1
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Chen BJ, Hsieh SM, Hsieh TH, Jhuang JY, Kao YC. DUSP22-rearranged primary cutaneous CD30-positive T-cell lymphoproliferative disorders and adult T-cell leukemia/lymphoma frequently share the LEF1+/TIA1- immunophenotype. Hum Pathol 2024; 150:58-66. [PMID: 38971328 DOI: 10.1016/j.humpath.2024.07.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2024] [Revised: 06/30/2024] [Accepted: 07/03/2024] [Indexed: 07/08/2024]
Abstract
DUSP22 rearrangements are genetic alterations observed in a subset of systemic anaplastic large cell lymphoma (S-ALCL), primary cutaneous anaplastic large cell lymphoma (C-ALCL), and lymphomatoid papulosis (LyP). Previous investigations have shown that the LEF1+/TIA1- immunoprofile and MSC E116K mutations are highly associated with DUSP22 rearrangement in ALCL. However, the existing literature primarily focuses on S-ALCL. Our understanding of the LEF1/TIA1 immunoprofile and MSC mutation status in C-ALCL/LyP is still limited. In this study, we aimed to assess LEF1/TIA1 expression and MSC mutations in a cohort of 23 C-ALCL/LyP cases, along with a control group of histological mimickers. DUSP22 rearrangements were detected by fluorescence in situ hybridization in eight cases (6/10 C-ALCL, 2/13 LyP). We found LEF1 expression in five out of eight (63%) DUSP22-rearranged cases (3/6 C-ALCL, 2/2 LyP), and none of the 15 cases lacking DUSP22 rearrangements. Furthermore, we also found frequent LEF1 expression in adult T-cell leukemia/lymphoma (ATLL; 10 of 11, 91%) within the control group. TIA1 expression was consistently negative in all DUSP22-rearranged C-ALCL/LyP and ATLL cases tested. MCS E116K mutation was identified in one of five DUSP22-rearranged C-ALCL cases. RNA sequencing of a DUSP22-rearranged C-ALCL revealed a novel DUSP22::SNHG fusion coexisting with a CD58::WNT2B fusion. In conclusion, our findings demonstrated a lower rate of LEF1 expression in DUSP22-rearranged C-ALCL/LyP compared to previous reports that predominantly focused on S-ALCL. Moreover, we observed that the majority of ATLL cases also expressed LEF1, suggesting that the LEF1+/TIA1- immunoprofile does not differentiate DUSP22-rearranged C-ALCL/LyP from ATLL.
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MESH Headings
- Humans
- Dual-Specificity Phosphatases/genetics
- Mitogen-Activated Protein Kinase Phosphatases/genetics
- Male
- Female
- Middle Aged
- Lymphoid Enhancer-Binding Factor 1/genetics
- Lymphoid Enhancer-Binding Factor 1/analysis
- Adult
- Aged
- Gene Rearrangement
- Skin Neoplasms/genetics
- Skin Neoplasms/pathology
- Immunophenotyping
- Ki-1 Antigen/genetics
- Ki-1 Antigen/analysis
- Biomarkers, Tumor/genetics
- Biomarkers, Tumor/analysis
- Aged, 80 and over
- In Situ Hybridization, Fluorescence
- Mutation
- Lymphomatoid Papulosis/genetics
- Lymphomatoid Papulosis/pathology
- Young Adult
- Phenotype
- Lymphoma, Primary Cutaneous Anaplastic Large Cell/genetics
- Lymphoma, Primary Cutaneous Anaplastic Large Cell/pathology
- Immunohistochemistry
- Lymphoma, Large-Cell, Anaplastic/genetics
- Lymphoma, Large-Cell, Anaplastic/pathology
- Lymphoma, Large-Cell, Anaplastic/immunology
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Affiliation(s)
- Bo-Jung Chen
- Department of Pathology, Shuang Ho Hospital, Taipei Medical University, New Taipei City, 23561, Taiwan; Department of Pathology, School of Medicine, College of Medicine, Taipei Medical University, Taipei, 110, Taiwan.
| | - Shu-Min Hsieh
- Department of Clinical Pathology, Shuang Ho Hospital, Taipei Medical University, New Taipei City, 23561, Taiwan.
| | - Tsung-Han Hsieh
- Joint Biobank, Office of Human Research, Taipei Medical University, Taipei, 110, Taiwan.
| | - Jie-Yang Jhuang
- Department of Pathology, MacKay Memorial Hospital, Taipei, 10449, Taiwan; Department of Medicine, School of Medicine, MacKay Medical College, New Taipei City, 252, Taiwan.
| | - Yu-Chien Kao
- Department of Pathology, School of Medicine, College of Medicine, Taipei Medical University, Taipei, 110, Taiwan; Department of Pathology, Taipei Medical University Hospital, Taipei, 110, Taiwan; Department of Pathology, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, 704, Taiwan.
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2
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Fattah YH, Crasto D, Liu SS, Linhares Y, Kerdel F, Hanly A, Karai LJ. DUSP22-IRF4 Rearranged CD30-Positive Primary Cutaneous Lymphoproliferative Disorder With Gamma/Delta Phenotype. Am J Dermatopathol 2023; 45:831-834. [PMID: 37883980 DOI: 10.1097/dad.0000000000002573] [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: 10/28/2023]
Abstract
ABSTRACT CD30-positive primary cutaneous lymphoproliferative disorders (CD30 + PCLPD) are a heterogeneous group of cutaneous T-cell lymphoma (CTCL) that includes lymphomatoid papulosis (LyP) and primary cutaneous anaplastic large cell lymphoma. They exist as a clinical and pathological spectrum, which display significant overlap and variability. The diagnosis is made based on correlation between clinical and histopathologic findings. LyP with 6p25.3 rearrangement subtype represents <5% of LyP cases and is defined by DUSP22-IRF4 rearrangement on 6p25.3 locus. The reported cases express the alpha/beta T-cell receptor and follow an indolent clinical behavior typical of LyP. The same rearrangement is detected in 28% of anaplastic large cell lymphoma. We hereby present an extraordinary case of CD30 + PCLPD with DUSP22-IRF4 rearrangement and novel expression of gamma/delta T-cell immunophenotype in a young patient. Although the gamma/delta T-cell immunophenotype has been described in many other T-cell lymphomas, this is the first reported association with CD30 + PCLPD with DUSP22-IRF4 rearrangement.
