of Cellular Pathology, Hospital de la Reina, Ponferrada, Spain
- Research Department, Institute for Biomedical Research of a Coruña (INIBIC), University of a Coruña (UDC), A Coruña, Spain; and
| | - David Cassarino
- Pathologist, Los Angeles Medical Center (LAMC), Southern California Kaiser Permanente, Departments of Pathology and Dermatology, Los Angeles, CA
| |
Collapse
|
3
|
Luherne C, Menguy S, Ferte T, Beylot-Barry M, Seneschal J, Milpied B, Vial JP, Gros A, Amintas S, Vergier B, Pham-Ledard A. A High Programmed Cell Death Protein 1 Hormone Receptor Score on Skin Biopsy is Associated with Sézary Syndrome Diagnosis: A Study of 91 Patients with Erythroderma. Acta Derm Venereol 2022; 102:adv00773. [PMID: 35758515 PMCID: PMC9558750 DOI: 10.2340/actadv.v102.1062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Erythroderma is challenging to diagnose. The aim of this single-centre retrospective study was to identify factors that can be used to improve the diagnosis of erythroderma. Among 91 patients with erythroderma, 21 were diagnosed with eczema, 17 with psoriasis, 20 with drug-induced erythroderma, 13 with erythrodermic mycosis fungoides and 20 with Sézary syndrome. Nail alterations, ear involvement, and severe scaling were significantly associated with psoriasis (p = 0.044). Fever and hypereosinophilia were associated with drug-induced erythroderma. Expression of programmed cell death protein 1 was observed in all skin biopsies. However, with Sézary syndrome, programmed cell death protein 1 expression was significantly higher than with other aetiologies. A programmed cell death protein 1 hormone receptor score (H-score) >50 was associated with Sézary syndrome (p < 0.001, sensitivity 75%, specificity 92%) as well as CXCL13 expression (p < 0.044). CD7 loss was more frequent with erythrodermic mycosis fungoides and Sézary syndrome (p = 0.022). This study reports the importance of programmed cell death protein 1 expression for the differential diagnosis of Sézary syndrome and other aetiologies, including erythrodermic mycosis fungoides.
Collapse
|
4
|
Arnovitz S, Mathur P, Tracy M, Mohsin A, Mondal S, Quandt J, Hernandez KM, Khazaie K, Dose M, Emmanuel AO, Gounari F. Tcf-1 promotes genomic instability and T cell transformation in response to aberrant β-catenin activation. Proc Natl Acad Sci U S A 2022; 119:e2201493119. [PMID: 35921443 PMCID: PMC9371646 DOI: 10.1073/pnas.2201493119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2022] [Accepted: 07/06/2022] [Indexed: 11/18/2022] Open
Abstract
Understanding the mechanisms promoting chromosomal translocations of the rearranging receptor loci in leukemia and lymphoma remains incomplete. Here we show that leukemias induced by aberrant activation of β-catenin in thymocytes, which bear recurrent Tcra/Myc-Pvt1 translocations, depend on Tcf-1. The DNA double strand breaks (DSBs) in the Tcra site of the translocation are Rag-generated, whereas the Myc-Pvt1 DSBs are not. Aberrantly activated β-catenin redirects Tcf-1 binding to novel DNA sites to alter chromatin accessibility and down-regulate genome-stability pathways. Impaired homologous recombination (HR) DNA repair and replication checkpoints lead to retention of DSBs that promote translocations and transformation of double-positive (DP) thymocytes. The resulting lymphomas, which resemble human T cell acute lymphoblastic leukemia (T-ALL), are sensitive to PARP inhibitors (PARPis). Our findings indicate that aberrant β-catenin signaling contributes to translocations in thymocytes by guiding Tcf-1 to promote the generation and retention of replication-induced DSBs allowing their coexistence with Rag-generated DSBs. Thus, PARPis could offer therapeutic options in hematologic malignancies with active Wnt/β-catenin signaling.
