1
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Fisher CM, Capen SF, Bandino JP, Holmes AR, Lee CM. Prominent tissue hemophagocytic lymphohistiocytosis obscuring primary cutaneous gamma/delta (γδ) T-cell lymphoma. J Cutan Pathol 2024. [PMID: 39295229 DOI: 10.1111/cup.14718] [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: 10/03/2023] [Revised: 08/14/2024] [Accepted: 09/01/2024] [Indexed: 09/21/2024]
Abstract
Primary cutaneous gamma/delta (γδ) T-cell lymphoma (PCGDTCL) is a rare, aggressive malignant neoplasm of γδ T lymphocytes arising within the skin and subcutis. We present a challenging case of PCGDTCL diagnosed in a 35-year-old male soldier who presented with constitutional symptoms, pancytopenia, hemophagocytic lymphohistiocytosis (HLH), disseminated lymphadenopathy, and cutaneous lesions on his extremities and back following a deployment to Iraq and Syria. Histopathologic evaluation of an excisional biopsy showed that PCGDTCL can be focal, localized to the subcutaneous adipose tissue, and obscured by predominant HLH in the surrounding tissues. Pathologists should recognize that the diagnosis of PCGDTCL may be confounded by florid HLH and require multiple biopsies and a comprehensive immunohistochemical panel.
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Affiliation(s)
- Craig M Fisher
- Department of Dermatology, Wilford Hall Ambulatory Surgical Center, JBSA Lackland, Texas, USA
| | - Steven F Capen
- Department of Pathology and Area Laboratory Services, Brooke Army Medical Center, JBSA-Fort Sam Houston, Texas, USA
| | - Justin P Bandino
- Department of Dermatology, Wilford Hall Ambulatory Surgical Center, JBSA Lackland, Texas, USA
| | - Allen R Holmes
- Department of Pathology and Area Laboratory Services, Brooke Army Medical Center, JBSA-Fort Sam Houston, Texas, USA
| | - Christine M Lee
- Department of Pathology and Area Laboratory Services, Brooke Army Medical Center, JBSA-Fort Sam Houston, Texas, USA
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2
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Shaker N, Blankenship H, Masatkar V, Niu S, Sangueza OP. Navigating Diagnostic and Therapeutic Challenges in Primary Cutaneous Gamma/Delta T-Cell Lymphoma: A Case Study of Fatal Outcomes Within Two Months. Am J Dermatopathol 2024; 46:593-596. [PMID: 39150181 DOI: 10.1097/dad.0000000000002743] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/17/2024]
Abstract
ABSTRACT Primary cutaneous gamma/delta T-cell lymphoma (PCGD-TCL) is a rare yet highly aggressive subtype of primary cutaneous lymphoma. Characterized by its challenging diagnosis and poor prognosis, PCGD-TCL presents unique clinical and histopathological features that distinguish it from other primary cutaneous lymphoma subtypes. Here, we report the case of a 75-year-old man who initially presented with multiple erythematous indurated plaques over his back and bilateral lower extremities. The initial biopsy suggested primary cutaneous T-cell lymphoma (PCTCL) with a CD30-negative phenotype. However, within a 2-month interval, the disease progressed rapidly, manifesting as extensive skin involvement across the chest and upper extremities. A repeat skin biopsy was performed, revealing dermal atypical lymphocytes without epidermotropism. Immunohistochemical analysis demonstrated positivity for CD3, CD5, and CD4, as well as T-cell receptor delta (TCR delta) expression, along with the loss of CD8 and CD30 expression. These findings were consistent with a diagnosis of PCGD-TCL. Despite therapeutic interventions, including systemic treatments, the patient's condition deteriorated rapidly, ultimately leading to his demise within a month of receiving the PCGD-TCL diagnosis. This case highlights the diagnostic complexities associated with PCGD-TCL, emphasizing the importance of careful histopathological examination and immunophenotypic characterization. Given its aggressive nature and propensity for rapid dissemination, early recognition of PCGD-TCL is paramount for initiating appropriate therapeutic interventions. However, effective treatment options for PCGD-TCL remain limited, and the disease typically carries an unfavorable prognosis. Further research is needed to elucidate the underlying molecular mechanisms driving the pathogenesis of PCGD-TCL, to identify novel therapeutic targets, and to improve patient outcomes. In addition, increased awareness among clinicians and pathologists regarding the clinical presentation and diagnostic criteria of PCGD-TCL is crucial for facilitating timely diagnosis and management of this challenging malignancy.
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Affiliation(s)
- Nada Shaker
- Department of Pathology, The Ohio State University Wexner Medical Center/James Cancer Hospital, Columbus, OH
| | - Heath Blankenship
- Department of Pathology and Dermatology, Wake Forest University, School of Medicine, Medical Center Boulevard, Winston-Salem, NC; and
| | - Vaishali Masatkar
- Department of Pathology and Dermatology, Wake Forest University, School of Medicine, Medical Center Boulevard, Winston-Salem, NC; and
| | - Shuo Niu
- Department of Pathology, Wake Forest University, School of Medicine, Medical Center Boulevard, Winston-Salem, NC
| | - Omar P Sangueza
- Department of Pathology and Dermatology, Wake Forest University, School of Medicine, Medical Center Boulevard, Winston-Salem, NC; and
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3
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Kempf W, Mitteldorf C, Cerroni L, Willemze R, Berti E, Guenova E, Scarisbrick JJ, Battistella M. Classifications of cutaneous lymphomas and lymphoproliferative disorders: An update from the EORTC cutaneous lymphoma histopathology group. J Eur Acad Dermatol Venereol 2024; 38:1491-1503. [PMID: 38581201 DOI: 10.1111/jdv.19987] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2023] [Accepted: 02/28/2024] [Indexed: 04/08/2024]
Abstract
The classification of primary cutaneous lymphomas and lymphoproliferative disorders (LPD) is continuously evolving by integrating novel clinical, pathological and molecular data. Recently two new classifications for haematological malignancies including entities of cutaneous lymphomas were proposed: the 5th edition of the WHO classification of haematolymphoid tumours and the International Consensus Classification (ICC) of mature lymphoid neoplasms. This article provides an overview of the changes introduced in these two classifications compared to the previous WHO classification. The main changes shared by both classifications include the downgrading of CD8+ acral T-cell lymphoma to CD8+ acral T-cell LPD, and the recognition of entities that were previously categorized as provisional and have now been designated as definite types including primary cutaneous small or medium CD4+ T-cell LPD, primary cutaneous gamma/delta T-cell lymphoma, primary cutaneous CD8+ aggressive epidermotropic cytotoxic T-cell lymphoma, Epstein-Barr virus-positive mucocutaneous ulcer. Both classifications consider primary cutaneous marginal zone B-cell clonal neoplasm as an indolent disease but use a different terminology: primary cutaneous marginal zone lymphoma (WHO) and primary cutaneous marginal zone LPD (ICC). The 5th WHO classification further introduces and provides essential and desirable diagnostic criteria for each disease type and includes chapters on reactive B- or T-cell rich lymphoid proliferations formerly referred as cutaneous pseudolymphomas, as well as histiocyte and CD8 T-cell rich LPD in patients with inborn error of immunity. As already emphasized in previous lymphoma classifications, the importance of integrating clinical, histological, phenotypic and molecular features remains the crucial conceptual base for defining cutaneous (and extracutaneous) lymphomas.
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Affiliation(s)
- W Kempf
- Kempf und Pfaltz Histologische Diagnostik, Zurich, Switzerland
- Department of Dermatology, University Hospital Zurich, Zurich, Switzerland
| | - C Mitteldorf
- Department of Dermatology, Venereology and Allergology, University Medical Center Göttingen, Göttingen, Germany
| | - L Cerroni
- Research Unit of Dermatopathology, Department of Dermatology, Medical University of Graz, Graz, Austria
| | - R Willemze
- Department of Dermatology, Leiden University Medical Center, Leiden, The Netherlands
| | - E Berti
- Department of Dermatology, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - E Guenova
- Department of Dermatology, Lausanne University Hospital, Lausanne, Switzerland
- Faculty of Biology and Medicine, University of Lausanne, Lausanne, Switzerland
| | - J J Scarisbrick
- Centre for Rare Diseases, University Hospital of Birmingham, Birmingham, UK
| | - M Battistella
- Service de Pathologie, Hôpital Saint-Louis, AP-HP, Paris, France
- Inserm U976 "Human Immunology, Pathophysiology and Immunotherapy", Université Paris Cité, Paris, France
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4
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Nielsen PR, Schejbel L, Josefsson PL, Skov L, Nielsen SL. Atypical presentation of γ/δ mycosis fungoides with an unusual phenotype and SOCS1 mutation. Open Life Sci 2024; 19:20220925. [PMID: 39091627 PMCID: PMC11292030 DOI: 10.1515/biol-2022-0925] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2024] [Revised: 06/12/2024] [Accepted: 06/19/2024] [Indexed: 08/04/2024] Open
Abstract
Mycosis fungoides is the most frequent subtype of primary cutaneous T-cell lymphomas. The diagnosis is based on a thorough clinic-pathologic correlation, which can, especially in early-stage disease, be challenging due to similarities with several benign skin disorders such as psoriasis and atopic dermatitis. Here, we present a case of an 81-year-old man with a 20-year-long medical history of skin problems treated as psoriasis with limited effect. Since December 2021, the patient experienced worsening of his skin symptoms with rapidly growing tumors and widespread patches and plaques. Positron emission tomography/computed tomography evaluation revealed markedly metabolic activity related to the skin tumors and increased FDG uptake in several retroperitoneal lymph nodes. Histological assessment of skin biopsies demonstrated a highly proliferative T-cell lymphoma with a γ/δ+ and CD8+ cytotoxic phenotype. The morphology of the tumor cells appeared blastic with an abnormal immunephenotype CD3+, CD2-, CD5dim, CD4-, CD8+, CD56-, and CD30-. Next-generation sequencing detected a likely pathogenic SOCS1 mutation with an allele frequency of 72% as well as a STAT3 variant of unknown significance. This case highlights the diagnostic complexity of an indolent skin lymphoma evolving into an aggressive cytotoxic lymphoma.