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Affiliation(s)
- Yasmin H Fattah
- Department of Dermatology, Larkin Community Hospital, South Miami, FL
| | - David Crasto
- Department of Dermatology, Larkin Community Hospital, South Miami, FL
| | - Shuo S Liu
- Department of Dermatology, Larkin Community Hospital, South Miami, FL
| | | | - Franz Kerdel
- Skin Center of South Miami, South Miami, FL; and
| | - Andrew Hanly
- Global Pathology, Sonic Health Care USA, Miami Lakes, FL
| | - Laszlo J Karai
- Global Pathology, Sonic Health Care USA, Miami Lakes, FL
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3
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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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4
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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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5
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Bhabha FK, McCormack C, Campbell BA, Lade S, Buelens O, Van Der Weyden C, Prince HM. CD30-positive lymphoproliferative disorders-An Australian Clinical Practice Statement from the Peter MacCallum Cancer Centre. Australas J Dermatol 2023; 64:194-203. [PMID: 36892928 DOI: 10.1111/ajd.14016] [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: 07/31/2022] [Revised: 02/01/2023] [Accepted: 02/12/2023] [Indexed: 03/10/2023]
Abstract
The CD30-postive lymphoproliferative disorders, including lymphomatoid papulosis and primary cutaneous anaplastic large cell lymphoma, account for up to 30% of all cutaneous T-cell lymphomas (CTCLs) and are the second most common form of CTCLs after mycosis fungoides. Both conditions differ in their clinical presentations; however, they share the expression of the CD30 antigen as a common immunophenotypic hallmark. There is a wide spectrum of management options depending on factors such as extent of disease, staging and treatment tolerability. This Clinical Practice Statement is reflective of the current clinical practice in Australia.
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Affiliation(s)
- Friyana K Bhabha
- Department of Surgical Oncology, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - Christopher McCormack
- Department of Surgical Oncology, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - Belinda A Campbell
- Department of Radiation Oncology, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia.,Department of Clinical Pathology, The University of Melbourne, Parkville, Victoria, Australia
| | - Stephen Lade
- Department of Pathology, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - Odette Buelens
- Nurse Practitioner, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - Carrie Van Der Weyden
- Department of Haematology, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - H Miles Prince
- Department of Haematology, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
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6
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Goodlad JR, Cerroni L, Swerdlow SH. Recent advances in cutaneous lymphoma-implications for current and future classifications. Virchows Arch 2023; 482:281-298. [PMID: 36278991 PMCID: PMC9852132 DOI: 10.1007/s00428-022-03421-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2022] [Revised: 08/27/2022] [Accepted: 09/27/2022] [Indexed: 01/24/2023]
Abstract
The Revised European-American Classification of mature lymphoid neoplasms published in 1994 and the 2001, 2008 and 2016 WHO classifications that followed, were the product of international collaboration and consensus amongst haematopathologists, geneticists, molecular scientists and clinicians. Primary cutaneous lymphomas were fully incorporated into this process following the publication of the WHO-EORTC classification of cutaneous lymphomas in 2005. The definition, diagnostic criteria and recommended studies for primary cutaneous lymphoma continue to be refined. The 2022 International Consensus Classification represents the most recent update and an overview of all the main entities presenting primarily in the skin, together with the major changes in classification, are summarized herein. Primary cutaneous marginal zone lymphoma is segregated from other extranodal marginal zone lymphomas of mucosa-associated lymphoid tissue (MALT lymphoma) and downgraded to a lymphoproliferative disorder in line with its markedly indolent behaviour. In addition, two subtypes are recognised, based largely but not exclusively on whether they are heavy chain class-switched or IgM positive. Similarly, in keeping with a trend to greater conservatism, primary cutaneous acral CD8 positive T cell lymphoma is now also classified as a lymphoproliferative disorder. In addition, significant new insights into the biology of primary cutaneous lymphoma have also recently been forthcoming and will be presented. These studies have enhanced our knowledge of genetic, epigenetic and transcriptional changes in this group of diseases. They not only identify potential targets for novel therapies, but also raise as yet unanswered questions as to how we categorise cutaneous lymphomas, particularly with respect to relationships with similar lymphomas at extracutaneous sites.
