1
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Tang H, Rybski KJ, Luan Y, Smoller BR. Folliculotropic Mycosis Fungoides Is Associated with Decreased PD1 Staining Compared with Classic Mycosis Fungoides. Dermatopathology (Basel) 2023; 10:303-309. [PMID: 37873805 PMCID: PMC10594491 DOI: 10.3390/dermatopathology10040038] [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: 09/19/2023] [Revised: 10/12/2023] [Accepted: 10/17/2023] [Indexed: 10/25/2023] Open
Abstract
Programmed cell death protein 1 (PD-1) plays a pivotal role in immune system regulation, with its expression levels linked to malignancy prognosis. However, existing reports on PD-1 staining in mycosis fungoides (MF) present conflicting findings, and little attention has been given to PD-1 staining in different MF variants. To address this, we conducted a retrospective study, employing immunohistochemistry to examine PD-1 expression in cases of folliculotropic MF and non-folliculotropic MF. We analyzed 24 cases of folliculotropic MF and 18 cases of non-folliculotropic MF, and recorded both the percentage of PD-1-labeled tumor cells and the intensity score (negative, weak, medium, or strong). Our results revealed significant disparity in PD-1 labeling between patch/plaque MF and folliculotropic MF (p = 0.028). Non-folliculotropic MF exhibited higher PD-1 labeling in tumor cells (58.3%) compared to folliculotropic MF (40.2%). Notably, there was no significant difference in PD-1 staining between folliculotropic MF and non-folliculotropic MF when both were in the early stage/indolent disease category. However, when considering the tumor stage, folliculotropic MF exhibited PD-1 staining in tumor cells at a rate of 21.1%, while non-folliculotropic MF showed PD-1 staining in tumor cells at a rate of 46.6% (p = 0.005). Additionally, among folliculotropic MF cases, 13 out of 24 cases displayed differing PD-1 expression patterns between epidermal and dermal components, with preserved PD-1 staining in the epidermal component and loss of staining in the dermal component. Furthermore, consistent with the prior literature, tumor cells with large cell transformations exhibited significantly lower PD-1 labeling (p = 0.017). Our findings showcase the unique PD-1 staining patterns in MF.
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Affiliation(s)
- Haiming Tang
- Department of Pathology, Yale School of Medicine, New Haven, CT 06510, USA
| | - Kristin J. Rybski
- Department of Pathology and Laboratory Medicine, University of Rochester, Rochester, NY 14642, USA
| | - Yi Luan
- Department of Pharmacology, Yale School of Medicine, New Haven, CT 06510, USA
| | - Bruce R. Smoller
- Department of Pathology and Laboratory Medicine, University of Rochester, Rochester, NY 14642, USA
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2
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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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3
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Mycosis Fungoides and Sézary Syndrome: Microenvironment and Cancer Progression. Cancers (Basel) 2023; 15:cancers15030746. [PMID: 36765704 PMCID: PMC9913729 DOI: 10.3390/cancers15030746] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Revised: 01/23/2023] [Accepted: 01/24/2023] [Indexed: 01/27/2023] Open
Abstract
Mycosis fungoides and Sézary syndrome are epidermotropic cutaneous lymphomas, and both of them are rare diseases. Mycosis fungoides is the most frequent primary cutaneous lymphoma. In about 25% of patients with mycosis fungoides, the disease may progress to higher stages. The pathogenesis and risk factors of progression in mycosis fungoides and Sézary syndrome are not yet fully understood. Previous works have investigated inter- and intrapatient tumor cell heterogeneity. Here, we overview the role of the tumor microenvironment of mycosis fungoides and Sézary syndrome by describing its key components and functions. Emphasis is put on the role of the microenvironment in promoting tumor growth or antitumor immune response, as well as possible therapeutic targets. We focus on recent advances in the field and point out treatment-related alterations of the microenvironment. Deciphering the tumor microenvironment may help to develop strategies that lead to long-term disease control and cure.
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4
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Mitteldorf C. Multistaining for a better understanding of lymphoma biology. Br J Dermatol 2022; 187:139-140. [PMID: 35508376 DOI: 10.1111/bjd.21590] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Christina Mitteldorf
- Department for Dermatology, Venereology and Allergology, University Medical Centre Göttingen, Göttingen, Niedersachsen, Germany
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5
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Wechsler J, Ingen-Housz-Oro S, Deschamps L, Brunet-Possenti F, Deschamps J, Delfau MH, Calderaro J, Ortonne N. Prevalence of T-cell antigen losses in mycosis fungoides and CD30-positive cutaneous T-cell lymphoproliferations in a series of 153 patients. Pathology 2022; 54:729-737. [DOI: 10.1016/j.pathol.2022.02.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Revised: 01/28/2022] [Accepted: 02/09/2022] [Indexed: 10/18/2022]
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Lewis NE, Gao Q, Petrova-Drus K, Pulitzer M, Sigler A, Baik J, Moskowitz AJ, Horwitz SM, Dogan A, Roshal M. PD-1 improves accurate detection of Sezary cells by flow cytometry in peripheral blood in mycosis fungoides/Sezary syndrome. CYTOMETRY. PART B, CLINICAL CYTOMETRY 2022; 102:189-198. [PMID: 35451196 PMCID: PMC9162159 DOI: 10.1002/cyto.b.22070] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Revised: 02/27/2022] [Accepted: 04/07/2022] [Indexed: 05/03/2023]
Abstract
BACKGROUND Accurate Sezary cell detection in peripheral blood of mycosis fungoides/Sezary syndrome (MF/SS) patients by flow cytometry can be difficult due to overlapping immunophenotypes with normal T cells using standard markers. We assessed the utility of programmed death-1 (PD-1/CD279), a transmembrane protein expressed in some hematopoietic cells, for identification and quantitation of circulating Sezary cells among established markers using flow cytometry. METHODS 50 MF/SS and 20 control blood samples were immunophenotyped by flow cytometry. Principal component analysis (PCA) assessed contributions of antigens to separation of abnormal from normal T cell populations. PD-1 was assessed over time in blood and bone marrow of available MF/SS cases. RESULTS Normal CD4+ T cells showed dim/intermediate to absent PD-1 expression. PD-1 in Sezary cells was informatively brighter (≥1/3 log) than internal normal CD4+ T cells in 39/50 (78%) cases. By PCA, PD-1 ranked 3rd behind CD7 and CD26 in population separation as a whole; it ranked in the top 3 markers in 32/50 (64%) cases and 1st in 4/50 (8%) cases when individual abnormal populations were compared to total normal CD4+ T cells. PD-1 clearly separated Sezary from normal CD4+ T cells in 15/26 (58%, 30% of total) cases with few and subtle alterations of pan-T cell antigens/CD26 and was critical in 6 (12% of total), without which identification and quantification were significantly affected or nearly impossible. PD-1 remained informative in blood/bone marrow over time in most patients. CONCLUSIONS PD-1 significantly contributes to accurate flow cytometric Sezary cell assessment in a routine Sezary panel.