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Affiliation(s)
- Pia Rude Nielsen
- Department of Pathology, Herlev and Gentofte Hospital, Copenhagen University Hospital, Borgmester Ib Juuls Vej 73, Staircase 7, floor 4 (L5), 2730 Herlev, Copenhagen, Denmark
| | - Lone Schejbel
- Department of Pathology, Herlev and Gentofte Hospital, Copenhagen University Hospital, Copenhagen, Denmark
| | - Pär Lars Josefsson
- Department of Hematology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Lone Skov
- Department of Dermatology and Allergy, Herlev and Gentofte Hospital, Copenhagen University Hospital, Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Signe Ledou Nielsen
- Department of Pathology, Herlev and Gentofte Hospital, Copenhagen University Hospital, Copenhagen, Denmark
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5
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Mark E, Kempf W, Guitart J, Pulitzer M, Mitteldorf C, Hristov A, Torres-Cabala C, Marchi E, Cropley T, Rodriguez Pinilla SM, Griffin T, Fernandez R, Pileri S, Pileri A, Tabanelli V, Borretta L, Subtil A, Plaza JA, Piris JAMA, Feldman AL, Cerroni L, Gru AA. Lymphomatoid Papulosis With T-cell Receptor-Gamma Delta Expression: A Clinicopathologic Case-series of 26 Patients of an Underrecognized Immunophenotypic Variant of Lymphomatoid Papulosis. Am J Surg Pathol 2024; 48:501-510. [PMID: 38533681 DOI: 10.1097/pas.0000000000002200] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/28/2024]
Abstract
Lymphomatoid papulosis (LyP) has several histopathologic presentations. LyP featuring gamma-delta (γδ) T-cell receptor expression may masquerade as and may be misdiagnosed as aggressive cutaneous T-cell lymphoma, particularly primary cutaneous γδ T-cell lymphoma (PCGDTL) or γδ mycosis fungoides. We performed a clinicopathologic analysis of the largest series of LyP featuring γδ T-cell expression. We identified 26 patients with a diagnosis of LyP with γδ T cells from our institutions, as well as through a comprehensive review of the literature, and characterized these cases. Most cases were treated with topical steroids or not treated at all. The majority of cases showed a CD4 - CD8 + phenotype and featured at least one cytotoxic marker. Histopathologic features included an intraepidermal or dermal infiltrate with large cells and frequent angiotropism. One case was initially misdiagnosed as PCGDTL, requiring further therapy. Our case series, the largest international cohort of γδ T cell predominant LyP cases, confirms marked clinicopathologic heterogeneity that may contribute to misdiagnosis, reasserting the need to identify classic clinical features, CD30 + T-cell components, and markers of cytotoxicity when dealing with this differential diagnosis. A limitation of this study includes somewhat limited follow-up, histologic, and immunophenotypic information for some cases.
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Affiliation(s)
| | - Werner Kempf
- Department of Dermatology, Kempf und Pfaltz Histologische Diagnostik, University of Zurich, Zurich, Switzerland
| | - Joan Guitart
- Department of Dermatology, Northwestern University, Chicago, IL
| | - Melissa Pulitzer
- Department of Pathology, Memorial Sloan-Kettering Cancer Center, New York City, NY
| | - Christina Mitteldorf
- Department of Dermatology, University Medical Center Göttingen, Venereology and Allergology, Göttingen, Germany
| | - Alexandra Hristov
- Departments of Pathology and Dermatology, University of Michigan, Ann Arbor, MI
| | - Carlos Torres-Cabala
- Departments of Pathology and Dermatology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | | | - Thomas Cropley
- Department of Dermatology, University of Virginia, Charlottesville, VA
| | | | - Teresa Griffin
- Department of Dermatology, Northwestern University, Chicago, IL
| | - Rony Fernandez
- Department of Dermatology, Northwestern University, Chicago, IL
| | - Stefano Pileri
- Department of Pathology, European Institute of Oncology IRCCS, Hematopathology Division, Milan
| | - Alessandro Pileri
- Department of Surgical and Medical Science, Bologna University, Bologna, Italy
- Dermatology Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna
| | | | | | - Antonio Subtil
- Department of Pathology, University of British Columbia, Royal Jubilee Hospital, Victoria, Canada
| | - Jose Antonio Plaza
- Departments of Pathology and Dermatology, The Ohio State University, Columbus, OH
| | | | - Andrew L Feldman
- Mayo Clinic, Department of Laboratory Medicine and Pathology, Rochester, MN
| | - Lorenzo Cerroni
- Department of Dermatology, Medical University of Graz, Graz, Austria
| | - Alejandro A Gru
- Department of Pathology
- Department of Dermatology, University of Virginia, Charlottesville, VA
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6
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Ashok Kumar P, Sivapiragasam A, Wang D, Huang D, Gentile T. Descriptive Analysis and Factors Influencing Survival in Patients With Primary Cutaneous Gamma-Delta T Cell Lymphoma. A Retrospective National Cancer Database Study. CLINICAL LYMPHOMA, MYELOMA & LEUKEMIA 2023; 23:897-904. [PMID: 37690902 DOI: 10.1016/j.clml.2023.08.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Revised: 08/16/2023] [Accepted: 08/18/2023] [Indexed: 09/12/2023]
Abstract
BACKGROUND Gamma delta T cells gives rise to a rare malignancy called Primary cutaneous Gamma-Delta T cell lymphoma (PCGDTCL). METHODS From the National Cancer Database (NCDB), 110 (0.015%) patients with PCGDTCL were identified. RESULTS Males aged >60 years were the commonest cohort. Caucasian race was the most common (Caucasian: 79.09%, African American:16.36%). Most patients were diagnosed at stage 1 (52.33%), followed by stage 4 (30.23%). On analyzing income categories, <$48,000 group had 48.15% stage 4 (13/27) and 40.74% (11/27) stage 1. Overall survival (OS) of the study group at 3 years by Kaplan-Meier (KM) analysis was 46.6%. African American race (37.5%), income of <$48,000 (27.6%) and government insurance (38.8%) had lower survival rates in KM analysis. In the adjusted hazard ratio (HR) analysis, only age <=40 years compared to >60 years (0.165 [0.036, 0.768], P= .0217) reached significance. Although the group that did not receive any chemotherapy or radiation seemed to have a better survival by KM analysis at 74.3% at 3 years, significance was not seen in the adjusted HR estimates and majority of the patients in this group were stage 1. This group may have received topical treatments which may have not been captured in NCDB. Adjusted analysis also revealed chemoradiation to have a lower mortality risk compared to chemotherapy alone (0.229 [0.079, 0.670], P = .0071), suggesting that aggressive strategies may be required for management when needed. CONCLUSION Socioeconomic disparities significantly impact access to healthcare and are of particular importance in rare lymphomas.
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Affiliation(s)
- Prashanth Ashok Kumar
- Division of Hematology-Oncology, Upstate Cancer Center, Upstate University Hospital, Syracuse, NY.
| | - Abirami Sivapiragasam
- Division of Hematology-Oncology, Upstate Cancer Center, Upstate University Hospital, Syracuse, NY
| | - Dongliang Wang
- Department of Public Health and Preventive Medicine, Upstate University Hospital, Syracuse, NY
| | - Danning Huang
- Department of Public Health and Preventive Medicine, Upstate University Hospital, Syracuse, NY
| | - Teresa Gentile
- Division of Hematology-Oncology, Upstate Cancer Center, Upstate University Hospital, Syracuse, NY
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7
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Saleh JS, Subtil A, Hristov AC. Primary cutaneous T-cell lymphoma: a review of the most common entities with focus on recent updates. Hum Pathol 2023; 140:75-100. [PMID: 37802757 DOI: 10.1016/j.humpath.2023.09.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Revised: 06/01/2023] [Accepted: 06/07/2023] [Indexed: 10/08/2023]
Abstract
Cutaneous T-cell lymphomas are an heterogeneous group of uncommon lymphoid neoplasms that are challenging to diagnose and require close collaboration between dermatologists, pathologists and hematologists/oncologists. This article reviews the most common cutaneous T-cell lymphomas: mycosis fungoides (both classic and variant forms) as well as its leukemic counterpart Sézary syndrome, CD30+ T-cell lymphoproliferative disorders including the ever-expanding group of lymphomatoid papulosis and primary cutaneous anaplastic large cell lymphoma, and primary cutaneous CD4+ small/medium lymphoproliferative disorder. We discuss the classic clinical and histopathologic features of these lymphomas and review how they can be distinguished from reactive entities. In particularly, updates to these diagnostic categories and current controversies in classification are highlighted. Moreover, we review the prognosis and treatment for each entity. These lymphomas exhibit variable prognosis, and therefore it is important to correctly classify atypical cutaneous T-cell infiltrates for appropriate patient treatment and prognosis. Cutaneous T-cell lymphomas are at the interface of several medical specialties; this review seeks to summarize key features of these lymphomas and highlight new and emerging insights into these lymphomas.
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Affiliation(s)
- Jasmine S Saleh
- Department of Pathology, University of Michigan, Ann Arbor, MI, 48109, USA; Department of Dermatology, University of Michigan, Ann Arbor, MI, 48109, USA
| | - Antonio Subtil
- Department of Pathology, Royal Jubilee Hospital, University of British Columbia, Victoria, British Columbia, V8R1J8, Canada
| | - Alexandra C Hristov
- Department of Pathology, University of Michigan, Ann Arbor, MI, 48109, USA; Department of Dermatology, University of Michigan, Ann Arbor, MI, 48109, USA.
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8
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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.
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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
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9
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Saleh JS, Subtil A, Hristov AC. Primary cutaneous T-cell lymphoma: a review of the most common entities with focus on recent updates. Hum Pathol 2023; 138:76-102. [PMID: 37307932 DOI: 10.1016/j.humpath.2023.06.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Revised: 06/01/2023] [Accepted: 06/07/2023] [Indexed: 06/14/2023]
Abstract
Cutaneous T-cell lymphomas are an heterogeneous group of uncommon lymphoid neoplasms that are challenging to diagnose and require close collaboration between dermatologists, pathologists and hematologists/oncologists. This article reviews the most common cutaneous T-cell lymphomas: mycosis fungoides (both classic and variant forms) as well as its leukemic counterpart Sézary syndrome, CD30+ T-cell lymphoproliferative disorders including the ever-expanding group of lymphomatoid papulosis and primary cutaneous anaplastic large cell lymphoma, and primary cutaneous CD4+ small/medium lymphoproliferative disorder. We discuss the classic clinical and histopathologic features of these lymphomas and review how they can be distinguished from reactive entities. In particularly, updates to these diagnostic categories and current controversies in classification are highlighted. Moreover, we review the prognosis and treatment for each entity. These lymphomas exhibit variable prognosis, and therefore it is important to correctly classify atypical cutaneous T-cell infiltrates for appropriate patient treatment and prognosis. Cutaneous T-cell lymphomas are at the interface of several medical specialties; this review seeks to summarize key features of these lymphomas and highlight new and emerging insights into these lymphomas.
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Affiliation(s)
- Jasmine S Saleh
- Department of Pathology, University of Michigan, Ann Arbor, MI, 48109, USA; Department of Dermatology, University of Michigan, Ann Arbor, MI, 48109, USA
| | - Antonio Subtil
- Department of Pathology, Royal Jubilee Hospital, University of British Columbia, Victoria, British Columbia, V8R1J8, Canada
| | - Alexandra C Hristov
- Department of Pathology, University of Michigan, Ann Arbor, MI, 48109, USA; Department of Dermatology, University of Michigan, Ann Arbor, MI, 48109, USA.