Collapse
Affiliation(s)
- Stephen Arnovitz
- Department of Medicine, University of Chicago, Chicago, IL 60637
| | - Priya Mathur
- Department of Medicine, University of Chicago, Chicago, IL 60637
| | - Melissa Tracy
- Department of Medicine, University of Chicago, Chicago, IL 60637
| | - Azam Mohsin
- Department of Medicine, University of Chicago, Chicago, IL 60637
| | - Soumi Mondal
- Department of Medicine, University of Chicago, Chicago, IL 60637
| | - Jasmin Quandt
- Department of Medicine, University of Chicago, Chicago, IL 60637
| | | | | | - Marei Dose
- Department of Medicine, University of Chicago, Chicago, IL 60637
| | | | - Fotini Gounari
- Department of Medicine, University of Chicago, Chicago, IL 60637
- Department of Immunology, Mayo Clinic, Scottsdale, AZ 85259
| |
Collapse
|
5
|
TCF-1: a maverick in T cell development and function. Nat Immunol 2022; 23:671-678. [PMID: 35487986 PMCID: PMC9202512 DOI: 10.1038/s41590-022-01194-2] [Citation(s) in RCA: 25] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Accepted: 03/22/2022] [Indexed: 02/01/2023]
Abstract
The T cell-specific DNA-binding protein TCF-1 is a central regulator of T cell development and function along multiple stages and lineages. Because it interacts with β-catenin, TCF-1 has been classically viewed as a downstream effector of canonical Wnt signaling, although there is strong evidence for β-catenin-independent TCF-1 functions. TCF-1 co-binds accessible regulatory regions containing or lacking its conserved motif and cooperates with other nuclear factors to establish context-dependent epigenetic and transcription programs that are essential for T cell development and for regulating immune responses to infection, autoimmunity and cancer. Although it has mostly been associated with positive regulation of chromatin accessibility and gene expression, TCF-1 has the potential to reduce chromatin accessibility and thereby suppress gene expression. In addition, the binding of TCF-1 bends the DNA and affects the chromatin conformation genome wide. This Review discusses the current understanding of the multiple roles of TCF-1 in T cell development and function and their mechanistic underpinnings.
Collapse
|
6
|
Abstract
Primary cutaneous T cell lymphomas (CTCLs) are a heterogeneous group of lymphomas that present in the skin with no evidence of extracutaneous disease at the time of diagnosis. CTCL subtypes demonstrate a variety of clinical, histological, and molecular features, and can follow an indolent or a very aggressive course. The underlying pathogenetic mechanisms are not yet entirely understood. The pathophysiology of CTCL is complex and a single initiating factor has not yet been identified. Diagnosis is based on clinicopathological correlation and requires an interdisciplinary team. Treatment decision is made based on short-term and long-term goals. Therapy options comprise skin-directed therapies, such as topical steroids or phototherapy, and systemic therapies, such as monoclonal antibodies or chemotherapy. So far, the only curative treatment approach is allogeneic haematopoietic stem cell transplantation. Novel therapies, such as chimeric antigen receptor T cells, monoclonal antibodies or small molecules, are being investigated in clinical trials. Patients with CTCL have reduced quality of life and a lack of effective treatment options. Further research is needed to better identify the underlying mechanisms of CTCL development and course as well as to better tailor treatment strategies to individual patients.
Collapse
|
7
|
Askin O, Altunkalem RN, Uzuncakmak TK, Toplu FŞ, Engin B. Erythroderma: A clinicopathological study of 47 cases from 2018 to 2020. Dermatol Ther 2020; 33:e14342. [PMID: 32979015 DOI: 10.1111/dth.14342] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2020] [Revised: 09/21/2020] [Accepted: 09/23/2020] [Indexed: 12/27/2022]
Abstract
Erythroderma, or exfoliative dermatitis, is an inflammatory disorder characterized by erythema and scaling, affecting most of the skin surface. It may be a result of many different causes such as previous dermatoses (psoriasis, eczema, atopic dermatitis [AD], pityriasis rubra pilaris, and pemphigus foliaceous), drug reactions, malignancies (mycosis fungoides [MF], Sézary syndrome, adult T cell leukemia/lymphoma), infections, and idiopathic disorders. Regardless of the etiology, the clinical appearance of erythroderma is similar in all patients. The most prominent physical examination findings in almost all patients are diffuse erythema and scaling. In a 2-year period, 47 patients who were hospitalized and treated in our department were included in the study. We classified patients into seven subgroups: psoriasis, AD, drug-induced erythroderma, MF, pityriasis rubra pilaris, bullous pemphigoid, and polymorphous light eruption. All patients had a biopsy during the acute stage and diagnoses were histopathologically confirmed. Some patients had multiple biopsies for histopathological confirmation. In our study, the majority of the patients were men over the age of 54. The most common etiological cause of erythroderma is psoriasis. We aim to analyze clinical, laboratory, and histopathological findings of erythrodermic inpatients prospectively in Istanbul University-Cerrahpasa Cerrahpasa Medical Faculty between January 2018 and 2020.