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Affiliation(s)
- Natasha E Lewis
- Hematopathology Service, Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Qi Gao
- Hematopathology Service, Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Kseniya Petrova-Drus
- Hematopathology Service, Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
- Diagnostic Molecular Pathology Service, Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Melissa Pulitzer
- Dermatopathology Service, Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Allison Sigler
- Hematopathology Service, Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Jeeyeon Baik
- Hematopathology Service, Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Alison J Moskowitz
- Lymphoma Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Steven M Horwitz
- Lymphoma Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Ahmet Dogan
- Hematopathology Service, Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Mikhail Roshal
- Hematopathology Service, Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
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7
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Pileri A, Tabanelli V, Fuligni F, Agostinelli C, Guglielmo A, Sabattini E, Grandi V, Pileri SA, Pimpinelli N. PD-1 and PD-L1 expression in mycosis fungoides and Sézary Syndrome. Ital J Dermatol Venerol 2022; 157:355-362. [PMID: 35373781 DOI: 10.23736/s2784-8671.22.07275-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND The mechanisms involved in mycosis fungoides and Sezary Syndrome progression are largely unknown. Over the last decade the interest in immune system contrast of neoplasm has grown owing to the introduction of immunotherapy. PD-1 and its ligand (PD-L1) are the target of several immunotherapy treatment. In the literature reports on the expression of PD-1 and PD-L1 have provided contrasting results. METHODS In our analysis we investigated PD-1 expression in neoplastic cells and in tumour infiltrating lymphocytes (TILs) as well as PD-L1 expression in tumour cells and in tumour associated macrophages (TAMs). PD-L1 and PD-1 positive cells were counted in 5 high-power fields (HPF) and scored as the average number of positive neoplastic cells/TILs/TAMs per HPF. RESULTS From databases of two institutions (Bologna and Florence) thirty-five patients corresponding to 43 biopsies were retrieved. In seven instances sequential biopsies were present. No statistically significant expression was observed comparing early to advanced stages by analysing PD-1 by tumour cells and TILs and of PD-L1 by tumour cells and TAMs. CONCLUSIONS Our results corroborate that PD-1 and PD-L1 expression is not stage-dependent in mycosis fungoides and Sezary syndrome. However, PD-1 and PD-L1 expression in affected patients provides a rationale to schedule anti PD-1/PD-L1 drugs.
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Affiliation(s)
- Alessandro Pileri
- Dermatology Unit, IRCCS Policlinico Sant'Orsola, Bologna, Italy - .,Dermatology Unit, Department of Experimental Diagnostic and Specialty Medicine, University of Bologna, Bologna, Italy -
| | - Valentina Tabanelli
- Division of Haematopathology, European Institute of Oncology (IEO) IRCCS, Milan, Italy
| | - Fabio Fuligni
- Department of Genetics and Genome Biology, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Claudio Agostinelli
- Haematopathology Unit, Department of Experimental Diagnostic and Specialty Medicine, S. Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy.,Haematopathology Unit, IRCCS Policlinico Sant'Orsola, Bologna, Italy
| | - Alba Guglielmo
- Dermatology Unit, IRCCS Policlinico Sant'Orsola, Bologna, Italy.,Dermatology Unit, Department of Experimental Diagnostic and Specialty Medicine, University of Bologna, Bologna, Italy
| | - Elena Sabattini
- Haematopathology Unit, Department of Experimental Diagnostic and Specialty Medicine, S. Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
| | - Vieri Grandi
- Department of Health Sciences, Division of Dermatology, University of Florence, Florence, Italy
| | - Stefano A Pileri
- Division of Haematopathology, European Institute of Oncology (IEO) IRCCS, Milan, Italy
| | - Nicola Pimpinelli
- Department of Health Sciences, Division of Dermatology, University of Florence, Florence, Italy
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8
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Dobos G, Miladi M, Michel L, Ram-Wolff C, Battistella M, Bagot M, de Masson A. Recent advances on cutaneous lymphoma epidemiology. Presse Med 2022; 51:104108. [PMID: 35026392 DOI: 10.1016/j.lpm.2022.104108] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Revised: 11/26/2021] [Accepted: 01/05/2022] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND Primary cutaneous lymphomas are a group of T- (CTCL) and B-cell (CBCL) malignancies. These diseases have different clinical presentations and prognosis. Our knowledge on their epidemiology is limited. Aim of this review was to summarise recent findings on the incidence of CTCL and CBCL, how they change over time, and to describe possible causes and consequences. We found that although there are important differences in the epidemiology of cutaneous lymphomas in different countries, the relative frequency of certain, especially rare lymphomas remains stable. Several studies described growing incidences of both CTCL and CBCL. The emergence of new diagnostic criteria, a more precise definition of the entities and new biomarkers enable a better classification of cases.
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Affiliation(s)
- G Dobos
- Dermatology Department, Saint-Louis Hospital, AP-HP, Paris, France; INSERM U976 Human Immunology, Pathophysiology and Immune Therapies, Paris, France; Université de Paris, Paris, France; Department of Dermatology, Venerology and Allergology, Charité-Universitätsmedizin Berlin, Germany
| | - M Miladi
- Dermatology Department, Saint-Louis Hospital, AP-HP, Paris, France
| | - L Michel
- INSERM U976 Human Immunology, Pathophysiology and Immune Therapies, Paris, France; Université de Paris, Paris, France
| | - C Ram-Wolff
- Dermatology Department, Saint-Louis Hospital, AP-HP, Paris, France
| | - M Battistella
- INSERM U976 Human Immunology, Pathophysiology and Immune Therapies, Paris, France; Université de Paris, Paris, France; Pathology Department, Saint-Louis Hospital, AP-HP, Paris, France
| | - M Bagot
- Dermatology Department, Saint-Louis Hospital, AP-HP, Paris, France; INSERM U976 Human Immunology, Pathophysiology and Immune Therapies, Paris, France; Université de Paris, Paris, France.