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10
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Tamaki T, Karube K, Sakihama S, Tsuruta Y, Awazawa R, Hayashi M, Nakada N, Matsumoto H, Yagi N, Ohshiro K, Nakazato I, Kitamura S, Nishi Y, Miyagi T, Yamaguchi S, Nakachi S, Morishima S, Masuzaki H, Takahashi K, Fukushima T, Wada N. A Comprehensive Study of the Immunophenotype and its Clinicopathologic Significance in Adult T-Cell Leukemia/Lymphoma. Mod Pathol 2023; 36:100169. [PMID: 36997002 DOI: 10.1016/j.modpat.2023.100169] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Revised: 03/10/2023] [Accepted: 03/17/2023] [Indexed: 03/31/2023]
Abstract
Adult T-cell leukemia/lymphoma (ATLL) is a mature T-cell tumor caused by human T-lymphotropic virus type 1 (HTLV-1). The typical ATLL immunophenotypes are described in the 2017 World Health Organization Classification of Tumours of Haematopoietic and Lymphoid Tissues (positive: CD2, CD3, CD5, CD4, and CD25; negative: CD7, CD8, and cytotoxic markers; and partially positive: CD30, CCR4, and FOXP3). However, limited studies are available on the expression of these markers, and their mutual relationship remains unknown. Furthermore, the expression status of novel markers associated with T-cell lymphomas, including Th1 markers (T-bet and CXCR3), Th2 markers (GATA3 and CCR4), T follicular helper markers (BCL6, PD1, and ICOS), and T-cell receptor (TCR) markers, and their clinicopathologic significance is unclear. In this study, we performed >20 immunohistochemical stains in 117 ATLL cases to determine the comprehensive immunophenotypic profile of ATLL, which were compared on the basis of clinicopathologic factors, including morphologic variants (pleomorphic vs anaplastic), biopsy locations, treatments, Shimoyama classification-based clinical subtype, and overall survival. CD3+/CD4+/CD25+/CCR4+ was considered a typical immunophenotype of ATLL, but approximately 20% of cases did not conform to this pattern. Simultaneously, the following new findings were obtained: (1) most cases were negative for TCR-β and TCR-δ (104 cases, 88.9%), indicating the usefulness of negative conversion of TCR expression to provide differentiation from other T-cell tumors; (2) the positivity of CD30 and CD15 and the negativity of FOXP3 and CD3 were significantly associated with anaplastic morphology; and (3) atypical cases, such as T follicular helper marker-positive (12 cases, 10.3%) and cytotoxic molecule-positive cases (3 cases, 2.6%), were identified. No single markers could predict the overall survival among patients with acute/lymphoma subtypes of ATLL. The results of this study illustrate the diversity of ATLL phenotypes. In T-cell tumors occurring in HTLV-1 carriers, the possibility of ATLL should not be eliminated even when the tumor exhibits an atypical phenotype, and the confirmation of HTLV-1 in the tissue is recommended.
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Affiliation(s)
- Tomoko Tamaki
- Department of Pathology and Oncology, Graduate School of Medicine, University of the Ryukyus, Okinawa, Japan.
| | - Kennosuke Karube
- Department of Pathology and Laboratory Medicine, Graduate School of Medicine, Nagoya University, Aichi, Japan; Laboratory of Hemato-Immunology, Graduate School of Health Sciences, University of the Ryukyus, Nishihara, Japan.
| | - Shugo Sakihama
- Laboratory of Hemato-Immunology, Graduate School of Health Sciences, University of the Ryukyus, Nishihara, Japan
| | - Yuma Tsuruta
- Department of Pathology, Nakagami Hospital, Okinawa, Japan
| | - Ryoko Awazawa
- Department of Dermatology, Nakagami Hospital, Okinawa, Japan
| | - Masaki Hayashi
- Department of Hematology, Nakagami Hospital, Okinawa, Japan
| | | | | | - Nobutake Yagi
- Department of Dermatology, Okinawa Prefectural Nanbu Medical Center and Children's Medical Center, Okinawa, Japan
| | - Kazuiku Ohshiro
- Department of Hematology and Oncology, Okinawa Prefectural Nanbu Medical Center and Children's Medical Center, Okinawa, Japan
| | - Iwao Nakazato
- Department of Pathology, Okinawa Prefectural Nanbu Medical Center and Children's Medical Center, Okinawa, Japan
| | - Sakiko Kitamura
- Division of Endocrinology, Diabetes and Metabolism, Hematology, Rheumatology (Second Department of Internal Medicine), Graduate School of Medicine, University of the Ryukyus, Okinawa, Japan
| | - Yukiko Nishi
- Division of Endocrinology, Diabetes and Metabolism, Hematology, Rheumatology (Second Department of Internal Medicine), Graduate School of Medicine, University of the Ryukyus, Okinawa, Japan
| | - Takuya Miyagi
- Department of Dermatology, Graduate School of Medicine, University of the Ryukyus, Okinawa, Japan
| | - Sayaka Yamaguchi
- Department of Dermatology, Graduate School of Medicine, University of the Ryukyus, Okinawa, Japan
| | - Sawako Nakachi
- Division of Endocrinology, Diabetes and Metabolism, Hematology, Rheumatology (Second Department of Internal Medicine), Graduate School of Medicine, University of the Ryukyus, Okinawa, Japan
| | - Satoko Morishima
- Division of Endocrinology, Diabetes and Metabolism, Hematology, Rheumatology (Second Department of Internal Medicine), Graduate School of Medicine, University of the Ryukyus, Okinawa, Japan
| | - Hiroaki Masuzaki
- Division of Endocrinology, Diabetes and Metabolism, Hematology, Rheumatology (Second Department of Internal Medicine), Graduate School of Medicine, University of the Ryukyus, Okinawa, Japan
| | - Kenzo Takahashi
- Department of Dermatology, Graduate School of Medicine, University of the Ryukyus, Okinawa, Japan
| | - Takuya Fukushima
- Laboratory of Hemato-Immunology, Graduate School of Health Sciences, University of the Ryukyus, Nishihara, Japan
| | - Naoki Wada
- Department of Pathology and Oncology, Graduate School of Medicine, University of the Ryukyus, Okinawa, Japan
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11
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Murray DW, Fagan KK, Timmermann PC, Grider DJ. Erythematous Patches and Plaques: What to Make of a Rash that Looks like Pepperoni Pizza? Am J Dermatopathol 2023; 45:427-428. [PMID: 37191374 DOI: 10.1097/dad.0000000000002425] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/17/2023]
Affiliation(s)
| | - Kiley K Fagan
- Section of Dermatology, Department of Internal Medicine, Virginia Tech Carilion School of Medicine, Roanoke, VA
| | - Paul C Timmermann
- Section of Dermatology, Department of Internal Medicine, Virginia Tech Carilion School of Medicine, Roanoke, VA
| | - Douglas J Grider
- Virginia Tech Carilion School of Medicine, Roanoke, VA
- Section of Dermatology, Department of Internal Medicine, Virginia Tech Carilion School of Medicine, Roanoke, VA
- Department of Basic Science Education, Virginia Tech Carilion School of Medicine, Roanoke, VA; and
- Dominion Pathology Associates, Roanoke, VA
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12
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Aggressive Cutaneous Lymphomas and Their Mimics. Surg Pathol Clin 2023; 16:361-383. [PMID: 37149363 DOI: 10.1016/j.path.2023.01.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/12/2023]
Abstract
Cutaneous lymphomas encompass a heterogeneous group of neoplasms with a wide spectrum of clinical presentations, histopathologic features, and prognosis. Because there are overlapping pathologic features among indolent and aggressive forms and with systemic lymphomas that involve the skin, clinicopathologic correlation is essential. Herein, the clinical and histopathologic features of aggressive cutaneous B- and T-cell lymphomas are reviewed. Indolent cutaneous lymphomas/lymphoproliferative disorders, systemic lymphomas, and reactive processes that may mimic these entities are also discussed. This article highlights distinctive clinical and histopathologic features, increases awareness of rare entities, and presents new and evolving developments in the field.
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13
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Shimshak S, Sokumbi O, Isaq N, Goyal A, Comfere N. A Practical Guide to the Diagnosis, Evaluation, and Treatment of Cutaneous T-Cell Lymphoma. Dermatol Clin 2023; 41:209-229. [DOI: 10.1016/j.det.2022.07.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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14
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Primary cutaneous lymphoma: the 2018 update of the WHO-EORTC classification. Presse Med 2022; 51:104126. [DOI: 10.1016/j.lpm.2022.104126] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2021] [Accepted: 05/02/2022] [Indexed: 11/22/2022] Open
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15
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Gamma/Delta (γδ) T Cells: The Role of the T-Cell Receptor in Diagnosis and Prognosis of Hematologic Malignancies. Am J Dermatopathol 2022; 44:237-248. [PMID: 35287137 DOI: 10.1097/dad.0000000000002041] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
ABSTRACT There are 2 types of T cells: αβ and γδ T cells, named based on the composition of the T-cell receptor. γδ T cells are rare, making up 0.5%-10% of T cells. Although most leukemias, lymphomas, and immune-mediated conditions derive from αβ T cells, a handful of rare but important diseases are generally derived from γδ T cells, particularly primary cutaneous γδ T-cell lymphoma, hepatosplenic T-cell lymphoma, and monomorphic epitheliotropic intestinal T-cell lymphoma. There are also malignancies that may evince a γδ TCR phenotype, including large granulocytic lymphocyte leukemia, T-cell acute lymphobplastic leukemia (T-ALL), and mycosis fungoides, although such cases are rare. In this article, we will review the genesis of the T-cell receptor, the role of γδ T cells, and the importance of TCR type and methods of detection and outline the evidence for prognostic significance (or lack thereof) in lymphomas of γδ T cells. We will also highlight conditions that rarely may present with a γδ TCR phenotype and assess the utility of testing for TCR type in these diseases.
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16
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CD5+ Gamma Delta T-Cell Lymphoproliferative Disorder/Lymphoma Without Cytotoxic Granules in the Skin. Am J Dermatopathol 2022; 44:680-682. [PMID: 35234187 DOI: 10.1097/dad.0000000000002171] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
ABSTRACT We report a case of an unusual and aggressive gamma delta T-cell lymphoproliferative disorder/lymphoma presenting in the skin that lacked the expected cytotoxic markers and had increased expression of CD5, CD20, CD79a, CD30, and PD-1 without CD56. Monoclonal TCR-γ gene rearrangement was identified. A computed tomography scan of the chest, abdomen, and pelvis revealed a 7.7-cm soft-tissue inguinal mass and prominent retroperitoneal and pelvic lymphadenopathy, without hepatosplenomegaly. Flow cytometry finding on peripheral blood was normal. The clinical, morphologic, and immunophenotypic features of this case defy the current World Health Organization and European Organization for Research and Treatment of Cancer classifications, and a similar case has not been reported previously.
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17
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Guitart J, Chung C, Torres-Cabala CA. The dilemma of Primary γδ Epidermotropic T-cell lymphoma: Distinction from Mycosis Fungoides, Signs of Cytotoxicity, and Need for More Detailed Analysis. J Cutan Pathol 2022; 49:419-420. [PMID: 35080039 DOI: 10.1111/cup.14204] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2021] [Revised: 01/19/2022] [Accepted: 01/21/2022] [Indexed: 11/29/2022]
Affiliation(s)
- Joan Guitart
- Department of Dermatology, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Christopher Chung
- Department of Dermatology, Northwestern University Feinberg School of Medicine, Chicago, IL
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18
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Primary Cutaneous Gamma-Delta T-Cell Lymphoma Mimicking anaplastic lymphoma kinase-1-Negative Anaplastic Large Cell Lymphoma: A Case Report. Am J Dermatopathol 2022; 44:62-65. [PMID: 34889814 DOI: 10.1097/dad.0000000000002014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
ABSTRACT Primary cutaneous gamma-delta T-cell lymphoma is a rare and aggressive neoplasm, representing less than 1% of all cutaneous T-cell lymphomas. In this article, we report the case of a 49-year-old woman who presented with a history of generalized skin rash and a recent mass on the left upper extremity, as well as right inguinal soft tissue swelling and splenomegaly. Histologic examination of the mass revealed a diffuse subcutaneous infiltrate of large anaplastic and CD30-positive lymphoid cells with rimming of the adipocytes. This case demonstrates unusual cytologic features in primary cutaneous gamma-delta T-cell lymphoma that mimic the features of anaplastic lymphoma kinase-1-negative anaplastic large-cell lymphoma.