Collapse
Affiliation(s)
- Ozge Askin
- Department of Dermatology and Venereology, Cerrahpaşa Medical Faculty, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Rozerin Neval Altunkalem
- Department of Dermatology and Venereology, Cerrahpaşa Medical Faculty, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Tugba Kevser Uzuncakmak
- Department of Dermatology and Venereology, Cerrahpaşa Medical Faculty, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Ferdane Şeyma Toplu
- Department of Public Health, Cerrahpaşa Medical Faculty, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Burhan Engin
- Department of Dermatology and Venereology, Cerrahpaşa Medical Faculty, Istanbul University-Cerrahpasa, Istanbul, Turkey
| |
Collapse
|
8
|
Vonderheid EC, Kantor GR, Telang GH, Bujanouskas P, Kadin ME. A histo-immunopathologic and prognostic study of erythrodermic cutaneous T-cell lymphoma. J Cutan Pathol 2019; 46:913-924. [PMID: 31403211 DOI: 10.1111/cup.13564] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2019] [Revised: 07/23/2019] [Accepted: 08/05/2019] [Indexed: 02/03/2023]
Abstract
BACKGROUND Sézary syndrome (SS) and erythrodermic mycosis fungoides (E-MF) represent two expressions of erythrodermic cutaneous T-cell lymphoma (E-CTCL). METHODS Histopathologic features were compared on skin specimens from 41 patients with SS and 70 patients with E-MF. Immunopathologic findings were compared on 42 SS and 79 E-MF specimens. RESULTS Specimens of SS usually showed band-like dermal infiltrates with intermediate-sized lymphoid cells and few plasma cells; on the other hand E-MF more often had a perivascular infiltrative pattern, predominance of small/mixed lymphoid cells and eosinophils. SS also had lower numbers of CD8+ cells and higher numbers of CD62L+ cells compared to E-MF. For E-MF patients, the presence of large Pautrier collections, infiltrates with intermediate-sized cells, increased number of mitotic figures and ≥50% CD62L+ cells in the dermal infiltrate correlated with a relatively poor disease-specific survival. However, only the presence of mitotic figures retained prognostic significance with clinical stage as a covariate. CONCLUSIONS Clinical stage provides the most important prognostic information for patients with E-CTCL. However, mitotic activity for E-MF and CD8+ cells <20% for SS have additional value. We hypothesize that observed differences in plasma cell and eosinophil numbers may reflect the influence of CD62L+ central memory T-cells in the microenvironment.
Collapse
Affiliation(s)
- Eric C Vonderheid
- Sydney Kimmel Comprehensive Cancer Center, Johns Hopkins Medical Institutes, Baltimore, Maryland
| | - Gary R Kantor
- Dermatopathologist, Dermpath Diagnostics, Institute for Dermatopathology, Newtown Square, Pennsylvania
| | - Gladys H Telang
- Department of Dermatology, The Warren Alpert Medical School of Brown University, Providence, Rhode Island
| | | | - Marshall E Kadin
- Department of Dermatology, Boston University and Roger Williams Medical Center, Providence, Rhode Island
| |
Collapse
|
9
|
Abstract
Erythroderma, often described as generalized exfoliative dermatitis, is a condition in which erythema involves greater than 90% of the body surface, often as a result of an underlying inflammatory skin condition, which can result in a variety of systemic manifestations and potentially lead to life-threatening complications.