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Affiliation(s)
- JR Goodlad
- Department of Pathology, NHS Greater Glasgow and Clyde, Level 3 Laboratory Medicine Building Queen Elizabeth University Hospital, 1345 Govan Rd, Glasgow, G51 4TF UK
| | - L Cerroni
- Department of Dermatology, Medical University of Graz, Graz, Austria
| | - SH Swerdlow
- Department of Pathology, University of Pittsburgh School of Medicine, Pittsburgh, PA USA
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7
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Magro CM, Mo JH, Telang G. Localized lymphomatoid papulosis: Unilesional lymphomatoid papulosis, regional lymphomatoid papulosis, and persistent agmination of lymphomatoid papulosis. Clin Dermatol 2022; 40:622-638. [PMID: 35907581 DOI: 10.1016/j.clindermatol.2022.07.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Lymphomatoid papulosis (LYP), the most common primary cutaneous CD30-positive lymphoproliferative disorder, is heralded by multiple papular and nodular lesions at anatomically discontiguous cutaneous sites. The histologic patterns are protean. An uncommon form of LYP is one that is anatomically confined. Cases of unilesional LYP, regional LYP, and persistent agmination of LYP were encountered in the routine and consultative practices of Weill Cornell Medicine, Division of Dermatopathology. The clinical presentation, outcomes, light microscopic findings, and phenotypic profile are reviewed. There were 10 cases of LYP presenting as solitary plaques or nodules primarily occurring in older patients and without a relevant medical history in most. Most cases occurred at an acral site with many localized to the foot; the morphology was one of a necrotizing angiocentric type E pattern and borderline type C morphology. Two of the unilesional patients in our series went on to develop mycosis fungoides, one at the initial site of unilesional type A LYP, and the other at a discontiguous site. Excluding one case, the solitary lesions underwent complete regression; after the lesions regressed, some cases had no apparent recurrence. The second anatomically confined variant of LYP in our series was regional LYP exhibiting a type E morphology in two cases and a hybrid type A and granulomatous eccrinotropic morphology in one case. There was no subsequent development of lymphoma, nor was there any spread to additional anatomic sites. The final category was persistent agmination of LYP, whereby the agminated papules of LYP were superimposed on a plaque of cutaneous T-cell lymphoma represented by mycosis fungoides in two and follicular helper T-cell lymphoma in one. In conclusion, anatomically confined LYP defines an uncommon form of LYP, but it is an important one to recognize because the histology can be worrisome despite an indolent clinical course. The clinical presentation, the infrequent association with lymphoma/leukemia, and histology are similar to conventional LYP, although there appears to be a greater tendency for complete regression without recurrence, excluding cases of persistent agmination of LYP whereby the clinical course warrants categorization as a form of cutaneous T cell lymphoma (CTCL).
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Affiliation(s)
- Cynthia M Magro
- Division of Dermatopathology, Weill Cornell Medicine, New York, New York, USA.
| | - Joshua H Mo
- Department of Dermatology, Brown University Alpert School of Medicine, Providence, Rhode Island, USA
| | - Gladys Telang
- Department of Dermatology, Brown University Alpert School of Medicine, Providence, Rhode Island, USA
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8
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Genetics Abnormalities with Clinical Impact in Primary Cutaneous Lymphomas. Cancers (Basel) 2022; 14:cancers14204972. [PMID: 36291756 PMCID: PMC9599538 DOI: 10.3390/cancers14204972] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2022] [Revised: 10/04/2022] [Accepted: 10/04/2022] [Indexed: 11/18/2022] Open
Abstract
Simple Summary The genetic landscape of cutaneous T-cell lymphomas analyzed by sequencing high throughput techniques shows a heterogeneous somatic mutational profile and genomic copy number variations in the TCR signaling effectors, the NF-κB elements, DNA damage/repair elements, JAK/STAT pathway elements and epigenetic modifiers. A mutational and genomic stratification of these patients provides new opportunities for the development or repurposing of (personalized) therapeutic strategies. The genetic heterogeneity in cutaneous B-cell lymphoma parallels with the specific subtype. Damaging mutations in primary cutaneous diffuse large B-cell lymphoma of the leg type, involving MYD88 gene, or BCL6 and MYC translocations or CDKN2A deletions are useful for diagnostic purposes. The more indolent forms, as the primary cutaneous lymphoma of follicle center cell (somatic mutations in TNFRSF14 and 1p36 deletions) and the cutaneous lymphoproliferative disorder of the marginal zone cells (FAS gene), present with a more restricted pattern of genetic alterations. Abstract Primary cutaneous lymphomas comprise a heterogeneous group of extranodal non-Hodgkin lymphomas (NHL) that arise from skin resident lymphoid cells and are manifested by specific lymphomatous cutaneous lesions with no evidence of extracutaneous disease at the time of diagnosis. They may originate from mature T-lymphocytes (70% of all cases), mature B-lymphocytes (25–30%) or, rarely, NK cells. Cutaneous T-cell lymphomas (CTCL) comprise a heterogeneous group of T-cell malignancies including Mycosis Fungoides (MF) the most frequent subtype, accounting for approximately half of CTCL, and Sézary syndrome (SS), which is an erythrodermic and leukemic subtype characterized by significant blood involvement. The mutational landscape of MF and SS by NGS include recurrent genomic alterations in the TCR signaling effectors (i.e., PLCG1), the NF-κB elements (i.e., CARD11), DNA damage/repair elements (TP53 or ATM), JAK/STAT pathway elements or epigenetic modifiers (DNMT3). Genomic copy number variations appeared to be more prevalent than somatic mutations. Other CTCL subtypes such as primary cutaneous anaplastic large cell lymphoma also harbor genetic alterations of the JAK/STAT pathway in up to 50% of cases. Recently, primary cutaneous aggressive epidermotropic T-cell lymphoma, a rare fatal subtype, was found to contain a specific profile of JAK2 rearrangements. Other aggressive cytotoxic CTCL (primary cutaneous γδ T-cell lymphomas) also show genetic alterations in the JAK/STAT pathway in a large proportion of patients. Thus, CTCL patients have a heterogeneous genetic/transcriptional and epigenetic background, and there is no uniform treatment for these patients. In this scenario, a pathway-based personalized management is required. Cutaneous B-cell lymphoma (CBCL) subtypes present a variable genetic profile. The genetic heterogeneity parallels the multiple types of specialized B-cells and their specific tissue distribution. Particularly, many recurrent hotspot and damaging mutations in primary cutaneous diffuse large B-cell lymphoma of the leg type, involving MYD88 gene, or BCL6 and MYC translocations and BLIMP1 or CDKN2A deletions are useful for diagnostic and prognostic purposes for this aggressive subtype from other indolent CBCL forms.