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19
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Goyal A, O'Leary D, Duncan LM. The significance of epidermal involvement in primary cutaneous gamma/delta (γδ) T-cell lymphoma: A systematic review and meta-analysis. J Cutan Pathol 2021; 48:1449-1454. [PMID: 34151455 DOI: 10.1111/cup.14082] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Revised: 05/11/2021] [Accepted: 05/24/2021] [Indexed: 11/27/2022]
Abstract
BACKGROUND Primary cutaneous gamma/delta (γδ) T-cell lymphoma (PCGDTCL) is a rare, aggressive peripheral T-cell lymphoma. There is evidence that patients with epidermotropic PCGDTCL may have an improved prognosis compared with those with only dermal and/or subcutaneous involvement. METHODS Systematic review of the literature and application of inclusion criteria yielded 48 manuscripts detailing the cases of 104 patients. RESULTS Of the 104 patients, 57 were male (51.4%) and 47 were female (48.5%) Based on provided histopathologic descriptions, 57 cases (54.8%) had no epidermotropism, 47 cases (45.2%) patients demonstrated any degree of epidermotropism, and 25 cases were predominantly epidermotropic (25/104, 24%). Five-year overall survivals for patients with no epidermotropism, any epidermotropism, and predominantly epidermotropic presentation were 32.8%, 28.9%, and 40.0%, respectively (p = 0.40). The most commonly performed immunohistochemical markers were CD3, CD4, CD8, CD5, CD7, CD30, CD56, TCR beta, TCR γ, and TCR δ. There was no statistically significant difference in immunophenotype between groups. Lesion morphology was described in the majority of cases (85/104, 80.9%); most cases presented as a combination of nodules, plaques, and tumors (77.4%). Several cases had more atypical presentations, including "mycosis-fungoides-like" and ulcerated. CONCLUSION In PCGDTCL, neither epidermotropism nor predominantly epidermotropic phenotype predict a better prognosis. In addition, the case report literature in dermatology and dermatopathology is rich and highly valuable.
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Affiliation(s)
- Amrita Goyal
- Dermatopathology Unit, Pathology Service, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Daniel O'Leary
- Division of Hematology, Oncology, and Transplantation, University of Minnesota, Minneapolis, Minnesota, USA
| | - Lyn M Duncan
- Dermatopathology Unit, Pathology Service, Massachusetts General Hospital, Boston, Massachusetts, USA
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20
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Alberti-Violetti S, Maronese CA, Venegoni L, Merlo V, Berti E. Primary Cutaneous Gamma-Delta T Cell Lymphomas: A Case Series and Overview of the Literature. Dermatopathology (Basel) 2021; 8:515-524. [PMID: 34842638 PMCID: PMC8628721 DOI: 10.3390/dermatopathology8040054] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2021] [Revised: 11/09/2021] [Accepted: 11/11/2021] [Indexed: 11/17/2022] Open
Abstract
Primary cutaneous gamma-delta T cell lymphomas (PCGDTCLs) are rare and aggressive cutaneous malignancies that have been diagnostically challenging for dermopathologists and clinicians since their first published descriptions in 1991. Since then, the availability of immunostaining for T cell receptors γ and δ in formalin-fixed paraffin-embedded samples has greatly increased our knowledge of the gamma-delta phenotype by showing that it may also be present in the context of indolent entities, such as mycosis fungoides (MFs) and lymphomatoid papulosis, and this has raised questions concerning its diagnostic and prognostic implications. We here describe the histological and clinical differences between the dermo-epidermal and subcutaneous sub-groups of PCGDTCL observed in a cohort of 20 patients attending a single experienced centre, with particular focus on cases with an MF-like presentation, which are still less well defined than those of classic MF.
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Affiliation(s)
- Silvia Alberti-Violetti
- UOC Dermatologia, Fondazione IRCCS Ca’ Granda, Ospedale Maggiore Policlinico, 20122 Milan, Italy; (C.A.M.); (V.M.); (E.B.)
- Department of Pathophysiology and Transplantation, University of Milan, 20122 Milan, Italy;
| | - Carlo Alberto Maronese
- UOC Dermatologia, Fondazione IRCCS Ca’ Granda, Ospedale Maggiore Policlinico, 20122 Milan, Italy; (C.A.M.); (V.M.); (E.B.)
- Department of Pathophysiology and Transplantation, University of Milan, 20122 Milan, Italy;
| | - Luigia Venegoni
- Department of Pathophysiology and Transplantation, University of Milan, 20122 Milan, Italy;
| | - Valentina Merlo
- UOC Dermatologia, Fondazione IRCCS Ca’ Granda, Ospedale Maggiore Policlinico, 20122 Milan, Italy; (C.A.M.); (V.M.); (E.B.)
| | - Emilio Berti
- UOC Dermatologia, Fondazione IRCCS Ca’ Granda, Ospedale Maggiore Policlinico, 20122 Milan, Italy; (C.A.M.); (V.M.); (E.B.)
- Department of Pathophysiology and Transplantation, University of Milan, 20122 Milan, Italy;
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21
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Chen BJ, Wang RC, Jhuang JY, Chen SW, Su YZ, Tseng CE, Chiang CT, Wu YT, Chuang SS. Primary cutaneous gamma/delta T-cell lymphoma in Taiwan: A series of six cases with frequent solitary presentation and relatively indolent behavior. J Cutan Pathol 2021; 49:350-357. [PMID: 34778979 DOI: 10.1111/cup.14169] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Revised: 10/22/2021] [Accepted: 11/06/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND Primary cutaneous gamma/delta T-cell lymphoma (PCDG-TCL) is aggressive, frequently presenting as multiple plaques, tumors, and/or subcutaneous nodules. METHODS In this study, we conducted a retrospective study in a tertiary center in Taiwan to characterize this rare tumor. RESULTS We identified six patients. Five presented with a solitary lesion, including two with clinical impression of epidermal inclusion cyst or lipoma. Two of four evaluable cases exhibited epidermotropism, with one mimicking Pautrier microabscess. The neoplastic cells were pleomorphic and mostly medium- to large-sized. In all cases, the neoplastic cells expressed T-cell receptor (TCR)-γ and/or TCR-δ, with four co-expressing βF1. Two of these βF1+ cases co-expressed TCR-γ but not TCR-δ (two different clones). All were negative for Epstein-Barr virus (EBV), low stage, and treated with radiotherapy alone or combined chemotherapy and radiotherapy. In two patients, lymphoma relapsed in 3 and 7 months, respectively, and one patient died of the disease in 7 months. Four other patients were free of disease for 6 to 126 months. CONCLUSION PCGD-TCL cases in Taiwan are more commonly solitary, frequently with indolent courses. The two currently available TCR-δ clones alone might be insufficient to detect all tumors.
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Affiliation(s)
- Bo-Jung Chen
- Department of Pathology, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan.,Department of Pathology, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Ren Ching Wang
- Department of Pathology and Laboratory Medicine, Taichung Veterans General Hospital, Taichung, Taiwan.,Department of Nursing, College of Nursing, HungKuang University, Taichung, Taiwan
| | - Jie-Yang Jhuang
- Department of Pathology, Mackay Memorial Hospital, Taipei, Taiwan
| | - Shang-Wen Chen
- Division of Hemato-Oncology, Department of Internal Medicine, Lioying Chi-Mei Hospital, Tainan, Taiwan
| | - Ying-Zhen Su
- Department of Pathology, Chi-Mei Medical Center, Tainan, Taiwan
| | - Chih-En Tseng
- Department of Anatomic Pathology, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Chia-Yi, Taiwan.,School of Medicine, Tzu Chi University, Hualian, Taiwan
| | - Chien-Ta Chiang
- Department of Anatomic Pathology, Far Eastern Memorial Hospital, New Taipei City, Taiwan
| | - You-Ting Wu
- Department of Pathology, Chia-Yi Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Chia-Yi, Taiwan
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22
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Peddi K, Wiggins B, Choudhury O, Ortolani M. Gamma Delta T-Cell Receptor Lymphoma Causing Bilateral Pulmonary Embolism. Cureus 2021; 13:e18072. [PMID: 34692293 PMCID: PMC8523364 DOI: 10.7759/cureus.18072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/18/2021] [Indexed: 11/16/2022] Open
Abstract
Pulmonary embolism is a previously uncharacterized complication of primary cutaneous gamma delta T-cell lymphoma (PCGDTL), a type of cutaneous T-cell receptor lymphoma that accounts for less than 1% of non-Hodgkin’s lymphomas. We report the first documented case of bilateral pulmonary embolism in the setting of PCGDTL in a 30-year-old woman who presented with acute dyspnea.
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Affiliation(s)
- Kanksha Peddi
- Internal Medicine, Ascension Genesys Hospital, Grand Blanc, USA
| | - Brandon Wiggins
- Internal Medicine, Ascension Genesys Hospital, Grand Blanc, USA
| | | | - Mark Ortolani
- Emergency Medicine, Ascension Genesys Hospital, Grand Blanc, USA
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23
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A Previously Unrecognized Granulomatous Variant of Gamma-Delta T-Cell Lymphoma. Dermatopathology (Basel) 2021; 8:221-228. [PMID: 34204191 PMCID: PMC8293259 DOI: 10.3390/dermatopathology8020027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Revised: 06/14/2021] [Accepted: 06/15/2021] [Indexed: 11/17/2022] Open
Abstract
Primary cutaneous γδ T-cell lymphoma (PCGD-TCL) is an extremely rare and aggressive T-cell neoplasm with complex heterogeneity. We present a series of two patients who presented with firm, subcutaneous nodules and were diagnosed with PCGD-TCL. In both cases, biopsies demonstrated a both superficial and deep adnexotropic infiltrate comprised of angiocentric, medium- to large-sized atypical lymphocytes. The infiltrate extended into the panniculus. Immuno–histochemical stains highlighted atypical lymphocytes that expressed CD3, CD8 and CD56 but were negative for EBV ISH. A brisk histiocytic response with focal aggregation into granulomas was highlighted with a PG-M1 stain. The atypical lymphocytes were positive for gene rearrangements on a TCR delta stain and negative for βF-1. CT and PET scan in one of the two patients demonstrated diffuse, subcutaneous, ground-glass foci; hypermetabolic soft tissue nodules; and lymphadenopathy in the lungs, as well as splenomegaly. A diagnosis of histiocyte-rich PCGD-TCL was rendered. A histiocyte-rich, granulomatous variant of γδ T-cell lymphoma is extremely rare. Its potentially misleading resemblance to inflammatory granulomatous conditions could pose a diagnostic pitfall in this already challenging condition. This variant may resemble granulomatous mycosis fungoides and granulomatous slack skin syndrome, but it has a distinct, aggressive clinical outcome.