Collapse
Affiliation(s)
- Emily Rose
- Keck School of Medicine, University of Southern California, Los Angeles, CA USA
| |
Collapse
|
10
|
Chau T, Parsi KK, Ogawa T, Kiuru M, Konia T, Li CS, Fung MA. Psoriasis or not? Review of 51 clinically confirmed cases reveals an expanded histopathologic spectrum of psoriasis. J Cutan Pathol 2017; 44:1018-1026. [PMID: 28833447 DOI: 10.1111/cup.13033] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2017] [Revised: 08/04/2017] [Accepted: 08/16/2017] [Indexed: 11/26/2022]
Abstract
BACKGROUND Psoriasis is usually diagnosed clinically, so only non-classic or refractory cases tend to be biopsied. Diagnostic uncertainty persists when dermatopathologists encounter features regarded as non-classic for psoriasis. OBJECTIVE Define and document classic and non-classic histologic features in skin biopsies from patients with clinically confirmed psoriasis. METHODS Minimal clinical diagnostic criteria were informally validated and applied to a consecutive series of biopsies histologically consistent with psoriasis. Clinical confirmation required 2 of the following criteria: (1) classic morphology, (2) classic distribution, (3) nail pitting, and (4) family history, with #1 and/or #2 as 1 criterion in every case RESULTS: Fifty-one biopsies from 46 patients were examined. Classic features of psoriasis included hypogranulosis (96%), club-shaped rete ridges (96%), dermal papilla capillary ectasia (90%), Munro microabscess (78%), suprapapillary plate thinning (63%), spongiform pustules (53%), and regular acanthosis (14%). Non-classic features included irregular acanthosis (84%), junctional vacuolar alteration (76%), spongiosis (76%), dermal neutrophils (69%), necrotic keratinocytes (67%), hypergranulosis (65%), neutrophilic spongiosis (61%), dermal eosinophils (49%), compact orthokeratosis (37%), papillary dermal fibrosis (35%), lichenoid infiltrate (25%), plasma cells (16%), and eosinophilic spongiosis (8%). CONCLUSIONS Psoriasis exhibits a broader histopathologic spectrum. The presence of some non-classic features does not necessarily exclude the possibility of psoriasis.
Collapse
Affiliation(s)
- Thinh Chau
- Department of Dermatology, University of California, Davis School of Medicine, Sacramento, California
| | - Kory K Parsi
- Department of Dermatology, University of California, Davis School of Medicine, Sacramento, California
| | - Toru Ogawa
- Department of Dermatology, University of California, Davis School of Medicine, Sacramento, California
| | - Maija Kiuru
- Department of Dermatology, University of California, Davis School of Medicine, Sacramento, California.,Department of Pathology and Laboratory Medicine, University of California, Davis School of Medicine, Sacramento, California
| | - Thomas Konia
- Department of Dermatology, University of California, Davis School of Medicine, Sacramento, California.,Department of Pathology and Laboratory Medicine, University of California, Davis School of Medicine, Sacramento, California
| | - Chin-Shang Li
- Division of Biostatistics, Department of Public Health Sciences, University of California, Davis School of Medicine, Sacramento, California
| | - Maxwell A Fung
- Department of Dermatology, University of California, Davis School of Medicine, Sacramento, California.,Department of Pathology and Laboratory Medicine, University of California, Davis School of Medicine, Sacramento, California
| |
Collapse
|
11
|
|
12
|
Klemke CD, Booken N, Weiss C, Nicolay JP, Goerdt S, Felcht M, Géraud C, Kempf W, Assaf C, Ortonne N, Battistella M, Bagot M, Knobler R, Quaglino P, Arheiliger B, Santucci M, Jansen P, Vermeer MH, Willemze R. Histopathological and immunophenotypical criteria for the diagnosis of Sézary syndrome in differentiation from other erythrodermic skin diseases: a European Organisation for Research and Treatment of Cancer (EORTC) Cutaneous Lymphoma Task Force Study of 97 cases. Br J Dermatol 2015; 173:93-105. [PMID: 25864856 DOI: 10.1111/bjd.13832] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/12/2015] [Indexed: 11/30/2022]
Abstract