| | - A de Masson
- Dermatology Department, Saint-Louis Hospital, AP-HP, Paris, France; INSERM U976 Human Immunology, Pathophysiology and Immune Therapies, Paris, France; Université de Paris, Paris, France
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9
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Ribereau-Gayon E, Le Borgne De Lavillandre J, Deschamps T, Balme B, Harou O, Grange F. Syringotropic Mycosis Fungoides with Vasculopathic Ulcers and Expression of T-follicular-helper Cell Markers. Acta Derm Venereol 2021; 101:adv00569. [PMID: 34230976 PMCID: PMC9425591 DOI: 10.2340/00015555-3868] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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10
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Rendón-Serna N, Correa-Londoño LA, Velásquez-Lopera MM, Bermudez-Muñoz M. Cell signaling in cutaneous T-cell lymphoma microenvironment: promising targets for molecular-specific treatment. Int J Dermatol 2021; 60:1462-1480. [PMID: 33835479 DOI: 10.1111/ijd.15451] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Revised: 12/31/2020] [Accepted: 01/12/2021] [Indexed: 01/01/2023]
Abstract
Cutaneous T-cell lymphomas (CTCL) result from the infiltration and proliferation of a population of T cells in the skin, inducing changes in the activity of both T cells and surrounding skin cells. In the CTCL microenvironment, cell interactions mediated by cell signaling pathways are altered. Defining changes in cell signaling enables to understand T-cell deregulations in the CTCL microenvironment and thus the progression of the disease. Moreover, characterizing signaling networks activated in CTCL stages can lead to consider new molecular biomarkers and therapeutic targets. Focusing on mycosis fungoides (MF), the most frequent variant of CTCL, and Sézary syndrome (SS), its leukemic variant, this review highlights recent molecular and genetic findings revealing modifications of key signaling pathways involved in (1) cell proliferation, cell growth, and cell survival such as MAP kinases and PI3K/Akt; (2) immune responses derived from TCR, TLR, JAK/STAT, and NF-kB; and (3) changes in tissue conditions such as extracellular matrix remodeling, hypoxia, and angiogenesis. Alterations in these signaling networks promote malignant T-cell proliferation and survival, T-cell migration, inflammation, and suppression of immune regulation of malignant T cells, making a skin microenvironment that allows disease progression. Targeting key proteins of these signaling pathways, using molecules already available and used in research, in clinical trials, and with other disease indications, can open the way to different therapeutic options in CTCL treatment.
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Affiliation(s)
- Natalia Rendón-Serna
- Instituto de Biología, Universidad de Antioquia, Medellin, Colombia.,Centro de Investigaciones Dermatológicas CIDERM, Facultad de Medicina, Universidad De Antioquia, Medellin, Colombia
| | - Luis A Correa-Londoño
- Centro de Investigaciones Dermatológicas CIDERM, Facultad de Medicina, Universidad De Antioquia, Medellin, Colombia
| | - Margarita M Velásquez-Lopera
- Centro de Investigaciones Dermatológicas CIDERM, Facultad de Medicina, Universidad De Antioquia, Medellin, Colombia
| | - Maria Bermudez-Muñoz
- Instituto de Biología, Universidad de Antioquia, Medellin, Colombia.,Centro de Investigaciones Dermatológicas CIDERM, Facultad de Medicina, Universidad De Antioquia, Medellin, Colombia
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11
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Dobos G, de Masson A, Ram-Wolff C, Beylot-Barry M, Pham-Ledard A, Ortonne N, Ingen-Housz-Oro S, Battistella M, d'Incan M, Rouanet J, Franck F, Vignon-Pennamen MD, Franck N, Carlotti A, Boulinguez S, Lamant L, Petrella T, Dalac S, Joly P, Courville P, Rivet J, Dereure O, Amatore F, Taix S, Grange F, Durlach A, Quéreux G, Josselin N, Moulonguet I, Mortier L, Dubois R, Maubec E, Laroche L, Michel L, Templier I, Barete S, Nardin C, Augereau O, Vergier B, Bagot M. Epidemiological changes in cutaneous lymphomas: an analysis of 8593 patients from the French Cutaneous Lymphoma Registry. Br J Dermatol 2020; 184:1059-1067. [PMID: 33131055 DOI: 10.1111/bjd.19644] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/28/2020] [Indexed: 12/16/2022]
Abstract
BACKGROUND Primary cutaneous lymphomas (PCLs) are a heterogeneous group of T-cell (CTCL) and B-cell (CBCL) malignancies. Little is known about their epidemiology at initial presentation in Europe and about potential changes over time. OBJECTIVES The aim of this retrospective study was to analyse the frequency of PCLs in the French Cutaneous Lymphoma Registry (GFELC) and to describe the demography of patients. METHODS Patients with a centrally validated diagnosis of primary PCL, diagnosed between 2005 and 2019, were included. RESULTS The calculated incidence was unprecedently high at 1·06 per 100 000 person-years. The number of included patients increased yearly. Most PCL subtypes were more frequent in male patients, diagnosed at a median age of 60 years. The relative frequency of rare CTCL remained stable, the proportion of classical mycosis fungoides (MF) decreased, and the frequency of its variants (e.g. folliculotropic MF) increased. Similar patterns were observed for CBCL; for example, the proportion of marginal-zone CBCL increased over time. CONCLUSIONS Changes in PCL frequencies may be explained by the emergence of new diagnostic criteria and better description of the entities in the most recent PCL classification. Moreover, we propose that an algorithm should be developed to confirm the diagnosis of PCL by central validation of the cases.