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24
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Torres-Cabala CA, Huen A, Iyer SP, Miranda RN. Gamma/Delta Phenotype in Primary Cutaneous T-cell Lymphomas and Lymphoid Proliferations: Challenges for Diagnosis and Classification. Surg Pathol Clin 2021; 14:177-194. [PMID: 34023099 DOI: 10.1016/j.path.2021.03.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Primary cutaneous T-cell lymphomas pose a diagnostic challenge for dermatopathologists, hematopathologists, and general surgical pathologists. Recognition of gamma/delta phenotype in cutaneous T proliferations has been enhanced by the availability of antibodies against TCRgamma and delta for immunohistochemistry. Thus, reporting gamma/delta phenotype in a cutaneous T-cell lymphoid proliferation may indicate a significant change in therapy and a challenge for dermatologists and oncologists who treat these patients. Herein, we discuss primary cutaneous gamma/delta T-cell lymphoma, its differential diagnosis, and other skin lymphoid proliferations that may show gamma/delta phenotype. Awareness of the occurrence of gamma/delta phenotype in both T-cell lymphomas and benign lymphoid proliferations involving skin is crucial for a better interpretation of histopathologic findings. Integration of clinical presentation, morphology, immunoprofile, and molecular findings is key for a correct diagnosis and appropriate therapy of lesions displaying gamma/delta T-cell phenotype.
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Affiliation(s)
- Carlos A Torres-Cabala
- Department of Pathology, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, Unit 85, Houston, TX 77030, USA; Department of Dermatology, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, Unit 1452, Houston, TX 77030, USA.
| | - Auris Huen
- Department of Dermatology, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, Unit 1452, Houston, TX 77030, USA
| | - Swaminathan P Iyer
- Department of Lymphoma/Myeloma, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, Unit 429, Houston, TX 77030, USA
| | - Roberto N Miranda
- Department of Hematopathology, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, Unit 72, Houston, TX 77030, USA
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25
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Machan S, Juárez Martín Á, Cullen Aravena D, Haro R, Pielasinski Ú, Fuertes L, Córdoba R, Santonja C, Rodríguez-Pinilla SM, Requena L. Acral lymphomatoid papulosis: Report of five cases, differential diagnosis, and review. J Cutan Pathol 2021; 48:650-658. [PMID: 33269496 DOI: 10.1111/cup.13929] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Revised: 11/17/2020] [Accepted: 11/21/2020] [Indexed: 11/26/2022]
Abstract
Acral lymphomatoid papulosis (a-LyP) is a rare clinical variant of LyP whose diagnosis may be challenging. A case series of a-LyP was studied clinically, histopathologically, immunohistochemically, and from molecular point of view. Including ours, 25 cases of a-LyP have so far been reported. Clinically, a-LyP may present as acral involvement exclusively, in combination with mucosal lesions, (in itself a rare presentation), or in association with conventional LyP. The age of presentation was slightly higher than that of conventional LyP (55 vs 45 years) and a male predominance has been observed, as usually reported. Histopathologically, no morphological differences exclusively from conventional LyP were observed. LyP types A and E were the main variants. We describe for the first time one case of type D a-LyP. Acral LyP is a rare entity and correct diagnosis can only be reached with clinical and histopathological correlation, to avoid aggressive treatment of this indolent lymphoproliferative disorder.
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Affiliation(s)
- Salma Machan
- Department of Dermatology, Fundación Jiménez Díaz, Universidad Autónoma, Madrid, Spain
| | - África Juárez Martín
- Department of Dermatology, Complejo Asistencial Universitario de Palencia, Palencia, Spain
| | | | - Rosario Haro
- Department of Dermatology, Fundación Jiménez Díaz, Universidad Autónoma, Madrid, Spain
| | - Úrsula Pielasinski
- Department of Dermatology, Fundación Jiménez Díaz, Universidad Autónoma, Madrid, Spain
| | - Laura Fuertes
- Department of Dermatology, Fundación Jiménez Díaz, Universidad Autónoma, Madrid, Spain
| | - Raúl Córdoba
- Department of Hematology, Fundación Jiménez Díaz, Universidad Autónoma, Madrid, Spain
| | - Carlos Santonja
- Department of Pathology, Fundación Jiménez Díaz, Universidad Autónoma, Madrid, Spain
| | | | - Luis Requena
- Department of Dermatology, Fundación Jiménez Díaz, Universidad Autónoma, Madrid, Spain
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26
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O'Neill K, Pastar I, Tomic-Canic M, Strbo N. Perforins Expression by Cutaneous Gamma Delta T Cells. Front Immunol 2020; 11:1839. [PMID: 32922397 PMCID: PMC7456908 DOI: 10.3389/fimmu.2020.01839] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Accepted: 07/08/2020] [Indexed: 01/13/2023] Open
Abstract
Gamma delta (GD) T cells are an unconventional T cell type present in both the epidermis and the dermis of human skin. They are critical to regulating skin inflammation, wound healing, and anti-microbial defense. Similar to CD8+ cytotoxic T cells expressing an alpha beta (AB) TCR, GD T cells have cytolytic capabilities. They play an important role in elimination of cutaneous tumors and virally infected cells and have also been implicated in pathogenicity of several autoimmune diseases. T cell cytotoxicity is associated with the expression of the pore forming protein Perforin. Perforin is an innate immune protein containing a membrane attack complex perforin-like (MACPF) domain and functions by forming pores in the membranes of target cells, which allow granzymes and reactive oxygen species to enter the cells and destroy them. Perforin-2, encoded by the gene MPEG1, is a newly discovered member of this protein family that is critical for clearance of intracellular bacteria. Cutaneous GD T cells express both Perforin and Perforin-2, but many questions remain regarding the role that these proteins play in GD T cell mediated cytotoxicity against tumors and bacterial pathogens. Here, we review what is known about Perforin expression by skin GD T cells and the mechanisms that contribute to Perforin activation.
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Affiliation(s)
- Katelyn O'Neill
- Department of Microbiology and Immunology, Miller School of Medicine, University of Miami, Miami, FL, United States
| | - Irena Pastar
- Wound Healing and Regenerative Medicine Research Program, Dr. Phillip Frost Department of Dermatology and Cutaneous Surgery, Miller School of Medicine, University of Miami, Miami, FL, United States
| | - Marjana Tomic-Canic
- Wound Healing and Regenerative Medicine Research Program, Dr. Phillip Frost Department of Dermatology and Cutaneous Surgery, Miller School of Medicine, University of Miami, Miami, FL, United States
| | - Natasa Strbo
- Department of Microbiology and Immunology, Miller School of Medicine, University of Miami, Miami, FL, United States
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27
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CD30 expression: a diagnostic pitfall for primary cutaneous gamma delta T cell lymphoma. Ann Hematol 2020; 100:2653-2657. [PMID: 32860088 DOI: 10.1007/s00277-020-04229-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2020] [Accepted: 08/24/2020] [Indexed: 10/23/2022]
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28
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Peripheral T cell lymphoma, NOS with aberrant αβ and γδ T cell receptor expression in a post-heart transplant patient. J Hematop 2020. [DOI: 10.1007/s12308-020-00393-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
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29
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Fonseca S, Pereira V, Lau C, Teixeira MDA, Bini-Antunes M, Lima M. Human Peripheral Blood Gamma Delta T Cells: Report on a Series of Healthy Caucasian Portuguese Adults and Comprehensive Review of the Literature. Cells 2020; 9:cells9030729. [PMID: 32188103 PMCID: PMC7140678 DOI: 10.3390/cells9030729] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2020] [Revised: 03/06/2020] [Accepted: 03/13/2020] [Indexed: 12/20/2022] Open
Abstract
Gamma delta T cells (Tc) are divided according to the type of Vδ and Vγ chains they express, with two major γδ Tc subsets being recognized in humans: Vδ2Vγ9 and Vδ1. Despite many studies in pathological conditions, only a few have quantified the γδ Tc subsets in healthy adults, and a comprehensive review of the factors influencing its representation in the blood is missing. Here we quantified the total γδ Tc and the Vδ2/Vγ9 and Vδ1 Tc subsets in the blood from 30 healthy, Caucasian, Portuguese adults, we characterized their immunophenotype by 8-color flow cytometry, focusing in a few relevant Tc markers (CD3/TCR-γδ, CD5, CD8), and costimulatory (CD28), cytotoxic (CD16) and adhesion (CD56) molecules, and we examined the impacts of age and gender. Additionally, we reviewed the literature on the influences of race/ethnicity, age, gender, special periods of life, past infections, diet, medications and concomitant diseases on γδ Tc and their subsets. Given the multitude of factors influencing the γδ Tc repertoire and immunophenotype and the high variation observed, caution should be taken in interpreting “abnormal” γδ Tc values and repertoire deviations, and the clinical significance of small populations of “phenotypically abnormal” γδ Tc in the blood.
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Affiliation(s)
- Sónia Fonseca
- Laboratory of Cytometry, Unit for Hematology Diagnosis, Department of Hematology, Hospital de Santo António (HSA), Centro Hospitalar Universitário do Porto (CHUP), Unidade Multidisciplinar de Investigação Biomédica, Instituto de Ciências Biomédicas Abel Salazar, Universidade do Porto (UMIB/ICBAS/UP); 4099-001 Porto Porto, Portugal; (S.F.); (C.L.); (M.d.A.T.)
| | - Vanessa Pereira
- Department of Clinical Pathology, Centro Hospitalar de Vila Nova de Gaia/Espinho (CHVNG/E); 4434-502 Vila Nova de Gaia, Portugal;
| | - Catarina Lau
- Laboratory of Cytometry, Unit for Hematology Diagnosis, Department of Hematology, Hospital de Santo António (HSA), Centro Hospitalar Universitário do Porto (CHUP), Unidade Multidisciplinar de Investigação Biomédica, Instituto de Ciências Biomédicas Abel Salazar, Universidade do Porto (UMIB/ICBAS/UP); 4099-001 Porto Porto, Portugal; (S.F.); (C.L.); (M.d.A.T.)
| | - Maria dos Anjos Teixeira
- Laboratory of Cytometry, Unit for Hematology Diagnosis, Department of Hematology, Hospital de Santo António (HSA), Centro Hospitalar Universitário do Porto (CHUP), Unidade Multidisciplinar de Investigação Biomédica, Instituto de Ciências Biomédicas Abel Salazar, Universidade do Porto (UMIB/ICBAS/UP); 4099-001 Porto Porto, Portugal; (S.F.); (C.L.); (M.d.A.T.)
| | - Marika Bini-Antunes
- Laboratory of Immunohematology and Blood Donors Unit, Department of Hematology, Hospital de Santo António (HSA), Centro Hospitalar Universitário do Porto (CHUP), Unidade Multidisciplinar de Investigação Biomédica, Instituto de Ciências Biomédicas Abel Salazar, Universidade do Porto (UMIB/ICBAS/UP); 4099-001Porto, Portugal;
| | - Margarida Lima
- Laboratory of Cytometry, Unit for Hematology Diagnosis, Department of Hematology, Hospital de Santo António (HSA), Centro Hospitalar Universitário do Porto (CHUP), Unidade Multidisciplinar de Investigação Biomédica, Instituto de Ciências Biomédicas Abel Salazar, Universidade do Porto (UMIB/ICBAS/UP); 4099-001 Porto Porto, Portugal; (S.F.); (C.L.); (M.d.A.T.)