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9
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Di Napoli A, Rogges E, Noccioli N, Gazzola A, Lopez G, Persechino S, Mancini R, Sabattini E. Deep Sequencing of Immunoglobulin Genes Identifies a Very Low Percentage of Monoclonal B Cells in Primary Cutaneous Marginal Zone Lymphomas with CD30-Positive Hodgkin/Reed–Sternberg-like Cells. Diagnostics (Basel) 2022; 12:diagnostics12020290. [PMID: 35204381 PMCID: PMC8870847 DOI: 10.3390/diagnostics12020290] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2021] [Revised: 12/31/2021] [Accepted: 01/20/2022] [Indexed: 11/16/2022] Open
Abstract
The spectrum of cutaneous CD30-positive lymphoproliferative disorders encompasses both inflammatory and neoplastic conditions. CD30+ Hodgkin and Reed–Sternberg-like cells have been occasionally reported in primary cutaneous marginal zone lymphoma, where they are thought to represent a side neoplastic component within a dominant background of lymphomatous small B cells. Herein, we describe the histological and molecular findings of three cases of primary cutaneous marginal zone lymphomas with CD30+ H/RS cells, in which next-generation sequencing analysis revealed the clonal population to consist in less than 5% of the cutaneous B-cell infiltrate, providing a thought-provoking focus on a possible main role for CD30+ cells in primary cutaneous marginal zone lymphoproliferations.
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Affiliation(s)
- Arianna Di Napoli
- Department of Clinical and Molecular Medicine, Sant’Andrea Hospital, Sapienza University, 00189 Rome, Italy; (E.R.); (N.N.); (G.L.); (R.M.)
- Correspondence: ; Tel.: +39-06-33775463
| | - Evelina Rogges
- Department of Clinical and Molecular Medicine, Sant’Andrea Hospital, Sapienza University, 00189 Rome, Italy; (E.R.); (N.N.); (G.L.); (R.M.)
| | - Niccolò Noccioli
- Department of Clinical and Molecular Medicine, Sant’Andrea Hospital, Sapienza University, 00189 Rome, Italy; (E.R.); (N.N.); (G.L.); (R.M.)
| | - Anna Gazzola
- Haematopathology Unit, IRCCS Azienda Ospedaliero Universitaria di Bologna, 40138 Bologna, Italy; (A.G.); (E.S.)
| | - Gianluca Lopez
- Department of Clinical and Molecular Medicine, Sant’Andrea Hospital, Sapienza University, 00189 Rome, Italy; (E.R.); (N.N.); (G.L.); (R.M.)
| | - Severino Persechino
- NESMOS Department, Dermatology Unit, Sant’Andrea Hospital, Sapienza University, 00189 Rome, Italy;
| | - Rita Mancini
- Department of Clinical and Molecular Medicine, Sant’Andrea Hospital, Sapienza University, 00189 Rome, Italy; (E.R.); (N.N.); (G.L.); (R.M.)
| | - Elena Sabattini
- Haematopathology Unit, IRCCS Azienda Ospedaliero Universitaria di Bologna, 40138 Bologna, Italy; (A.G.); (E.S.)
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10
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Runge JS, Novice ML, Briones N, Williams K, Lowe L, Boyer DF, Wilcox RA, Tejasvi T, Hristov AC. Patch/plaque mycosis-fungoides-like presentations of DUSP22-translocated T-cell lymphomas. J Cutan Pathol 2021; 49:299-305. [PMID: 34699105 DOI: 10.1111/cup.14156] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Revised: 10/02/2021] [Accepted: 10/19/2021] [Indexed: 11/27/2022]
Abstract
The DUSP22-IRF4 gene rearrangement results in downregulation of DUSP22, a presumed tumor suppressor in T-cell lymphomagenesis. It has been described in some cases of primary cutaneous and systemic anaplastic large-cell lymphoma, lymphomatoid papulosis, and transformed mycosis fungoides. Here we describe two patients with clinical lesions resembling patch/plaque mycosis fungoides that did not meet WHO criteria for large-cell transformation on histopathology yet showed a DUSP22 translocation. One patient who had a history of systemic anaplastic large-cell lymphoma with DUSP22 translocation presented with cutaneous involvement by his systemic lymphoma along with lymphomatoid papulosis and mycosis-fungoides-like lesions, all showing an identical immunophenotype and T-cell clone. These cases expand the spectrum of DUSP22-rearranged lymphomas to include mycosis-fungoides-like presentations without large-cell transformation.
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Affiliation(s)
- John S Runge
- Medical School, University of Michigan, Ann Arbor, Michigan, USA
| | - Madison L Novice
- Medical School, University of Michigan, Ann Arbor, Michigan, USA
| | - Naomi Briones
- Department of Dermatology, University of Michigan, Ann Arbor, Michigan, USA
| | - Kiyanna Williams
- Department of Dermatology, University of Michigan, Ann Arbor, Michigan, USA
| | - Lori Lowe
- Department of Dermatology, University of Michigan, Ann Arbor, Michigan, USA.,Department of Pathology, University of Michigan, Ann Arbor, Michigan, USA
| | - Daniel F Boyer
- Department of Pathology, University of Michigan, Ann Arbor, Michigan, USA
| | - Ryan A Wilcox
- Department of Internal Medicine, Hematology/Oncology Division, University of Michigan, Ann Arbor, Michigan, USA
| | - Trilokraj Tejasvi
- Department of Dermatology, University of Michigan, Ann Arbor, Michigan, USA
| | - Alexandra C Hristov
- Department of Dermatology, University of Michigan, Ann Arbor, Michigan, USA.,Department of Pathology, University of Michigan, Ann Arbor, Michigan, USA
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11
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Abstract
Primary cutaneous T cell lymphomas (CTCLs) are a heterogeneous group of lymphomas that present in the skin with no evidence of extracutaneous disease at the time of diagnosis. CTCL subtypes demonstrate a variety of clinical, histological, and molecular features, and can follow an indolent or a very aggressive course. The underlying pathogenetic mechanisms are not yet entirely understood. The pathophysiology of CTCL is complex and a single initiating factor has not yet been identified. Diagnosis is based on clinicopathological correlation and requires an interdisciplinary team. Treatment decision is made based on short-term and long-term goals. Therapy options comprise skin-directed therapies, such as topical steroids or phototherapy, and systemic therapies, such as monoclonal antibodies or chemotherapy. So far, the only curative treatment approach is allogeneic haematopoietic stem cell transplantation. Novel therapies, such as chimeric antigen receptor T cells, monoclonal antibodies or small molecules, are being investigated in clinical trials. Patients with CTCL have reduced quality of life and a lack of effective treatment options. Further research is needed to better identify the underlying mechanisms of CTCL development and course as well as to better tailor treatment strategies to individual patients.