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Affiliation(s)
- G Dobos
- Dermatology Department, Saint-Louis Hospital, AP-HP, Paris, France.,INSERM U976, Human Immunology Pathophysiology and Immune Therapies, Paris, France.,Université de Paris, Paris, France
| | - A de Masson
- Dermatology Department, Saint-Louis Hospital, AP-HP, Paris, France.,INSERM U976, Human Immunology Pathophysiology and Immune Therapies, Paris, France.,Université de Paris, Paris, France
| | - C Ram-Wolff
- Dermatology Department, Saint-Louis Hospital, AP-HP, Paris, France.,INSERM U976, Human Immunology Pathophysiology and Immune Therapies, Paris, France.,Université de Paris, Paris, France
| | - M Beylot-Barry
- Dermatology Department, Université de Bordeaux, Bordeaux, France
| | - A Pham-Ledard
- Dermatology Department, Université de Bordeaux, Bordeaux, France
| | - N Ortonne
- Pathology Department, Henri Mondor Hospital, INSERM U955, Université Paris Est, AP-HP, Paris, France
| | - S Ingen-Housz-Oro
- Dermatology Department, Henri Mondor Hospital, INSERM U955, Université Paris Est, AP-HP, Paris, France
| | - M Battistella
- INSERM U976, Human Immunology Pathophysiology and Immune Therapies, Paris, France.,Université de Paris, Paris, France.,Pathology Department, Saint-Louis Hospital, AP-HP, Paris, France
| | - M d'Incan
- Dermatology and Cutaneous Oncology, Estaing University Hospital, Université de Clermont-Ferrand, Clermont-Ferrand, France
| | - J Rouanet
- Pathology Department, NHE Clermont et SIPATH UNILABS, Clermont-Ferrand, France
| | - F Franck
- Pathology Department, NHE Clermont et SIPATH UNILABS, Clermont-Ferrand, France
| | | | - N Franck
- Dermatology Department, Cochin Hospital, AP-HP, Paris, France
| | - A Carlotti
- Pathology Department, Cochin Hospital, AP-HP, Paris, France
| | - S Boulinguez
- Dermatology Department, Cahors Hospital, Toulouse, France
| | - L Lamant
- Pathology and Cytopathology Department, Institut Universitaire du Cancer Toulouse, Toulouse, France
| | - T Petrella
- Pathology Department, Dijon Bourgogne University Hospital, Dijon, France
| | - S Dalac
- Dermatology Department, Dijon Bourgogne University Hospital, Dijon, France
| | - P Joly
- Dermatology Department, Rouen University Hospital, INSERM U1234, Rouen Institute for Research and Innovation in Biomedicine, Rouen, France
| | - P Courville
- Pathology Department, Rouen University Hospital, INSERM U1234, Rouen Institute for Research and Innovation in Biomedicine, Rouen, France
| | - J Rivet
- Dermatology Department, Université de Bordeaux, Bordeaux, France.,Pathology Department, Henri Mondor Hospital, INSERM U955, Université Paris Est, AP-HP, Paris, France
| | - O Dereure
- Dermatology Department, Montpellier University Hospital, Montpellier, France
| | - F Amatore
- Department of Dermatology and Oncodermatology, Aix-Marseille University, AP-HM, Timone Hospital, Marseille, France
| | - S Taix
- Department of Pathology, Aix-Marseille University, AP-HM, Timone Hospital, Marseille, France
| | - F Grange
- Dermatology Department, Robert Debré University Hospital, Reims, France
| | - A Durlach
- Pathology Department, Reims University Hospital, Reims, France
| | - G Quéreux
- Dermatology Department, Nantes University Hospital, Nantes, France
| | - N Josselin
- Pathology Department, Nantes University Hospital, Nantes, France
| | - I Moulonguet
- Dermatology Department, Saint-Louis Hospital, AP-HP, Paris, France
| | - L Mortier
- Dermatology Department, Claude Huriez University Hospital, INSERM U1189, Université de Lille, Lille, France
| | - R Dubois
- Pathology Department, Claude Huriez University Hospital, Lille, France
| | - E Maubec
- Dermatology Department, Avicenne Hospital, AP-HP, Paris, France
| | - L Laroche
- Dermatology Department, Avicenne Hospital, AP-HP, Paris, France
| | - L Michel
- INSERM U976, Human Immunology Pathophysiology and Immune Therapies, Paris, France.,Université de Paris, Paris, France
| | - I Templier
- Dermatology Department, Grenoble University Hospital, Grenoble, France
| | - S Barete
- Dermatology Department, Pité-Salpêtrière Hospital, AP-HP, Paris, France
| | - C Nardin
- Dermatology Department, Minjoz Hospital, Besancon, France, INSERM U1098, University of Franche Comté, EFS Bourgogne Franche-Comté and Franche-Comté University, Besançon, France
| | - O Augereau
- Pathology Department, Saint-André Hospital, Bordeaux University Hospital, INSERM U1053 - UMR BaRITOn, Eq 3 Oncogenèse des Lymphomes Cutanés, Université de Bordeaux, Bordeaux, France
| | - B Vergier
- Pathology Department, Saint-André Hospital, Bordeaux University Hospital, INSERM U1053 - UMR BaRITOn, Eq 3 Oncogenèse des Lymphomes Cutanés, Université de Bordeaux, Bordeaux, France
| | - M Bagot
- Dermatology Department, Saint-Louis Hospital, AP-HP, Paris, France.,INSERM U976, Human Immunology Pathophysiology and Immune Therapies, Paris, France.,Université de Paris, Paris, France
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12
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Gru AA, McHargue C, Salavaggione AL. A Systematic Approach to the Cutaneous Lymphoid Infiltrates: A Clinical, Morphologic, and Immunophenotypic Evaluation. Arch Pathol Lab Med 2020; 143:958-979. [PMID: 31339758 DOI: 10.5858/arpa.2018-0294-ra] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
CONTEXT.— The evaluation of cutaneous lymphoid infiltrates, both neoplastic and inflammatory, occurs very frequently in routine dermatopathologic examination and consultation practices. The "tough" cutaneous lymphoid infiltrate is feared by many pathologists; skin biopsies are relatively small, whereas diagnostic possibilities are relatively broad. It is true that cutaneous lymphomas can be difficult to diagnose and that in many circumstances multiple biopsies are required to establish a correct diagnostic interpretation. As a reminder, one should understand that low-grade cutaneous lymphomas are indolent disorders that usually linger for decades and that therapy does not result in disease cure. It is also important to remember that in most circumstances, those patients will die from another process that is completely unrelated to a diagnosis of skin lymphoma (even in the absence of specific therapy). OBJECTIVE.— To use a clinicopathologic, immunophenotypic, and molecular approach in the evaluation of common lymphocytic infiltrates. DATA SOURCES.— An in-depth analysis of updated literature in the field of cutaneous lymphomas was done, with particular emphasis on updated terminology from the most recent World Health Organization classification of skin and hematologic tumors. CONCLUSIONS.— A diagnosis of cutaneous lymphoid infiltrates can be adequately approached using a systematic scheme following the proposed ABCDE system. Overall, cutaneous T- and B-cell lymphomas are rare and "reactive" infiltrates are more common. Evaluation of lymphoid proliferations should start with a good sense of knowledge of the clinical presentation of the lesions, the clinical differential considerations, and a conscientious and appropriate use of immunohistochemistry and molecular tools.