- Correspondence: ; Tel.: + 351-22-20-77-500
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Torres-Cabala CA. Diagnosis of T-cell lymphoid proliferations of the skin: putting all the pieces together. Mod Pathol 2020; 33:83-95. [PMID: 31664155 DOI: 10.1038/s41379-019-0397-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2019] [Revised: 09/29/2019] [Accepted: 10/15/2019] [Indexed: 11/09/2022]
Abstract
The spectrum of T-cell lymphoid proliferations of the skin varies from indolent to highly aggressive diseases and therefore an accurate pathological diagnosis is paramount. Integration of clinical, histopathological, immunohistochemical, and molecular findings is of crucial importance in the evaluation of these processes. In this article, we discuss selected situations where difficulty may arise for the pathologist evaluating this type of skin biopsies, such as: the diagnosis of early (patch stage) mycosis fungoides, the distinction of mycosis fungoides with large cell transformation from primary cutaneous anaplastic large cell lymphoma, the recognition of new histopathological patterns of lymphomatoid papulosis and the entities they mimic, the evaluation of primary cutaneous anaplastic large cell lymphoma with expression of markers suggestive of systemic origin (such as ALK), the awareness of the wide range of clinical and pathological presentations of hydroa vacciniforme-like EBV-positive T-cell lymphoproliferative disorders, the evaluation of cases of primary cutaneous γδ T-cell lymphoma showing predominantly epidermotropic pattern of growth, and the correct interpretation of findings seen in indolent proliferations such as primary cutaneous acral CD8-positive T-cell lymphoma and primary cutaneous small/medium size CD4 + T-cell lymphoproliferative disorder.
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Affiliation(s)
- Carlos A Torres-Cabala
- Departments of Pathology and Dermatology, The University of Texas - MD Anderson Cancer Center, 1515 Holcombe Blvd Unit 85, Houston, TX, 77030, USA.
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Jothishankar B, Venkataraman G, Goldberg RC, Abdulla F. Heterogeneity of T-cell receptor expression at transformation in mycosis fungoides/Sezary Syndrome (MF/SS). Ann Diagn Pathol 2019; 43:151404. [DOI: 10.1016/j.anndiagpath.2019.151404] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2019] [Revised: 08/02/2019] [Accepted: 08/29/2019] [Indexed: 11/26/2022]
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MESH Headings
- Aged
- Biopsy
- Bone Marrow/pathology
- Codon, Nonsense
- Cytokines/metabolism
- Diagnosis, Differential
- Exanthema/etiology
- Fatal Outcome
- Fever/etiology
- Humans
- Lymphohistiocytosis, Hemophagocytic/diagnosis
- Lymphohistiocytosis, Hemophagocytic/etiology
- Lymphohistiocytosis, Hemophagocytic/metabolism
- Lymphoma, T-Cell, Cutaneous/complications
- Lymphoma, T-Cell, Cutaneous/diagnosis
- Lymphoma, T-Cell, Cutaneous/genetics
- Male
- Pancytopenia/etiology
- Skin/pathology
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Affiliation(s)
- Marcela V Maus
- From the Departments of Medicine (M.V.M., M.B.L.) and Pathology (K.M.C., V.N.), Massachusetts General Hospital, and the Departments of Medicine (M.V.M., M.B.L.) and Pathology (K.M.C., V.N.), Harvard Medical School - both in Boston
| | - Mark B Leick
- From the Departments of Medicine (M.V.M., M.B.L.) and Pathology (K.M.C., V.N.), Massachusetts General Hospital, and the Departments of Medicine (M.V.M., M.B.L.) and Pathology (K.M.C., V.N.), Harvard Medical School - both in Boston
| | - Kristine M Cornejo
- From the Departments of Medicine (M.V.M., M.B.L.) and Pathology (K.M.C., V.N.), Massachusetts General Hospital, and the Departments of Medicine (M.V.M., M.B.L.) and Pathology (K.M.C., V.N.), Harvard Medical School - both in Boston
| | - Valentina Nardi
- From the Departments of Medicine (M.V.M., M.B.L.) and Pathology (K.M.C., V.N.), Massachusetts General Hospital, and the Departments of Medicine (M.V.M., M.B.L.) and Pathology (K.M.C., V.N.), Harvard Medical School - both in Boston
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A Skin Plaque Preceding Systemic Relapse of Gamma-Delta Hepatosplenic T-Cell Lymphoma. Am J Dermatopathol 2019; 42:364-367. [DOI: 10.1097/dad.0000000000001569] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Jungbluth AA, Frosina D, Fayad M, Pulitzer MP, Dogan A, Busam KJ, Imai N, Gnjatic S. Immunohistochemical Detection of γ/δ T Lymphocytes in Formalin-fixed Paraffin-embedded Tissues. Appl Immunohistochem Mol Morphol 2019; 27:581-583. [PMID: 29517505 PMCID: PMC7790162 DOI: 10.1097/pai.0000000000000650] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
T lymphocytes can be distinguished based on the composition of the T-cell receptor (TCR) chain in α/β T cells and γ/δ T cells. Correspondingly, α/β lymphomas can be distinguished from γ/δ lymphomas. The latter are rare neoplasms, which are usually confined to particular organs and tissues and carry a dismal prognosis. Until recently, monoclonal antibody (mAb) clone g3.20 to the TCR γ-chain was the reagent of choice for the immunohistochemical detection of γ/δ T cells and lymphomas in standard formalin-fixed paraffin-embedded tissues. However, due to technical problems, mAb g3.20 became recently unavailable. Our attempts to identify another commercially available clone to the TCR γ-chain were unsuccessful. However, we were able to identify a mAb (clone H-41, SC-100289; Santa Cruz, Dallas, TX) to the TCR δ-chain. H-41 works well in immunohistochemistry on paraffin-embedded tissue and comparison with previously stained cases, shows superior immunolabeling to mAb g3.20. H-41 to the TCR δ-chain appears to be a suitable reagent for the replacement of mAb g3.20.
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Affiliation(s)
| | - Denise Frosina
- Department of Pathology, Memorial Sloan Kettering Cancer Center
| | - Miriam Fayad
- Department of Pathology, Memorial Sloan Kettering Cancer Center
| | | | - Ahmet Dogan
- Department of Pathology, Memorial Sloan Kettering Cancer Center
| | - Klaus J Busam
- Department of Pathology, Memorial Sloan Kettering Cancer Center
| | - Naoko Imai
- Tisch Cancer Institute, Hematology/Oncology, Immunology, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Sacha Gnjatic
- Tisch Cancer Institute, Hematology/Oncology, Immunology, Icahn School of Medicine at Mount Sinai, New York, NY
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Cocks M, Porcu P, Wick MR, Gru AA. Recent Advances in Cutaneous T-cell Lymphoma: Diagnostic and Prognostic Considerations. Surg Pathol Clin 2019; 12:783-803. [PMID: 31352988 DOI: 10.1016/j.path.2019.03.006] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
This review describes the latest advances in the diagnosis of cutaneous T-cell lymphoma focusing on the most clinically useful features introduced since the publication of the World Health Organization revision in 2017. Clinical entities described include mycosis fungoides, Sézary syndrome, lymphomatoid papulosis, primary cutaneous anaplastic large cell lymphoma, primary cutaneous gamma delta T-cell lymphoma, primary cutaneous acral CD8+ T-cell lymphoma, primary cutaneous CD4+ small/medium T-cell lymphoproliferative disorder, and hydroa-vacciniforme-like lymphoproliferative disorder. Distinguishing histologic clues to diagnosis are discussed, and important molecular advances are described. Key prognostic indicators that may assist clinicians with timely and appropriate management options are presented.
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Affiliation(s)
- Margaret Cocks
- Department of Pathology, University of Virginia, PO Box 800214, 1215 Lee Street, Hospital Expansion Building Room 2015, Charlottesville, VA 22908, USA
| | - Pierluigi Porcu
- Division of Medical Oncology and Hematopoietic Stem Cell Transplantation, Jefferson University, Suite 420A, 925 Chestnut Street, Philadelphia, PA 19107, USA
| | - Mark R Wick
- Department of Pathology, University of Virginia, PO Box 800214, 1215 Lee Street, Hospital Expansion Building Room 3020, Charlottesville, VA 22908, USA
| | - Alejandro A Gru
- Department of Pathology, University of Virginia, PO Box 800214, 1215 Lee Street, Hospital Expansion Building Room 3018, Charlottesville, VA 22908, USA.
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How I treat primary cutaneous CD30+ lymphoproliferative disorders. Blood 2019; 134:515-524. [DOI: 10.1182/blood.2019000785] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2019] [Accepted: 05/14/2019] [Indexed: 12/12/2022] Open
Abstract
Abstract
The primary cutaneous CD30+ lymphoproliferative disorders are a family of extranodal lymphoid neoplasms that arise from mature postthymic T cells and localize to the skin. Current classification systems recognize lymphomatoid papulosis (LyP), primary cutaneous anaplastic large cell lymphoma, and borderline cases. In the majority of patients, the prognosis of primary cutaneous CD30+ lymphoproliferative disorders is excellent; however, relapses are common, and complete cures are rare. Skin-directed and systemic therapies are used as monotherapy or in combination to achieve the best disease control and minimize overall toxicity. We discuss 3 distinct presentations of primary cutaneous CD30+ lymphoproliferative disorder and present recommendations for a multidisciplinary team approach to diagnosis, evaluation, and management of these conditions in keeping with existing consensus guidelines.
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Atypical Histiocytic Lesion Preceding a Peripheral T-Cell Lymphoma Involving the Skin Exhibiting the Same Molecular Alterations. Am J Dermatopathol 2019; 41:148-154. [PMID: 30085957 DOI: 10.1097/dad.0000000000001245] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Peripheral T-cell lymphoma (PTCL), not otherwise specified (NOS) is a diagnosis of exclusion, showing extreme cytological and phenotypic heterogeneity. Skin involvement of PTCL may be primary or secondary. Diagnosis of histiocytosis may be difficult, requiring clinical-pathological correlation. We describe a laryngeal atypical histiocytic lesion (AHL) and a nasal PTCL, NOS with cutaneous involvement in the same patient presenting with peculiar histopathologic and immunophenotypic features. The laryngeal neoplasm showed morphological and immunophenotypic evidence of histiocytic differentiation and does not fit any other category of the WHO classification nor the revised classification of histiocytosis. The nasal and cutaneous lesions presented features close to natural killer/T-cell lymphoma and gamma-delta T-cell lymphoma but did not meet accurately the WHO criteria. A somatic activating Q61K mutation was found on exon 3 of the NRAS gene in both AHL and PTCL, NOS. The mutation on NRAS gene in both AHL and PTCL, NOS may suggest a common origin from a precursor cell.