BACKGROUND Patients with erythrodermic disease are a diagnostic challenge regarding the clinical and histological differential diagnosis. OBJECTIVES To evaluate histopathological and immunohistochemical diagnostic markers for Sézary syndrome. METHODS Ninety-seven erythrodermic cases [Sézary syndrome (SS), n = 57; erythrodermic inflammatory dermatoses (EIDs), n = 40] were collected by the EORTC Cutaneous Lymphoma Task Force histopathology group. Evaluation criteria were (i) epidermal and dermal changes; (ii) morphology of the infiltrate; (iii) immunohistochemical analysis of marker loss (CD2, CD3, CD4, CD5 and CD7); (iv) bystander infiltrate by staining for CD8, FOXP3 and CD25; and (v) expression of Ki-67, CD30, PD-1 and MUM-1. RESULTS The workshop panel made a correct diagnosis of SS in 51% of cases (cutaneous T-cell lymphoma 81%) and of EID in 80% without clinical or laboratory data. Histology revealed a significantly increased degree of epidermotropism (P < 0.001) and more intraepidermal atypical lymphocytes (P = 0.0014) in SS biopsies compared with EID. Pautrier microabscesses were seen only in SS (23%) and not in EID (P = 0.0012). SS showed significantly more dermal cerebriform and blastic lymphocytes than EID. Immunohistochemistry revealed a significant loss of CD7 expression (< 50%) in 33 of 51 (65%) cases of SS compared with two of 35 (6%) EID (P < 0.001). The lymphocytic infiltrate in SS skin samples was found significantly to express PD-1 (P = 0.0053), MUM-1 (P = 0.0017) and Ki-67 (P < 0.001), and showed less infiltration of CD8(+) lymphocytes (P < 0.001). A multivariate analysis identified CD7 loss, increased numbers of small cerebriform lymphocytes, low numbers of CD8(+) lymphocytes and increased proliferation (Ki-67(+) lymphocytes) as the strongest indicators for the diagnosis of SS. CONCLUSIONS A number of different histological and immunophenotypical criteria are required to differentiate between SS and EIDs.
Collapse
Affiliation(s)
- C D Klemke
- Department of Dermatology, Venereology and Allergology, University Medical Center Mannheim, Ruprecht-Karls-University of Heidelberg, Mannheim, Germany
| | - N Booken
- Department of Dermatology, Venereology and Allergology, University Medical Center Mannheim, Ruprecht-Karls-University of Heidelberg, Mannheim, Germany
| | - C Weiss
- Division of Statistics, University Medical Center Mannheim, Ruprecht-Karls-University of Heidelberg, Mannheim, Germany
| | - J P Nicolay
- Department of Dermatology, Venereology and Allergology, University Medical Center Mannheim, Ruprecht-Karls-University of Heidelberg, Mannheim, Germany
| | - S Goerdt
- Department of Dermatology, Venereology and Allergology, University Medical Center Mannheim, Ruprecht-Karls-University of Heidelberg, Mannheim, Germany
| | - M Felcht
- Department of Dermatology, Venereology and Allergology, University Medical Center Mannheim, Ruprecht-Karls-University of Heidelberg, Mannheim, Germany
| | - C Géraud
- Department of Dermatology, Venereology and Allergology, University Medical Center Mannheim, Ruprecht-Karls-University of Heidelberg, Mannheim, Germany
| | - W Kempf
- Department of Dermatology and Venereology, University of Zurich, Zurich, Switzerland
| | - C Assaf
- Department of Dermatology, Helios Clinic Krefeld, Krefeld, Germany
| | - N Ortonne
- Department of Pathology, Hôpital Henri-Mondor, Créteil, France
| | - M Battistella
- Department of Pathology, AP-HP, Hôpital Saint Louis, Université Paris Diderot, Sorbonne Paris Cité, UMR-S 1165, F-75010, Paris, France
| | - M Bagot
- Department of Dermatology, Hôpital Saint-Louis, Université Paris Diderot, Sorbonne Paris Cité, Inserm U976, 1 Avenue Claude Vellefaux, 75010, Paris, France
| | - R Knobler
- Department of Dermatology, University of Vienna, Vienna, Austria
| | - P Quaglino
- Dermatologic Clinic, Department of Medical Science, University of Torino, Torino, Italy
| | - B Arheiliger
- Department of Dermatology, Johannes Wesling Klinikum, Minden, Germany
| | - M Santucci
- Division of Pathological Anatomy, University of Florence, Florence, Italy
| | - P Jansen
- Department of Dermatology, Leiden University Medical Center, Leiden, the Netherlands
| | - M H Vermeer
- Department of Dermatology, Leiden University Medical Center, Leiden, the Netherlands
| | - R Willemze