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Affiliation(s)
- Alejandro A Gru
- From the Departments of Pathology (Drs Gru and Salavaggione) and Dermatology (Dr Gru), University of Virginia, Charlottesville; and the Department of Dermatology (Dr McHargue), Henry Ford Health System, Detroit, Michigan
| | - Chauncey McHargue
- From the Departments of Pathology (Drs Gru and Salavaggione) and Dermatology (Dr Gru), University of Virginia, Charlottesville; and the Department of Dermatology (Dr McHargue), Henry Ford Health System, Detroit, Michigan
| | - Andrea L Salavaggione
- From the Departments of Pathology (Drs Gru and Salavaggione) and Dermatology (Dr Gru), University of Virginia, Charlottesville; and the Department of Dermatology (Dr McHargue), Henry Ford Health System, Detroit, Michigan
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13
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Mitteldorf C. Kutane Lymphome – neue Perspektiven durch Kombinationstherapien? J Dtsch Dermatol Ges 2020; 18:185-187. [DOI: 10.1111/ddg.14032_g] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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14
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Xie M, Huang X, Ye X, Qian W. Prognostic and clinicopathological significance of PD-1/PD-L1 expression in the tumor microenvironment and neoplastic cells for lymphoma. Int Immunopharmacol 2019; 77:105999. [PMID: 31704289 DOI: 10.1016/j.intimp.2019.105999] [Citation(s) in RCA: 39] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2019] [Revised: 10/08/2019] [Accepted: 10/21/2019] [Indexed: 12/20/2022]
Abstract
BACKGROUND Recently, unprecedented clinical efficacy was observed during treatment of many solid tumors because of the introduction of programmed cell death 1 (PD-1)/programmed cell death 1 ligand 1 (PD-L1) immune checkpoint inhibitors. Preliminary clinical data indicates that checkpoint inhibition also represents a promising therapeutic strategy for certain lymphoid malignancies. However, PD-1/PD-L1 expression levels on neoplastic cells and in the tumor microenvironment vary among subtypes and their prognostic implications remain uncertain. MAIN BODY Here, we review the clinicopathological significance of PD-1/PD-L1 expression in lymphomas. Increased infiltration of PD-1+ tumor-infiltrating lymphocytes (TILs) is a favorable prognostic factor in diffuse large B-cell lymphoma (DLBCL) but not in Hodgkin's lymphoma (HL). Higher numbers of PD-1+ TILs were observed in follicular lymphoma (FL) than in other subtypes of B-cell lymphoma; however, its prognostic significance remains controversial. Infiltration of PD-L1+ immune cells showed a trend toward better overall survival in nasal natural killer (NK)/T-cell lymphoma and adult T-cell leukemia/lymphoma, more likely to be classified as activated macrophages and dendritic cells in microenvironment but its biological effect is not clarified. Peripheral PD-1+ T cells could be detected in blood samples from DLBCL and chronic lymphocytic leukemia (CLL) and correlated with disease progression and poor prognosis. PD-1+ neoplastic T cells were more frequently observed in cutaneous T-cell lymphoma, including Sézary syndrome and mycosis fungoides, which may be involved in the progression of epithelial-derived T lymphoma. Studies on PD-L1 expression in neoplastic cells mostly focused on DLBCL. PD-L1+ neoplastic cells were observed only in a small subset of DLBCL, mainly associated with activated B cell (ABC) subtypes and Epstein-Barr virus (EBV) positivity; however, its prognostic role remains controversial. In either T or B lymphoma, elevated serum or plasma levels of soluble PD-L1 represent adverse prognostic factors. Notably, in clinical trials of classical HL, the frequency of 9p24.1 chromosome alterations increases the abundance of PD-1 ligand expression, appearing to predict responses to anti-PD-1/PD-L1 therapy. The cytogenetic alterations affecting chromosome 9p24.1 including the CIITA rearrangement were also frequently observed in certain specific subtypes of large B-cell lymphomas. CONCLUSIONS The clinical roles of PD-1/PD-L1 expression vary between subtypes of lymphoma. Future studies should delineate the prognostic and predictive roles of PD-1 and PD-L1 expression.
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Affiliation(s)
- Mixue Xie
- Senior Department of Haematology, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, Zhejiang Province 310003, China
| | - Xianbo Huang
- Senior Department of Haematology, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, Zhejiang Province 310003, China
| | - Xiujin Ye
- Senior Department of Haematology, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, Zhejiang Province 310003, China.
| | - Wenbin Qian
- Department of Haematology, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, Zhejiang Province 310003, China; Malignant Lymphoma Diagnosis and Therapy Center, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, Zhejiang Province 310003, China.
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15
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Gerlach MM, Juskevicius D, Vela V, Dirnhofer S, Tzankov A. Bone Marrow Infiltration of Angioimmunoblastic T-Cell Lymphoma: Identification and Prognostic Impact of Histologic Patterns and Diagnostic Application of Ancillary Phenotypic and Molecular Analyses. Arch Pathol Lab Med 2019; 144:602-611. [PMID: 31556696 DOI: 10.5858/arpa.2019-0007-oa] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
CONTEXT.— Angioimmunoblastic T-cell lymphomas originate from T follicular helper cells and express respective markers (BCL6, CD10, CXCL13, ICOS, and PD-1). Although commonly present, bone marrow involvement by angioimmunoblastic T-cell lymphoma can be diagnostically challenging. Additionally, only little is known about the distribution of T follicular helper cells in healthy and reactively changed bone marrows or in samples affected by other lymphomas. OBJECTIVE.— To establish a diagnostic approach to reliably identify bone marrow infiltration of angioimmunoblastic T-cell lymphoma. DESIGN.— We analyzed the morphologic infiltration pattern and the expression of T follicular helper-cell markers in 42 matched paired lymph node and bone marrow samples and applied comparative clonality testing. Furthermore, we studied the expression of BCL6 and PD-1 in a control cohort of healthy, reactively changed, and otherwise affected bone marrows. RESULTS.— We identified 3 different bone marrow infiltration patterns correlating with overall survival (interstitial/micronodular infiltration with or without eosinophilia and diffuse infiltration with eosinophilia). The matched pairs showed a consistent (co)expression of PD-1 and BCL6 with a generally weaker expression in the bone marrow than in the lymph nodes. Comparative clonality testing was helpful in only a minority of cases. Infiltrates of the most important differential diagnoses contained either PD-1- or BCL6-positive tumor-infiltrating cells, but no coexpressing cells. CONCLUSIONS.— Bone marrow infiltration by angioimmunoblastic T-cell lymphoma displays 3 different patterns that correlate with prognosis. BCL6 and PD-1 can be reliably used to identify lymphoma infiltrates and to help rule out several differential diagnoses. Comparative clonality testing rarely provides additional value and cannot replace morphologic and phenotypic analyses.
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Affiliation(s)
- Magdalena M Gerlach
- From the Institute of Medical Genetics and Pathology, University Hospital Basel, Basel, Switzerland
| | - Darius Juskevicius
- From the Institute of Medical Genetics and Pathology, University Hospital Basel, Basel, Switzerland
| | - Visar Vela
- From the Institute of Medical Genetics and Pathology, University Hospital Basel, Basel, Switzerland
| | - Stefan Dirnhofer
- From the Institute of Medical Genetics and Pathology, University Hospital Basel, Basel, Switzerland
| | - Alexandar Tzankov
- From the Institute of Medical Genetics and Pathology, University Hospital Basel, Basel, Switzerland
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16
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Sokołowski M, Sokołowska A, Mazur G, Butrym A. Programmed cell death protein receptor and ligands in haematological malignancies - Current status. Crit Rev Oncol Hematol 2019; 135:47-58. [PMID: 30819446 DOI: 10.1016/j.critrevonc.2019.01.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2018] [Revised: 11/26/2018] [Accepted: 01/09/2019] [Indexed: 02/02/2023] Open
Abstract
The checkpoint inhibitors have been continuously present in haematology for 20 years. From the first description, several of them were enrolled to the list of the oncological drugs. The research on nivolumab, avelumab, durvolumab is still in progress. In the treatment of some diseases, for instance, Hodgkin lymphoma, the programmed death cell pathway has already an important role. During the last years, the guidelines were enriched by using these drugs, both in solid and haematological malignancies. In this review, we present a history of discovery, research and clinical use of this new class of drugs potentially providing a significant change in curability rates of some haematological malignancies.