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Cutaneous Lymphoproliferative Disorders: What's New in the Revised 4th Edition of the World Health Organization (WHO) Classification of Lymphoid Neoplasms. Adv Anat Pathol 2019; 26:93-113. [PMID: 30199396 DOI: 10.1097/pap.0000000000000208] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Cutaneous lymphoproliferative disorders remain a challenging aspect of dermatopathology, in part due to the rarity of the entities and extreme variability in clinical outcomes. Although many of the entities remain unchanged, the approach to some of them has changed in the new 2016 classification scheme of the World Health Organization. Chief among these are Epstein-Barr virus-associated lymphoproliferative disorders such as Epstein-Barr virus-associated mucocutaneous ulcer and hydroa vacciniforme-like lymphoproliferative disorder, primary cutaneous CD8+ aggressive epidermotropic cytotoxic T-cell lymphoma, primary cutaneous acral CD8+ T-cell lymphoma, primary cutaneous CD4+ small/medium T-cell lymphoproliferative disorder, and breast implant-associated anaplastic large cell lymphoma. In addition, translocations and gene rearrangements such as those involving the 6p25.3 locus have started to inform diagnosis and classification of anaplastic large cell lymphoma and lymphomatoid papulosis. In this review, we will examine what is new in the diagnostic toolbox of cutaneous lymphoproliferative disorders.
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The 2018 update of the WHO-EORTC classification for primary cutaneous lymphomas. Blood 2019; 133:1703-1714. [PMID: 30635287 DOI: 10.1182/blood-2018-11-881268] [Citation(s) in RCA: 741] [Impact Index Per Article: 148.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2018] [Accepted: 01/07/2019] [Indexed: 12/13/2022] Open
Abstract
Primary cutaneous lymphomas are a heterogeneous group of T- and B-cell lymphomas that present in the skin with no evidence of extracutaneous disease at the time of diagnosis. The 2005 World Health Organization-European Organization for Research and Treatment of Cancer (WHO-EORTC) consensus classification has served as a golden standard for the diagnosis and classification of these conditions. In September 2018, an updated version of the WHO-EORTC was published in the fourth edition of the WHO Classification of Skin Tumours Blue Book. In this classification, primary cutaneous acral CD8+ T-cell lymphoma and Epstein-Barr virus positive (EBV+) mucocutaneous ulcer are included as new provisional entities, and a new section on cutaneous forms of chronic active EBV disease has been added. The term "primary cutaneous CD4+ small/medium T-cell lymphoma" was modified to "primary cutaneous CD4+ small/medium T-cell lymphoproliferative disorder" because of its indolent clinical behavior and uncertain malignant potential. Modifications have also been made in the sections on lymphomatoid papulosis, increasing the spectrum of histologic and genetic types, and primary cutaneous marginal zone lymphomas recognizing 2 different subtypes. Herein, the characteristic features of these new and modified entities as well as the results of recent molecular studies with diagnostic, prognostic, and/or therapeutic significance for the different types of primary cutaneous lymphomas are reviewed. An update of the frequency and survival of the different types of primary cutaneous lymphomas is provided.
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Prieto-Torres L, Rodriguez-Pinilla SM, Onaindia A, Ara M, Requena L, Piris MÁ. CD30-positive primary cutaneous lymphoproliferative disorders: molecular alterations and targeted therapies. Haematologica 2019; 104:226-235. [PMID: 30630983 PMCID: PMC6355473 DOI: 10.3324/haematol.2018.197152] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2018] [Accepted: 12/07/2018] [Indexed: 01/06/2023] Open
Abstract
Primary cutaneous CD30-positive T-cell lymphoproliferative disorders are the second most common subgroup of cutaneous T-cell lymphomas. They include two clinically different entities with some overlapping features and borderline cases: lymphomatoid papulosis and primary cutaneous anaplastic large cell lymphoma. Molecular studies of primary cutaneous anaplastic large cell lymphoma reveal an increasing level of heterogeneity that is associated with histological and immunophenotypic features of the cases and their response to specific therapies. Here, we review the most significant genetic, epigenetic and molecular alterations described to date in primary cutaneous CD30-positive T-cell lymphoproliferative disorders, and their potential as therapeutic targets.
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Affiliation(s)
| | - Socorro M Rodriguez-Pinilla
- Department of Pathology, Hospital Universitario Fundación Jiménez Díaz, Madrid.,Hospital Universitario Fundación Jiménez Díaz, Madrid, CIBERONC, Madrid
| | - Arantza Onaindia
- Pathology, Hospital Universitario Marques de Valdecilla, Santander
| | - Mariano Ara
- Dermatology Hospital Clínico Universitario Lozano Blesa, Zaragoza, Spain
| | | | - Miguel Á Piris
- Department of Pathology, Hospital Universitario Fundación Jiménez Díaz, Madrid.,Hospital Universitario Fundación Jiménez Díaz, Madrid, CIBERONC, Madrid
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Olson GS, Moore SW, Richter JM, Garber JJ, Bowman BA, Rawlings CA, Flagg M, Corleis B, Kwon DS. Increased frequency of systemic pro-inflammatory Vδ1 + γδ T cells in HIV elite controllers correlates with gut viral load. Sci Rep 2018; 8:16471. [PMID: 30405182 PMCID: PMC6220338 DOI: 10.1038/s41598-018-34576-4] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2018] [Accepted: 10/17/2018] [Indexed: 12/11/2022] Open
Abstract
γδ T cells predominate in the intestinal mucosa and help maintain gut homeostasis and mucosal immunity. Although HIV infection significantly alters these cells, what drives these perturbations is unclear. Growing evidence suggests that impaired intestinal immune function in HIV leads to chronic immune activation and disease progression. This occurs even in HIV controllers - individuals with undetectable HIV viremia without antiretroviral therapy (ART). We show that Vδ1+ cells, a subset of γδ T cells described as being important in intestinal barrier function, increase in frequency in HIV-infected individuals, including HIV controllers. These cells resemble terminally differentiated effector memory cells, producing the pro-inflammatory cytokines IFNγ, TNFα, and MIP-1β upon stimulation. Importantly, pro-inflammatory Vδ1+ cell frequency correlates with levels of HIV RNA in intestinal tissue but not in plasma. This study supports a model in which local viral replication in the gut in HIV controllers disrupts the phenotype and function of Vδ1+ cells, a cell type involved in the maintenance of epithelial barrier integrity, and may thereby contribute to systemic immune activation and HIV disease progression.
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Affiliation(s)
- Gregory S Olson
- The Ragon Institute of MGH, MIT and Harvard, Cambridge, Massachusetts, United States of America
| | - Sarah W Moore
- The Ragon Institute of MGH, MIT and Harvard, Cambridge, Massachusetts, United States of America
| | - James M Richter
- Division of Gastroenterology, Massachusetts General Hospital, Boston, Massachusetts, United States of America
| | - John J Garber
- Division of Gastroenterology, Massachusetts General Hospital, Boston, Massachusetts, United States of America
| | - Brittany A Bowman
- The Ragon Institute of MGH, MIT and Harvard, Cambridge, Massachusetts, United States of America
| | - Crystal A Rawlings
- The Ragon Institute of MGH, MIT and Harvard, Cambridge, Massachusetts, United States of America
| | - Meaghan Flagg
- The Ragon Institute of MGH, MIT and Harvard, Cambridge, Massachusetts, United States of America
| | - Björn Corleis
- The Ragon Institute of MGH, MIT and Harvard, Cambridge, Massachusetts, United States of America
| | - Douglas S Kwon
- The Ragon Institute of MGH, MIT and Harvard, Cambridge, Massachusetts, United States of America.
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Subcutaneous Panniculitis-Like T-Cell Lymphoma Versus Lupus Erythematosus Panniculitis: Distinction by Means of the Periadipocytic Cell Proliferation Index. Am J Dermatopathol 2018; 40:567-574. [DOI: 10.1097/dad.0000000000001173] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Pulitzer M, Geller S, Kumar E, Frosina D, Moskowitz A, Horwitz S, Myskowski P, Kheterpal M, Chan A, Dogan A, Jungbluth A. T-cell receptor-δ expression and γδ+ T-cell infiltrates in primary cutaneous γδ T-cell lymphoma and other cutaneous T-cell lymphoproliferative disorders. Histopathology 2018; 73:653-662. [PMID: 29893430 DOI: 10.1111/his.13671] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2018] [Accepted: 06/10/2018] [Indexed: 01/16/2023]
Abstract
AIMS The diagnosis of cutaneous γδ T-cell lymphoma (GDTCL) requires the identification of γδ chains of the T-cell receptor (TCR). Our aim in this study was, by using a new monoclonal antibody (mAb) against TCRδ, to evaluate TCRδ expression in formalin-fixed paraffin-embedded (FFPE) skin tissue from TCRγ+ cutaneous T-cell lymphoma (CTCL), and to assess TCRδ expression within a spectrum of other cutaneous lymphoproliferative disorders (CLPDs). METHODS AND RESULTS Twelve cases (10 patients) with TCRγ+ CTCL and 132 additional CLPD cases (127 patients) were examined, including mycosis fungoides (MF) (n = 60), cutaneous GDTCL (n = 15), subcutaneous panniculitis-like T-cell lymphoma (SPTCL) (n = 11), and CD30+ lymphoproliferative disorder (LPD) (n = 24). Clone H-41 against TCRδ was used on a Leica Bond-3 automated stainer to label FFPE slides. H-41 immunostaining was graded as percentage infiltrate: high (50-100%), moderate (10-49%), and low (0-9%). In TCRγ+ tumours, 12 of 12 (100%) patients showed TCRδ expression comparable to TCRγ expression. No (0%) TCRγ+ cases were negative for TCRδ. In all CLPDs, TCRδ expression was as follows: GDTCL, 16 of 20 cases (14 of 15 patients) high, two moderate, and two low; MF, 0 of 60 cases high, nine moderate, and 51 low; CD30+ LPD, one of 24 cases high, two moderate, and 21 low; and SPTCL, 0 of 11 cases (0 of 9 patients) high, two moderate, and two low. Three MF-like cases and one SPTCL-like case showed high expression; the remainder showed low expression. CONCLUSIONS mAb H-41 against TCRδ matches TCRγ in immunostaining FFPE tissues from GDTCL, supporting H-41 as a replacement for mAb γ3.20. TCRδ expression in our study suggests that the true occurrence of γδ+ non-GDTCL CTCL/CLPD may be lower than suggested by the recent literature.