- Department of Dermatology, Leiden University Medical Center, Leiden, the Netherlands
| |
Collapse
|
13
|
Boonk SE, Çetinözman F, Vermeer MH, Jansen PM, Willemze R. Differential expression of TOX by skin-infiltrating T cells in Sézary syndrome and erythrodermic dermatitis. J Cutan Pathol 2015; 42:604-9. [PMID: 25777533 DOI: 10.1111/cup.12490] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2014] [Revised: 03/10/2015] [Accepted: 03/10/2015] [Indexed: 11/29/2022]
Abstract
BACKGROUND The histopathologic differentiation between Sézary syndrome (SS) and erythrodermic dermatitis may be extremely difficult. In this immunohistochemical study, it was investigated if thymocyte selection-associated high mobility group box protein (TOX) and C-MYC can be used as additional diagnostic markers to differentiate between SS and erythrodermic dermatitis. METHOD Paraffin-embedded skin biopsies from 15 SS patients and 17 erythrodermic dermatitis patients were stained and scored for TOX or C-MYC expression. RESULTS Strong nuclear staining for TOX in more than 50% of skin-infiltrating T cells was observed in 13 of 15 (87%) SS cases, whereas erythrodermic dermatitis cases showed weak nuclear staining in 11-50% (median: 25%) of the T cells; strong nuclear staining as found in SS was never observed in erythrodermic dermatitis. No significant differences in C-MYC expression between SS and erythrodermic dermatitis were found. In most patients of both groups, percentages of C-MYC positive-cells varied between less than 10 and 25% of skin-infiltrating T cells. CONCLUSION Our results suggest that strong expression of TOX in more than 50% of skin-infiltrating T cells in erythrodermic skin is a useful marker in the differentiation between SS and erythrodermic dermatitis, whereas staining for C-MYC does not contribute to differential diagnosis.
Collapse
Affiliation(s)
- Stephanie E Boonk
- Department of Dermatology, Leiden University Medical Center, Leiden, The Netherlands
| | - Fatma Çetinözman
- Department of Dermatology, Leiden University Medical Center, Leiden, The Netherlands
| | - Maarten H Vermeer
- Department of Dermatology, Leiden University Medical Center, Leiden, The Netherlands
| | - Patty M Jansen
- Department of Pathology, Leiden University Medical Center, Leiden, The Netherlands
| | - Rein Willemze
- Department of Dermatology, Leiden University Medical Center, Leiden, The Netherlands
| |
Collapse
|
14
|
|
15
|
Çetinözman F, Jansen PM, Willemze R. Expression of programmed death-1 in skin biopsies of benign inflammatory vs. lymphomatous erythroderma. Br J Dermatol 2014; 171:499-504. [PMID: 24601935 DOI: 10.1111/bjd.12934] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/17/2014] [Indexed: 12/31/2022]
Abstract
BACKGROUND Histological differentiation between Sézary syndrome (SS) and erythrodermic inflammatory dermatoses (EID) can be very difficult. Recent studies show that programmed death-1 (PD-1) is strongly expressed by the neoplastic cells in skin biopsies of SS, while similar studies in EID are lacking. OBJECTIVES To determine whether the number and distribution of PD-1(+) T cells could be used as an adjunct in the differentiation between SS and EID. METHODS Expression of PD-1 and a panel of T-cell markers was investigated in skin biopsies from 30 patients with various types of EID (12 idiopathic, 10 atopic, six psoriatic and two paraneoplastic) and 25 patients with SS. RESULTS Expression of PD-1 by > 50% of the infiltrating T cells was observed in 23 of 25 (92%) SS cases and in only four of 30 (13%) EID cases. PD-1 is expressed by neoplastic CD4(+) T cells in SS, while in contrast, PD-1 was predominantly expressed by dermal and epidermal CD8(+) T cells in EID. Expression of CD7 by ≤ 20% of the infiltrating T cells was observed only in SS (13 of 24; 54%), and not in any of the 30 cases of EID. CONCLUSIONS While PD-1 is expressed by CD4(+) neoplastic T cells in SS, our results suggest that PD-1 is expressed mainly by activated dermal and epidermal CD8(+) T cells in EID. Expression of PD-1 by > 50% of CD4(+) T cells and expression of CD7 by ≤ 20% of the infiltrating T cells strongly support a diagnosis of SS in skin biopsies of patients with erythroderma.