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Affiliation(s)
- Marcin Sokołowski
- Oddział Chorób Wewnętrznych I, Specjalistyczny Szpital im. Alfreda Sokołowskiego w Wałbrzychu, Poland
| | - Anna Sokołowska
- Oddział Chorób Wewnętrznych I, Specjalistyczny Szpital im. Alfreda Sokołowskiego w Wałbrzychu, Poland
| | - Grzegorz Mazur
- Dept. of Internal Diseases, Occupational Medicine, Hypertension and Clinical Oncology, Wroclaw Medical University, Wroclaw, Poland
| | - Aleksandra Butrym
- Dept. of Cancer Prevention and Therapy, Wroclaw Medical University, Poland.
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17
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Atanackovic D, Luetkens T. Biomarkers for checkpoint inhibition in hematologic malignancies. Semin Cancer Biol 2018; 52:198-206. [PMID: 29775689 DOI: 10.1016/j.semcancer.2018.05.005] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2018] [Revised: 05/14/2018] [Accepted: 05/14/2018] [Indexed: 01/27/2023]
Abstract
In the past few years we have seen remarkable paradigm shifts in the treatment of many solid tumors due to the introduction of inhibitors targeting immune checkpoints such as PD-1/PD-L1 and CTLA-4. Recent results indicate that checkpoint inhibition also represents a very promising approach for certain types of hematologic malignancies. Unfortunately, treatment with checkpoint inhibitors is also associated with substantial toxicities and high costs and only a subset of patients appears to derive clinical benefit from these treatments. This demonstrates the urgent need for biomarkers for the identification of patient populations that are likely to respond to this type of therapy and/or have fewer side effects. Here, we have reviewed available information on the prognostic and predictive value of biomarkers for anti-CTLA-4 and anti-PD-1/PD-L1 as the most commonly used checkpoint inhibitors. There are currently no reliable biomarkers capable of predicting responses to anti-CTLA-4 agents, such as ipilimumab, in hematologic malignancies. Certain polymorphisms in the CTLA-4 gene, however, seem to have an impact on the patients' outcome, especially in the case of chronic lymphocytic leukemia (CLL). There is now sufficient data supporting PD-L1 expression levels in the tumor tissue as an independent prognostic factor in B cell lymphomas such as diffuse large B-cell lymphoma (DLBCL). Overexpression of PD-L1 in the tumor tissue and elevated serum levels of soluble PD-L1 may also represent adverse prognostic factors in certain subtypes of T cell lymphomas. Finally, expression levels of PD-L1 also seem to predict responses to anti-PD-1/PD-L1 approaches in patients with Hodgkin lymphoma. Future studies will have to further delineate the prognostic/predictive role of PD-L1 expression as a biomarker in hematologic malignancies and may be able to identify confounding variables, which will hopefully to some extent be generalizable to other types of anti-tumor immunotherapies.
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Affiliation(s)
- Djordje Atanackovic
- Multiple Myeloma Program & Cancer Immunology, Division of Hematology and Hematologic Malignancies, University of Utah/Huntsman Cancer Institute, Salt Lake City, UT, United States.
| | - Tim Luetkens
- Multiple Myeloma Program & Cancer Immunology, Division of Hematology and Hematologic Malignancies, University of Utah/Huntsman Cancer Institute, Salt Lake City, UT, United States
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18
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Kim Y, Won C, Chang S, Lee M, Choi J, Lee W. Expression of programmed death-1 in cutaneous extranodal natural killer/T-cell lymphoma and its effect on clinical findings and biological behaviour. J Eur Acad Dermatol Venereol 2017; 31:821-827. [DOI: 10.1111/jdv.14165] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2016] [Accepted: 01/23/2017] [Indexed: 12/22/2022]
Affiliation(s)
- Y.J. Kim
- Department of Dermatology; Asan Medical Center; University of Ulsan College of Medicine; Seoul Korea
| | - C.H. Won
- Department of Dermatology; Asan Medical Center; University of Ulsan College of Medicine; Seoul Korea
| | - S.E. Chang
- Department of Dermatology; Asan Medical Center; University of Ulsan College of Medicine; Seoul Korea
| | - M.W. Lee
- Department of Dermatology; Asan Medical Center; University of Ulsan College of Medicine; Seoul Korea
| | - J.H. Choi
- Department of Dermatology; Asan Medical Center; University of Ulsan College of Medicine; Seoul Korea
| | - W.J. Lee
- Department of Dermatology; Asan Medical Center; University of Ulsan College of Medicine; Seoul Korea
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19
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Wang M, Zhao J, Zhang L, Wei F, Lian Y, Wu Y, Gong Z, Zhang S, Zhou J, Cao K, Li X, Xiong W, Li G, Zeng Z, Guo C. Role of tumor microenvironment in tumorigenesis. J Cancer 2017; 8:761-773. [PMID: 28382138 PMCID: PMC5381164 DOI: 10.7150/jca.17648] [Citation(s) in RCA: 881] [Impact Index Per Article: 125.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2016] [Accepted: 12/22/2016] [Indexed: 12/12/2022] Open
Abstract
Tumorigenesis is a complex and dynamic process, consisting of three stages: initiation, progression, and metastasis. Tumors are encircled by extracellular matrix (ECM) and stromal cells, and the physiological state of the tumor microenvironment (TME) is closely connected to every step of tumorigenesis. Evidence suggests that the vital components of the TME are fibroblasts and myofibroblasts, neuroendocrine cells, adipose cells, immune and inflammatory cells, the blood and lymphatic vascular networks, and ECM. This manuscript, based on the current studies of the TME, offers a more comprehensive overview of the primary functions of each component of the TME in cancer initiation, progression, and invasion. The manuscript also includes primary therapeutic targeting markers for each player, which may be helpful in treating tumors.