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Affiliation(s)
- Melissa Pulitzer
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Shamir Geller
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Erica Kumar
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Denise Frosina
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Alison Moskowitz
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Steven Horwitz
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Patricia Myskowski
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Meenal Kheterpal
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Alexander Chan
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Ahmet Dogan
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Achim Jungbluth
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
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Yamashita D, Shimada K, Takata K, Miyata-Takata T, Kohno K, Satou A, Sakakibara A, Nakamura S, Asano N, Kato S. Reappraisal of nodal Epstein-Barr Virus-negative cytotoxic T-cell lymphoma: Identification of indolent CD5 + diseases. Cancer Sci 2018; 109:2599-2610. [PMID: 29845715 PMCID: PMC6113510 DOI: 10.1111/cas.13652] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2018] [Revised: 05/15/2018] [Accepted: 05/23/2018] [Indexed: 01/25/2023] Open
Abstract
Nodal cytotoxic molecule (CM)‐positive peripheral T‐cell lymphoma (CTL) has recently been recognized as a clinicopathologically distinct disease. To further characterize this disease, here we compared 58 patients with Epstein‐Barr virus (EBV)‐negative CTL to 48 patients with EBV‐positive CTL. The two groups did not differ in histopathology, T‐cell receptor (TCR) expression or rearrangement incidences, or survival curves. However, patients with EBV‐negative CTL less frequently showed hepatic involvement (P = .007), B symptoms (P = .020), hemophagocytosis (P = .024), and detectable CD4 (P = .002) and CD5 (P = .009). Univariate and multivariate analyses identified three factors that independently predicted favorable survival, onset age <60 years (P = .002), CD5 expression (P = .002), and mixed morphology (P = .013), TCRαβ was not an independent predictor (P = .30), but was strongly linked with long survivorship among patients younger than 60 years old. A prognostic model incorporating these factors worked well for prognostic delineation, independently of the International Prognostic Index (P = .007 vs P = .082) and Prognostic Index for PTCL (P = .020 vs P = .15). Moreover, this constellation of findings indicated two nodal indolent diseases: CD5+TCRαβ (n = 13), and CD5+NK‐cell type lacking TCR expression or clonal TCRγ rearrangement (n = 4). The survival curves for these two groups were significantly superior to others (n = 29, P < .001). These diseases appear to be unique in their indolent clinical behavior, and should be managed differently from other diseases.
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Affiliation(s)
- Daisuke Yamashita
- Department of Pathology and Laboratory Medicine, Nagoya University Hospital, Nagoya, Japan
| | - Kazuyuki Shimada
- Department of Hematology and Oncology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Katsuyoshi Takata
- Department of Pathology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Tomoko Miyata-Takata
- Department of Pathology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Kei Kohno
- Department of Pathology and Laboratory Medicine, Nagoya University Hospital, Nagoya, Japan
| | - Akira Satou
- Department of Surgical Pathology, Aichi Medical University Hospital, Nagakute, Japan
| | - Ayako Sakakibara
- Department of Pathology and Laboratory Medicine, Nagoya University Hospital, Nagoya, Japan
| | - Shigeo Nakamura
- Department of Pathology and Laboratory Medicine, Nagoya University Hospital, Nagoya, Japan
| | - Naoko Asano
- Department of Molecular Diagnostics, Nagano Prefectural Suzaka Hospital, Suzaka, Japan
| | - Seiichi Kato
- Department of Pathology and Laboratory Medicine, Nagoya University Hospital, Nagoya, Japan.,Department of Pathology and Molecular Diagnostics, Aichi Cancer Center Hospital, Nagoya, Japan
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Geller S, Myskowski PL, Pulitzer M. NK/T-cell lymphoma, nasal type, γδ T-cell lymphoma, and CD8-positive epidermotropic T-cell lymphoma-clinical and histopathologic features, differential diagnosis, and treatment. ACTA ACUST UNITED AC 2018; 37:30-38. [PMID: 29719018 DOI: 10.12788/j.sder.2018.020] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
The cytotoxic lymphomas of the skin constitute a heterogeneous group of rare lymphoproliferative diseases that are derived from mature T cells and natural killer (NK) cells that express cytotoxic molecules (T-cell intracellular antigen- 1, granzyme A/B, and perforin). Although frequently characterized by an aggressive course and poor prognosis, these diseases can have variable clinical behavior. This review delivers up-to-date information about the clinical presentation, histopathologic features, differential diagnosis, and therapy of extranodal NK/T-cell lymphoma, nasal type, primary cutaneous gamma delta T-cell lymphoma, and primary cutaneous CD8+ aggressive epidermotropic cytotoxic T-cell lymphoma.
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Affiliation(s)
- Shamir Geller
- Dermatology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Patricia L Myskowski
- Dermatology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Melissa Pulitzer
- Dermatopathology Division, Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, New York, USA.
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Identification of T-cell receptor expression in EBV-positive neoplastic cells in extranodal NK/T-cell lymphoma, nasal-type, and comparison with T-cell receptor gene rearrangement by BIOMED-2 assay. Hum Pathol 2017; 73:51-58. [PMID: 29258904 DOI: 10.1016/j.humpath.2017.12.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2017] [Revised: 11/27/2017] [Accepted: 12/07/2017] [Indexed: 12/22/2022]
Abstract
The cellular lineage of extranodal NK/T-cell lymphoma, nasal-type (ENKTL), is determined by expression of T-cell receptor (TR) or TR gene rearrangement. In ENKTL, from TR immunohistochemistry, it may often be difficult to decide whether TR-positive cells are tumor cells or not, especially when TR is expressed in a subset of tumor cells. To analyze TR expression pattern and TR rearrangement in T-lineage ENKTL, we performed double immunofluorescence staining for Epstein-Barr virus-encoded small RNAs (EBER)/T-cell receptor (TCR) βF1 and CD56/TCR βF1 in 12 cases of ENKTL that showed TCR βF1 expression in immunohistochemistry. TR gene rearrangement was analyzed using a commercial BIOMED-2 multiplex polymerase chain reaction system. Immunohistochemistry showed that all 12 cases expressed TCR βF1 in a wide range of infiltrating cells from 100% to <1%. Two of them expressed both TCR βF1 and TCR cγM1. EBER/TCR-βF1-positivity was confirmed in 10 cases by double staining. One case failed to show EBER/TCR-βF1-positive cells but showed a CD56/TCR βF1-positive result. Among 12 cases, 5 had poor-quality DNA, 3 of them showed no polymerase chain reaction product, and 2 cases showed nonspecific peak of low height. Five of 7 cases with good DNA quality demonstrated monoclonal TR gene rearrangement. Based on TR expression and TR gene rearrangement, 10 of 12 cases of ENKTL were decided as a T-lineage tumor. In conclusion, because of common TR silence and poor DNA quality, consideration of both immunohistochemistry and TR gene rearrangement is necessary to determine the lineage of ENKTL.
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48
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Abstract
Cutaneous T-cell lymphomas comprise a heterogeneous group of diseases characterized by monoclonal proliferations of T lymphocytes primarily involving skin, modified skin appendages, and some mucosal sites. This article addresses the basic clinical, histologic, and immunohistochemical characteristics of this group of diseases, with additional attention to evolving literature on dermoscopy, reflectance confocal microscopy, flow cytometry, and molecular data that may increasingly be applied to diagnostic and therapeutic algorithms in these diseases. Select unusual phenotypes or diagnostic examples of classic phenotypes are demonstrated, and flags for consideration while making a pathologic diagnosis of cutaneous T-cell lymphoma are suggested.
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Affiliation(s)
- Melissa Pulitzer
- Department of Pathology, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY 10065, USA.
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49
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Clinicopathologic Spectrum of Gastrointestinal T-cell Lymphoma: Reappraisal Based on T-cell Receptor Immunophenotypes. Am J Surg Pathol 2017; 40:777-85. [PMID: 26975035 DOI: 10.1097/pas.0000000000000630] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
The differential diagnosis of primary gastrointestinal EBV T-cell lymphoma (GITCL) includes enteropathy-associated T-cell lymphoma (EATL), peripheral T-cell lymphoma, not otherwise specified, adult T-cell leukemia/lymphoma, and anaplastic large cell lymphoma. Type II EATL is considered to be a tumor of intraepithelial lymphocytes. However, the evaluation of intraepithelial lymphocytosis by biopsy specimens is challenging, which poses a diagnostic problem between the EATL and peripheral T-cell lymphoma, not otherwise specified. This situation requested us to establish a pragmatic diagnostic approach for the classification of GITCL. We identified 42 cases of GITCL and analyzed clinicopathologic features, especially addressing their T-cell receptor (TCR) phenotype. Nine (21%) of 42 GITCL cases were positive for TCRγ protein expression. Among these TCRγ cases, TCRβ expression or not was detected in 5 and 4, respectively, but resulted in no further clinicopathologic differences. TCRβ positivity without TCRγ expression (βγ) was seen in 9 GITCL patients (21%). Twenty-four patients (57%) were negative for TCRβ and γ expression (βγ). Compared with TCRβγ or βγ type, TCRγ cases were characterized by exclusive involvement of intestinal sites (100% vs. 11%, P<0.001; 100% vs. 58%, P=0.032, respectively), but not of stomach (0% vs. 78%, P=0.002; 0% vs. 38%, P=0.039, respectively). Notably, TCRγ positivity was an independent unfavorable prognostic factor among our GITCL patients (P<0.001). Considering our results, TCRγ GITCL, that is, intestinal γδ T-cell lymphoma, appears to constitute a distinct disease entity.
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Merrill ED, Agbay R, Miranda RN, Aung PP, Tetzlaff MT, Young KH, Curry JL, Nagarajan P, Ivan D, Prieto VG, Medeiros LJ, Duvic M, Torres-Cabala CA. Primary Cutaneous T-Cell Lymphomas Showing Gamma-Delta (γδ) Phenotype and Predominantly Epidermotropic Pattern are Clinicopathologically Distinct From Classic Primary Cutaneous γδ T-Cell Lymphomas. Am J Surg Pathol 2017; 41:204-215. [PMID: 27879514 DOI: 10.1097/pas.0000000000000768] [Citation(s) in RCA: 45] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Primary cutaneous gamma-delta (γδ) T-cell lymphoma is a rare disease that typically involves the dermis and subcutis. Cases of primary cutaneous T-cell lymphomas showing γδ phenotype and predominantly epidermotropic pattern (EγδTCL) are not well defined. In this series, cases of primary cutaneous T-cell lymphomas showing γδ phenotype were reviewed and classified as predominantly epidermotropic (EγδTCL) when >75% of lymphoma cells resided in the epidermis or predominantly dermal and/or subcutaneous (DSγδTCL). Clinical, pathologic, and immunophenotypic features were compared in 27 biopsies from 13 patients of EγδTCL and 13 biopsies from 7 patients of DSγδTCL. The lymphoma cells were diffusely positive for CD3 and T-cell receptor (TCR)γ, mostly positive for granzyme B and TIA-1, variably positive for CD8, CD7, and CD30, and negative for CD4 and TCRβ. Two patients with EγδTCL had dissemination to lymph nodes and 1 to the lung; 1 patient with DSγδTCL had gastrointestinal involvement. The median survival of patients with EγδTCL was not reached, and with a median follow-up of 19.2 months, 3/13 died. In contrast, the median survival of patients with DSγδTCL was 10 months, and after a median follow-up of 15.6 months, 5/5 died (P<0.01). EγδTCL is a rare presentation of cutaneous T-cell lymphoma that can be distinguished from DSγδTCL based on the extent of epidermotropism and has a better prognosis and longer median survival than DSγδTCL. However, although EγδTCL resembles mycosis fungoides clinically and histologically, a subset of EγδTCL is more likely to behave more aggressively than typical mycosis fungoides.
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Affiliation(s)
- E Dean Merrill
- Departments of *Pathology ‡Hematopathology §Dermatology, The University of Texas MD Anderson Cancer Center, Houston, TX †University of Missouri- Kansas City School of Medicine, Kansas City, MO
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