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12
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Self-regressing oral CD30-positive, EBV-negative, T-cell lymphoproliferative lesions. A poorly understood process highlighted by ominous clinicopathologic features and indolent behavior. Oral Surg Oral Med Oral Pathol Oral Radiol 2021; 132:698-707. [PMID: 34526251 DOI: 10.1016/j.oooo.2021.05.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2021] [Revised: 04/22/2021] [Accepted: 05/30/2021] [Indexed: 11/24/2022]
Abstract
OBJECTIVE Intraoral, primary, CD30-positive (CD30+) T-cell lymphoproliferative disorders (TLPDs) are uncommon, and their clinicopathologic presentation and management can vary and may be challenging. Herein, we present a retrospective study of 4 examples of self-regressing primary CD30+ TLPD affecting the gingiva. STUDY DESIGN Archived files were retrospectively reviewed for oral CD30+ TLPDs featuring (1) proper immunohistochemical documentation, (2) Epstein-Barr virus negativity, (3) adequate follow-up information corroborating regression, and (4) no history of hematopoietic malignancy or related-mucocutaneous disease. RESULTS Three women and 1 man (age range, 55-82 years; mean, 68.3 years) presented with rapidly growing gingival ulcers. Microscopic evaluation revealed diffuse infiltration by sheets of large, atypical cells admixed with lymphocytes and eosinophils, showing angiocentric distribution, focal neurotropism, and muscle infiltration. The lesional cells consistently stained for CD3 and CD30 and were variably immunoreactive against CD2, CD4, CD5, CD7, and CD8, but were negative for ALK1 and EBV-encoded small RNA. TCR-γ gene rearrangement studies revealed a monoclonal T-cell population in 1 case. All lesions showed complete regression 2 to 8 weeks postoperatively (mean follow-up, 4.5 weeks). CONCLUSIONS Notwithstanding their alarming clinicopathologic appearance, there are CD30+ TLPDs confined to the oral cavity that have an indolent course. However, clinical staging is essential to exclude aggressive systemic malignancy.
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Codreanu Chifa D, El Khoury M, Wahab CA, David J, Sanchez L, Trop I, Labelle M, Mesurolle B. Lymphome anaplasique à grandes cellules associé aux implants mammaires : qu’en savons-nous ? Partie II. IMAGERIE DE LA FEMME 2020. [DOI: 10.1016/j.femme.2020.06.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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14
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Di Raimondo C, Parekh V, Song JY, Rosen ST, Querfeld C, Zain J, Martinez XU, Abdulla FR. Primary Cutaneous CD30+ Lymphoproliferative Disorders: a Comprehensive Review. Curr Hematol Malig Rep 2020; 15:333-342. [DOI: 10.1007/s11899-020-00583-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
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15
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Kadin ME, Hamilton RG, Vonderheid EC. Evidence linking atopy and staphylococcal superantigens to the pathogenesis of lymphomatoid papulosis, a recurrent CD30+ cutaneous lymphoproliferative disorder. PLoS One 2020; 15:e0228751. [PMID: 32049976 PMCID: PMC7015403 DOI: 10.1371/journal.pone.0228751] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2019] [Accepted: 01/22/2020] [Indexed: 01/08/2023] Open
Abstract
Background Primary cutaneous CD30+ lymphoproliferative disorders (CD30CLPD) are the second most common type of cutaneous T cell lymphoma (CTCL) and include lymphomatoid papulosis (LyP) and primary cutaneous anaplastic large cell lymphoma (pcALCL). Case reports and small patient series suggest an association of CD30CLPD with atopic disorders. However, the prevalence of atopy in patients with CD30CLPD in retrospective studies depends on patients’ recall which is not always reliable. More objective criteria of atopy include evidence of skin reactivity to allergens (positive prick test) and evidence of allergen-specific IgE in serum. This study was undertaken to test the hypothesis that atopy is prevalent in patients with CD30CLPD using serologic criteria of allergen-specific IgE antibodies to aeroallergens and Staphylococcal aureus enterotoxin superantigens (SSAgs). Methods We tested serum samples of CD30CLPD for common IgE-specific airborne allergens with the Phadiatop test, which if positive, is regarded as serologic evidence of atopy in adults. Sera were also tested for IgE antibodies reactive to three Staphylococcal enterotoxins with superantigenic properties (SSAg-IgE). Control sera were obtained from adult subjects evaluated for rhino-sinusitis and a negative Phadiatop test. Patients’ history of an atopic disorder was obtained by retrospective chart review. Findings Nearly 50% of patients with the most common LyP types (A and C) had a positive Phadiatop test for allergic sensitization to common airborne allergens, and total serum IgE (IgE-t) was increased compared to non-atopic controls. At the IgE antibody concentration generally used to define serologic atopy (≥ 0.35 kUA/L), 8/31 (26%) samples of CD30CLPD and 7/28 (25%) samples of LyP were reactive to at least one SSAg-IgE compared to 3/52 (6%) control specimens (P = 0.016 and P = 0.028, respectively). TSST1-IgE was detected in 7 (23%) specimens of CD30CLPD, often together with SEB-IgE; SEA-IgE ≥ 0.35 kUA/L was not detected. For control specimens, TSST1-IgE exceeded the 0.35 kUA/L threshold in 3 (6%) specimens. Conclusions Patients with LyP types A and C have serologic evidence of atopy against common airborne antigens and SSAgs when compared to control adult subjects who had rhino-sinusitis and a negative Phadiatop test for aero-IgEs. Serologic evidence of atopy exceeded that determined by LyP patients’ personal history. The findings support our hypothesis that an atopic diathesis may contribute to the pathogenesis of the most common types of LyP (A and C).