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Affiliation(s)
- Maonan Wang
- Key Laboratory of Carcinogenesis of Ministry of Health, Xiangya Hospital, Central South University, Changsha, Hunan 410078, China
- Key Laboratory of Carcinogenesis and Cancer Invasion of Ministry of Education, Cancer Research Institute, Central South University, Changsha, Hunan 410078, China
| | - Jingzhou Zhao
- Key Laboratory of Carcinogenesis and Cancer Invasion of Ministry of Education, Cancer Research Institute, Central South University, Changsha, Hunan 410078, China
| | - Lishen Zhang
- Key Laboratory of Carcinogenesis and Cancer Invasion of Ministry of Education, Cancer Research Institute, Central South University, Changsha, Hunan 410078, China
| | - Fang Wei
- Key Laboratory of Carcinogenesis and Cancer Invasion of Ministry of Education, Cancer Research Institute, Central South University, Changsha, Hunan 410078, China
| | - Yu Lian
- Key Laboratory of Carcinogenesis and Cancer Invasion of Ministry of Education, Cancer Research Institute, Central South University, Changsha, Hunan 410078, China
| | - Yingfeng Wu
- Key Laboratory of Carcinogenesis and Cancer Invasion of Ministry of Education, Cancer Research Institute, Central South University, Changsha, Hunan 410078, China
| | - Zhaojian Gong
- Key Laboratory of Carcinogenesis and Cancer Invasion of Ministry of Education, Cancer Research Institute, Central South University, Changsha, Hunan 410078, China
| | - Shanshan Zhang
- Key Laboratory of Carcinogenesis of Ministry of Health, Xiangya Hospital, Central South University, Changsha, Hunan 410078, China
| | - Jianda Zhou
- Hunan Key Laboratory of Nonresolving Inflammation and Cancer, Disease Genome Research Center, The Third Xiangya Hospital, Central South University, Changsha, Hunan 410013, China
| | - Ke Cao
- Hunan Key Laboratory of Nonresolving Inflammation and Cancer, Disease Genome Research Center, The Third Xiangya Hospital, Central South University, Changsha, Hunan 410013, China
| | - Xiayu Li
- Hunan Key Laboratory of Nonresolving Inflammation and Cancer, Disease Genome Research Center, The Third Xiangya Hospital, Central South University, Changsha, Hunan 410013, China
| | - Wei Xiong
- Key Laboratory of Carcinogenesis of Ministry of Health, Xiangya Hospital, Central South University, Changsha, Hunan 410078, China
- Key Laboratory of Carcinogenesis and Cancer Invasion of Ministry of Education, Cancer Research Institute, Central South University, Changsha, Hunan 410078, China
- Hunan Key Laboratory of Nonresolving Inflammation and Cancer, Disease Genome Research Center, The Third Xiangya Hospital, Central South University, Changsha, Hunan 410013, China
| | - Guiyuan Li
- Key Laboratory of Carcinogenesis of Ministry of Health, Xiangya Hospital, Central South University, Changsha, Hunan 410078, China
- Key Laboratory of Carcinogenesis and Cancer Invasion of Ministry of Education, Cancer Research Institute, Central South University, Changsha, Hunan 410078, China
- Hunan Key Laboratory of Nonresolving Inflammation and Cancer, Disease Genome Research Center, The Third Xiangya Hospital, Central South University, Changsha, Hunan 410013, China
| | - Zhaoyang Zeng
- Key Laboratory of Carcinogenesis of Ministry of Health, Xiangya Hospital, Central South University, Changsha, Hunan 410078, China
- Key Laboratory of Carcinogenesis and Cancer Invasion of Ministry of Education, Cancer Research Institute, Central South University, Changsha, Hunan 410078, China
- Hunan Key Laboratory of Nonresolving Inflammation and Cancer, Disease Genome Research Center, The Third Xiangya Hospital, Central South University, Changsha, Hunan 410013, China
| | - Can Guo
- Key Laboratory of Carcinogenesis of Ministry of Health, Xiangya Hospital, Central South University, Changsha, Hunan 410078, China
- Key Laboratory of Carcinogenesis and Cancer Invasion of Ministry of Education, Cancer Research Institute, Central South University, Changsha, Hunan 410078, China
- Hunan Key Laboratory of Nonresolving Inflammation and Cancer, Disease Genome Research Center, The Third Xiangya Hospital, Central South University, Changsha, Hunan 410013, China
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20
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Primary Cutaneous Follicular Helper T-cell Lymphoma in a Patient With Neurofibromatosis Type 1: Case Report and Review of the Literature. Am J Dermatopathol 2017; 39:134-139. [PMID: 28134730 DOI: 10.1097/dad.0000000000000697] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Patients with neurofibromatosis type 1 (NF-1) have a well-known predisposition for certain types of malignancies, including lymphoproliferative disorders. Cutaneous T-cell lymphoma (CTCL) has been reported in patients with NF-1, although it is considered a rare entity in this subset of patients. Cutaneous follicular helper T-cell lymphoma (CTFHCL) is a recently emerged rare subtype of CTCL with peculiar clinical and histopathological features and represents a diagnostic and therapeutic challenge. Only a few cases of CTFHCL have been reported in the literature. We report a case of CTFHCL in a patient with NF-1 and compare our findings with previously reported cases. We aim to raise awareness among pathologists regarding this rare subtype of CTCL and emphasize characteristic histological features of CTFHCL, which can be confused with B-cell lymphomas and lead to mismanagement.
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21
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Decreased PD-1 positive blood follicular helper T cells in patients with psoriasis. Arch Dermatol Res 2016; 308:593-9. [DOI: 10.1007/s00403-016-1679-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2015] [Revised: 07/04/2016] [Accepted: 08/01/2016] [Indexed: 10/21/2022]
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22
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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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23
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Inghirami G, Chan WC, Pileri S. Peripheral T-cell and NK cell lymphoproliferative disorders: cell of origin, clinical and pathological implications. Immunol Rev 2015; 263:124-59. [PMID: 25510275 DOI: 10.1111/imr.12248] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
T-cell lymphoproliferative disorders are a heterogeneous group of neoplasms with distinct clinical-biological properties. The normal cellular counterpart of these processes has been postulated based on functional and immunophenotypic analyses. However, T lymphocytes have been proven to be remarkably capable of modulating their properties, adapting their function in relationship with multiple stimuli and to the microenvironment. This impressive plasticity is determined by the equilibrium among a pool of transcription factors and by DNA chromatin regulators. It is now proven that the acquisition of specific genomic defects leads to the enforcement/activation of distinct pathways, which ultimately alter the preferential activation of defined regulators, forcing the neoplastic cells to acquire features and phenotypes distant from their original fate. Thus, dissecting the landscape of the genetic defects and their functional consequences in T-cell neoplasms is critical not only to pinpoint the origin of these tumors but also to define innovative mechanisms to re-adjust an unbalanced state to which the tumor cells have become addicted and make them vulnerable to therapies and targetable by the immune system. In our review, we briefly describe the pathological and clinical aspects of the T-cell lymphoma subtypes as well as NK-cell lymphomas and then focus on the current understanding of their pathogenesis and the implications on diagnosis and treatment.