Collapse
Affiliation(s)
- F Çetinözman
- Department of Dermatology, Leiden University Medical Center, PO Box 9600, Leiden, 2300 RC, the Netherlands
| | | | | |
Collapse
|
16
|
Broeckx SY, Maes S, Martinello T, Aerts D, Chiers K, Mariën T, Patruno M, Franco-Obregón A, Spaas JH. Equine Epidermis: A Source of Epithelial-Like Stem/Progenitor Cells with In Vitro and In Vivo Regenerative Capacities. Stem Cells Dev 2014; 23:1134-48. [DOI: 10.1089/scd.2013.0203] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Affiliation(s)
- Sarah Y. Broeckx
- Global Stem cell Technology, Meldert-Lummen, Belgium
- Pell Cell Medicals, Opglabbeek, Belgium
| | | | - Tiziana Martinello
- Department of Comparative Biomedicine and Food Science, University of Padova, Legnaro, Italy
| | | | - Koen Chiers
- Department of Pathology, Bacteriology and Poultry Diseases, Faculty of Veterinary Medicine, Ghent University, Merelbeke, Belgium
| | - Tom Mariën
- Equitom Equine Hospital, Meldert-Lummen, Belgium
| | - Marco Patruno
- Department of Comparative Biomedicine and Food Science, University of Padova, Legnaro, Italy
| | - Alfredo Franco-Obregón
- Department of Biomechanics, Swiss Federal Institute of Technology, ETH, Zürich, Switzerland
- Department of Surgery, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Jan H. Spaas
- Global Stem cell Technology, Meldert-Lummen, Belgium
- Pell Cell Medicals, Opglabbeek, Belgium
| |
Collapse
|
17
|
|
18
|
Mackool BT, Goverman J, Nazarian RM. Case records of the Massachusetts General Hospital. Case 14-2012. A 43-year-old woman with fever and a generalized rash. N Engl J Med 2012; 366:1825-34. [PMID: 22571205 DOI: 10.1056/nejmcpc1111572] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Affiliation(s)
- Bonnie T Mackool
- Department of Dermatology, Massachusetts General Hospital, Boston, USA
| | | | | |
Collapse
|
19
|
Caudron A, Marie-Cardine A, Bensussan A, Bagot M. Actualités sur le syndrome de Sézary. Ann Dermatol Venereol 2012; 139:31-40. [DOI: 10.1016/j.annder.2011.09.188] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2011] [Revised: 06/27/2011] [Accepted: 09/22/2011] [Indexed: 01/23/2023]
|
20
|
Battistella M. [Cutaneous lymphoma at the Dermatology Day conference, Paris 2010]. Ann Dermatol Venereol 2011; 138:H1-11. [PMID: 21703464 DOI: 10.1016/s0151-9638(11)70070-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- M Battistella
- Service d'anatomie pathologique, hôpital Saint Louis, AP-HP, 1, avenue Claude Vellefaux, 75010 Paris, France.
| |
Collapse
|