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Affiliation(s)
- Marshall E. Kadin
- Department of Dermatology, Boston University, Boston, MA, United States of America
- Department of Pathology and Laboratory Medicine, Lifespan-Rhode Island Hospital, Providence, RI, United States of America
- Department of Dermatology and Skin Surgery, Roger Williams Medical Center, Providence, RI, United States of America
- * E-mail:
| | - Robert G. Hamilton
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, United States of America
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, MD, United States of America
- Johns Hopkins Dermatology, Allergy and Clinical Immunology Reference Laboratory, Baltimore, MD, United States of America
| | - Eric C. Vonderheid
- Department of Oncology, Johns Hopkins University School of Medicine, Baltimore, MD, United States of America
- Sydney Kimmel Cancer Center, Johns Hopkins University School of Medicine, Baltimore, MD, United States of America
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16
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Does Breast Implant–Associated ALCL Begin as a Lymphoproliferative Disorder? Plast Reconstr Surg 2020; 145:30e-38e. [DOI: 10.1097/prs.0000000000006390] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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17
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Oschlies I, King RL, Dotlic S, Montes-Moreno S, Ponzoni M, Traverse-Glehen A, Calaminici M, Ferry JA, Ott G, Goodlad JR. The clinico-pathological spectrum of primary cutaneous lymphoma other than mycosis fungoides/Sezary syndrome. Virchows Arch 2019; 476:683-699. [DOI: 10.1007/s00428-019-02713-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2019] [Revised: 10/28/2019] [Accepted: 11/01/2019] [Indexed: 12/30/2022]
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18
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Martinez-Cabriales SA, Walsh S, Sade S, Shear NH. Lymphomatoid papulosis: an update and review. J Eur Acad Dermatol Venereol 2019; 34:59-73. [PMID: 31494989 DOI: 10.1111/jdv.15931] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2019] [Accepted: 08/08/2019] [Indexed: 12/13/2022]
Abstract
Lymphomatoid papulosis (LyP) is a benign chronic often relapsing skin condition that belongs to the CD30-positive cutaneous lymphoproliferative disorders. LyP typically presents as crops of lesions with a tendency to self-resolve, and morphology can range from solitary to agminated or diffuse papules and plaques to nodules or tumours. The clinical-histological spectrum can range from borderline cases to overlap with primary cutaneous anaplastic cell lymphoma (pcALCL). Histology and immunophenotype commonly show overlap with other CD30-positive disorders and sometimes may be identical to pcALCL, making its diagnosis more difficult. Patients with LyP have an increased risk of developing a second neoplasm such as mycosis fungoides, pcALCL and/or Hodgkin lymphoma. Clinical correlation allows its proper classification and diagnosis, which is fundamental for treatment and prognosis. This review focuses on the clinical appearance, histopathological features, diagnosis, differential diagnosis and management of LyP.
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Affiliation(s)
- S A Martinez-Cabriales
- Department of Medicine, University of Toronto, Toronto, ON, Canada.,Department of Dermatology, Sunnybrook Health Sciences Centre, Toronto, ON, Canada.,Department of Dermatology, Autonomous University of Nuevo Leon, San Nicolas de los Garza, Mexico
| | - S Walsh
- Department of Medicine, University of Toronto, Toronto, ON, Canada.,Department of Dermatology, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - S Sade
- Department of Pathology, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - N H Shear
- Department of Medicine, University of Toronto, Toronto, ON, Canada.,Department of Dermatology, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
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19
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Xerri L, Adélaïde J, Avenin M, Guille A, Taix S, Bonnet N, Carbuccia N, Garnier S, Mescam L, Murati A, Chaffanet M, Coso D, Bouabdallah R, Bertucci F, Birnbaum D. Common origin of sequential cutaneous CD30+ lymphoproliferations with nodal involvement evidenced by genome-wide clonal evolution. Histopathology 2019; 74:654-662. [DOI: 10.1111/his.13783] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Affiliation(s)
- Luc Xerri
- Department of Bio-Pathology; Institut Paoli-Calmettes; Marseille France
- Aix-Marseille University; Marseille France
- Inserm-CNRS; CRCM; Marseille France
| | - José Adélaïde
- Inserm-CNRS; CRCM; Marseille France
- Department of Predictive Oncology; Institut Paoli-Calmettes; Marseille France
| | - Morgan Avenin
- Department of Bio-Pathology; Institut Paoli-Calmettes; Marseille France
- Aix-Marseille University; Marseille France
| | - Arnaud Guille
- Inserm-CNRS; CRCM; Marseille France
- Department of Predictive Oncology; Institut Paoli-Calmettes; Marseille France
| | - Sebastien Taix
- Department of Bio-Pathology; Institut Paoli-Calmettes; Marseille France
| | - Nathalie Bonnet
- Department of Haematology; Institut Paoli-Calmettes; Marseille France
| | - Nadine Carbuccia
- Inserm-CNRS; CRCM; Marseille France
- Department of Predictive Oncology; Institut Paoli-Calmettes; Marseille France
| | - Séverine Garnier
- Inserm-CNRS; CRCM; Marseille France
- Department of Predictive Oncology; Institut Paoli-Calmettes; Marseille France
| | - Lenaïg Mescam
- Department of Bio-Pathology; Institut Paoli-Calmettes; Marseille France
| | - Anne Murati
- Department of Bio-Pathology; Institut Paoli-Calmettes; Marseille France
| | - Max Chaffanet
- Inserm-CNRS; CRCM; Marseille France
- Department of Predictive Oncology; Institut Paoli-Calmettes; Marseille France
| | - Diane Coso
- Department of Haematology; Institut Paoli-Calmettes; Marseille France
| | - Reda Bouabdallah
- Department of Haematology; Institut Paoli-Calmettes; Marseille France
| | - François Bertucci
- Aix-Marseille University; Marseille France
- Inserm-CNRS; CRCM; Marseille France
- Department of Predictive Oncology; Institut Paoli-Calmettes; Marseille France
| | - Daniel Birnbaum