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Affiliation(s)
- Giorgio Inghirami
- Department of Molecular Biotechnology and Health Science and Center for Experimental Research and Medical Studies (CeRMS), University of Torino, Torino, Italy; Department of Pathology, and NYU Cancer Center, New York University School of Medicine, New York, NY, USA; Department of Pathology and Laboratory Medicine, Weill Cornell Medical College, New York, NY, USA
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24
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LeBlanc RE, Lefterova MI, Suarez CJ, Tavallaee M, Kim YH, Schrijver I, Kim J, Gratzinger D. Lymph node involvement by mycosis fungoides and Sézary syndrome mimicking angioimmunoblastic T-cell lymphoma. Hum Pathol 2015; 46:1382-9. [PMID: 26193796 DOI: 10.1016/j.humpath.2015.05.024] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2015] [Revised: 05/28/2015] [Accepted: 05/29/2015] [Indexed: 10/23/2022]
Abstract
Clinical management of cutaneous T-cell lymphoma (CTCL) and angioimmunoblastic T-cell lymphoma (AITL) differs markedly. Diagnostic distinction is critical. Herein, we describe a series of 4 patients with clinically, molecularly, and histopathologically annotated mycosis fungoides or Sézary syndrome whose nodal disease mimicked AITL. The patients otherwise exhibited classic clinical manifestations of mycosis fungoides/Sézary syndrome preceding the onset of lymphadenopathy by 1 to 5 years. Skin biopsies revealed epidermotropic infiltrates characteristic of CTCL. Lymph node biopsies revealed dense CD4+ T-cell infiltrates that coexpressed follicular helper T-cell markers and were accompanied by proliferations of high endothelial venules and arborizing CD21+ follicular dendritic cell networks. Two patients had T-cell receptor gene rearrangement studies performed on their skin, lymph node, and peripheral blood demonstrating identical polymerase chain reaction clones in all 3 tissues. A small secondary clonal B-cell population was present in 1 patient that mimicked the B-cell proliferations known to accompany AITL and persisted on successive nodal biopsies over several years. This latter phenomenon has not previously been described in CTCL. The potential for patients to be misdiagnosed with AITL for lack of consideration of advanced-stage CTCL with nodal involvement underscores the necessity of information sharing among the various pathologists and clinicians involved in the care of each patient.
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Affiliation(s)
- Robert E LeBlanc
- Department of Pathology, Stanford University School of Medicine, Stanford, CA 94305
| | - Martina I Lefterova
- Department of Pathology, Stanford University School of Medicine, Stanford, CA 94305
| | - Carlos J Suarez
- Department of Pathology, Stanford University School of Medicine, Stanford, CA 94305
| | - Mahkam Tavallaee
- Department of Dermatology, Stanford University School of Medicine, Stanford, CA 94305
| | - Youn H Kim
- Department of Dermatology, Stanford University School of Medicine, Stanford, CA 94305
| | - Iris Schrijver
- Department of Pathology, Stanford University School of Medicine, Stanford, CA 94305
| | - Jinah Kim
- Department of Pathology, Stanford University School of Medicine, Stanford, CA 94305
| | - Dita Gratzinger
- Department of Pathology, Stanford University School of Medicine, Stanford, CA 94305.
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Pathophysiology of T follicular helper cells in humans and mice. Nat Immunol 2015; 16:142-52. [PMID: 25594465 DOI: 10.1038/ni.3054] [Citation(s) in RCA: 321] [Impact Index Per Article: 35.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2014] [Accepted: 11/12/2014] [Indexed: 02/08/2023]
Abstract
Follicular helper T cells (TFH cells) compose a heterogeneous subset of CD4(+) T cells that induce the differentiation of B cells into plasma cells and memory cells. They are found within and in proximity to germinal centers in secondary lymphoid organs, and their memory compartment also circulates in the blood. Our knowledge on the biology of TFH cells has increased significantly during the past decade, largely as a result of mouse studies. However, recent studies on human TFH cells isolated from lymphoid organ and blood samples and recent observations on the developmental mechanism of human TFH cells have revealed both similarities and differences between human and mouse TFH cells. Here we present the similarities and differences between mouse and human lymphoid organ-resident TFH cells and discuss the role of TFH cells in response to vaccines and in disease pathogenesis.
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Expression of T-Follicular Helper Markers in Sequential Biopsies of Progressive Mycosis Fungoides and Other Primary Cutaneous T-Cell Lymphomas. Am J Dermatopathol 2015; 37:115-21. [DOI: 10.1097/dad.0000000000000258] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
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Lan TTH, Brown NA, Hristov AC. Controversies and Considerations in the Diagnosis of Primary Cutaneous CD4+ Small/Medium T-Cell Lymphoma. Arch Pathol Lab Med 2014; 138:1307-18. [DOI: 10.5858/arpa.2014-0299-cc] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Context.—Primary cutaneous CD4+ small/medium T-cell lymphoma is a provisional and controversial entity with a broad differential diagnosis. Despite being an uncommon lymphoma, it is a frequent diagnostic consideration in cutaneous biopsies with a dense lymphoid infiltrate because it shows overlapping features with reactive lymphoid hyperplasia (pseudolymphoma) and a variety of other primary cutaneous and systemic lymphomas. However, proper classification of this process is important for determining patient prognosis and treatment options.
Objective.—To review the clinical, morphologic, immunophenotypic, and genetic features of primary cutaneous CD4+ small/medium T-cell lymphoma and contrast those features with entities in the differential diagnosis.
Data Sources.—Applicable literature will be reviewed with emphasis on current controversies and distinguishing characteristics.
Conclusions.—Although many consider primary cutaneous CD4+ small/medium T-cell lymphoma to be indistinguishable from reactive lymphoid hyperplasia/pseudolymphoma, it can be differentiated from other primary cutaneous and systemic lymphomas. Patients with solitary lesions of primary cutaneous CD4+ small/medium T-cell lymphoma generally have an excellent prognosis. Nevertheless, a subset of patients who have been reported to meet criteria for this lymphoma have followed a more-aggressive course; however, those patients show some differing clinical, morphologic, and immunophenotypic features.
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Affiliation(s)
- Thanh T. Ha Lan
- From the Departments of Pathology (Drs Lan, Brown, and Hristov) and Dermatology (Drs Lan and Hristov), University of Michigan Health System, Ann Arbor
| | - Noah A. Brown
- From the Departments of Pathology (Drs Lan, Brown, and Hristov) and Dermatology (Drs Lan and Hristov), University of Michigan Health System, Ann Arbor
| | - Alexandra C. Hristov
- From the Departments of Pathology (Drs Lan, Brown, and Hristov) and Dermatology (Drs Lan and Hristov), University of Michigan Health System, Ann Arbor
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