- Aix-Marseille University; Marseille France
- Inserm-CNRS; CRCM; Marseille France
- Department of Predictive Oncology; Institut Paoli-Calmettes; Marseille France
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20
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Clemens MW, Jacobsen ED, Horwitz SM. 2019 NCCN Consensus Guidelines on the Diagnosis and Treatment of Breast Implant-Associated Anaplastic Large Cell Lymphoma (BIA-ALCL). Aesthet Surg J 2019; 39:S3-S13. [PMID: 30715173 DOI: 10.1093/asj/sjy331] [Citation(s) in RCA: 189] [Impact Index Per Article: 37.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
National Comprehensive Cancer Network (NCCN) guidelines represent the consensus standard of care for diagnosis and management of the majority of known cancers. NCCN guidelines on breast implant-associated anaplastic large cell lymphoma (BIA-ALCL) have been recognized by the US Food and Drug Administration and widely advocated by national specialty societies. Consensus guidelines have helped create a treatment standardization for BIA-ALCL at all stages of disease. NCCN guidelines are evidence-based where possible and utilize expert consensus opinion to fill in gaps that may exist. NCCN undergoes annual panel review by multidisciplinary faculty members, and this article represents the most up-to-date 2019 guidelines. Recommendations focus on parameters for achieving reliable diagnosis and disease management and emphasize the critical role for complete surgical ablation. Suggestions for adjunct treatments and chemotherapy regimens are included for advanced BIA-ALCL with lymph node involvement. BIA-ALCL recurrence and management of unresectable disease, and organ metastasis are addressed. Adherence to recognized BIA-ALCL guidelines ensures patients receive the most current efficacious treatment available.
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Affiliation(s)
- Mark W Clemens
- Department of Plastic Surgery, MD Anderson Cancer Center, Houston, TX
| | - Eric D Jacobsen
- Hematologic Oncology, Dana Farber Cancer Center, Brigham & Women’s Hospital, Harvard Medical School, Boston, MA
| | - Steven M Horwitz
- Department of Hematology, Memorial Sloan Kettering Cancer Center, New York, NY
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21
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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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22
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Kadin ME, Morgan J, Xu H, Glicksman CA. CD30+ T Cells in Late Seroma May Not Be Diagnostic of Breast Implant-Associated Anaplastic Large Cell Lymphoma. Aesthet Surg J 2017; 37:771-775. [PMID: 28402493 DOI: 10.1093/asj/sjw286] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
The objective was to analyze and discuss the implications of a nonmalignant CD30+ late seroma. Methods included collection of seroma fluid and peripheral blood from a patient with a late seroma 22 years after initial breast reconstruction. A panel of 24 monoclonal antibodies was used to detect T-cell receptor Vβ regions present on ~70% of normal human peripheral blood T lymphocytes. Flow cytometry gated on CD3+ and CD30+ activated T lymphocytes. Cytospins were used to inspect the morphology of the T lymphocytes. Results from the seroma fluid cytology revealed a spectrum of activated T lymphocytes as seen in the blood of patients with immune disorders such as infectious mononucleosis. Cells were judged to be nonmalignant by routine pathology. Flow cytometry revealed >23% of CD3+ T lymphocytes belonged to an expanded T-cell family expressing TCRVβ13.2. Most Vβ13.2 cells expressed T-cell activation antigen CD30 indicating that CD30 is not restricted to anaplastic large cell lymphoma (ALCL) in seroma fluids. A smaller expanded population of CD30+ T lymphocytes expressing TCRVβ 13.2 was detected in the blood. In conclusion, in this index case, an expanded population of CD30+ activated T lymphocytes was detected in seroma fluid surrounding a textured breast implant as well as in peripheral blood, consistent with a local and systemic immune response. The demonstration of an expanded CD30+ T-cell population in a polyclonal background suggests a possible role for bacterial superantigens as a pathogenic factor. These data further suggest that breast implant-associated anaplastic large cell lymphoma (BIA-ALCL) may be the end stage of a CD30+ T-cell lymphoproliferative disorder. LEVEL OF EVIDENCE 5.
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Affiliation(s)
- Marshall E Kadin
- Boston University School of Medicine, Boston, MA
- Roger Williams Medical Center, Providence, RI
| | - John Morgan
- Research Core Facility, Roger Williams Medical Center, Providence, RI
| | - Haiying Xu
- Roger Williams Medical Center, Providence, RI
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23
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Clemens MW, Horwitz SM. NCCN Consensus Guidelines for the Diagnosis and Management of Breast Implant-Associated Anaplastic Large Cell Lymphoma. Aesthet Surg J 2017; 37:285-289. [PMID: 28184418 DOI: 10.1093/asj/sjw259] [Citation(s) in RCA: 133] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Published case series demonstrate a lack of treatment standardization for breast implant-associated anaplastic large cell lymphoma (BIA-ALCL) with a wide variety of therapeutic strategies being employed at all stages of disease. The National Comprehensive Cancer Network (NCCN) annually publishes Clinical Practice Guidelines for Non-Hodgkin Lymphomas. For the first time, BIA-ALCL management will be included which signifies an important and needed guideline addition. The new BIA-ALCL guideline was achieved by a consensus of lymphoma oncologists, plastic surgeons, radiation oncologists, and surgical oncologists. NCCN guidelines focus on the diagnosis and management throughout the stages of many lymphoma subtypes based upon the most current data available. This article summarizes the essential recommendations and optimal therapeutic strategies of the NCCN guidelines critical to the plastic surgery community. We encourage international adoption of these BIA-ALCL treatment standards by our specialty societies across the oncology and surgery disciplines.
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Affiliation(s)
- Mark W. Clemens
- Dr Clemens is an Associate Professor, Department of Plastic Surgery, MD Anderson Cancer Center, Houston, TX. Dr Horwitz is an Attending Medical Oncologist of Lymphoma, Department of Hematology, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Steven M. Horwitz
- Dr Clemens is an Associate Professor, Department of Plastic Surgery, MD Anderson Cancer Center, Houston, TX. Dr Horwitz is an Attending Medical Oncologist of Lymphoma, Department of Hematology, Memorial Sloan Kettering Cancer Center, New York, NY
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24
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Neurotropic Gamma-Delta T-Cell Lymphoma With CD30-Positive Lymphoid Infiltrates. Am J Dermatopathol 2016; 38:e133-6. [DOI: 10.1097/dad.0000000000000560] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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25
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Kadin ME, Deva A, Xu H, Morgan J, Khare P, MacLeod RAF, Van Natta BW, Adams WP, Brody GS, Epstein AL. Biomarkers Provide Clues to Early Events in the Pathogenesis of Breast Implant-Associated Anaplastic Large Cell Lymphoma. Aesthet Surg J 2016; 36:773-81. [PMID: 26979456 DOI: 10.1093/asj/sjw023] [Citation(s) in RCA: 114] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/27/2016] [Indexed: 12/17/2022] Open
Abstract
Almost 200 women worldwide have been diagnosed with breast implant-associated anaplastic large cell lymphoma (BIA-ALCL). The unique location and specific lymphoma type strongly suggest an etio-pathologic link between breast implants and BIA-ALCL. It is postulated that chronic inflammation via bacterial infection may be an etiological factor. BIA-ALCL resembles primary cutaneous ALCL (pcALCL) in morphology, activated T-cell phenotype, and indolent clinical course. Gene expression array analysis, flow cytometry, and immunohistochemistry were used to study pcALCL and BIA-ALCL cell lines. Clinical samples were also studied to characterize transcription factor and cytokine profiles of tumor cells and surrounding lymphocytes. BIA-ALCL and pcALCL were found to have common expression of transcription factors SOCS3, JunB, SATB1, and a cytokine profile suggestive of a Th1 phenotype. Similar patterns were observed in a CD30+ cutaneous lymphoproliferative disorder (LPD). The patterns of cytokine and transcription factor expression suggest that BIA-ALCL is likely to arise from chronic bacterial antigen stimulation of T-cells. Further analysis of cytokine and transcription factor profiles may allow early detection and treatment of BIA-ALCL leading to better prognosis and survival. LEVEL OF EVIDENCE 5: Risk.
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Affiliation(s)
- Marshall E Kadin
- Dr Kadin is a Professor of Dermatology, Boston University School of Medicine, Boston, MA; and a Staff Physician, Roger Williams Medical Center, Providence, RI. Dr Deva is an Associate Professor of Cosmetic, Plastic, and Reconstructive Surgery, Macquarie University, NSW, Australia. Ms Xu is a Research Assistant, Dr Morgan is Director of the Research Core Facility, and Dr Khare is Director of the Cancer Immunotherapy and Gene Therapy Facility, Roger Williams Medical Center, Providence, RI. Dr MacLeod is Director of Cytogenetics at the Leibniz Institute, DSMZ - German Collection of Microorganisms and Cell Cultures, Braunschweig, Germany. Dr Van Natta is an Associate Clinical Professor, Department of Surgery, Indiana University School of Medicine, Indianapolis, IN. Dr Adams is an Associate Clinical Professor, Department of Plastic Surgery, University of Texas Southwestern Medical Center, Dallas, TX. Dr Brody is Professor Emeritus in the Division of Plastic Surgery, and Dr Epstein is a Professor of Pathology, University of Southern California Keck School of Medicine, Los Angeles, CA
| | - Anand Deva
- Dr Kadin is a Professor of Dermatology, Boston University School of Medicine, Boston, MA; and a Staff Physician, Roger Williams Medical Center, Providence, RI. Dr Deva is an Associate Professor of Cosmetic, Plastic, and Reconstructive Surgery, Macquarie University, NSW, Australia. Ms Xu is a Research Assistant, Dr Morgan is Director of the Research Core Facility, and Dr Khare is Director of the Cancer Immunotherapy and Gene Therapy Facility, Roger Williams Medical Center, Providence, RI. Dr MacLeod is Director of Cytogenetics at the Leibniz Institute, DSMZ - German Collection of Microorganisms and Cell Cultures, Braunschweig, Germany. Dr Van Natta is an Associate Clinical Professor, Department of Surgery, Indiana University School of Medicine, Indianapolis, IN. Dr Adams is an Associate Clinical Professor, Department of Plastic Surgery, University of Texas Southwestern Medical Center, Dallas, TX. Dr Brody is Professor Emeritus in the Division of Plastic Surgery, and Dr Epstein is a Professor of Pathology, University of Southern California Keck School of Medicine, Los Angeles, CA
| | - Haiying Xu
- Dr Kadin is a Professor of Dermatology, Boston University School of Medicine, Boston, MA; and a Staff Physician, Roger Williams Medical Center, Providence, RI. Dr Deva is an Associate Professor of Cosmetic, Plastic, and Reconstructive Surgery, Macquarie University, NSW, Australia. Ms Xu is a Research Assistant, Dr Morgan is Director of the Research Core Facility, and Dr Khare is Director of the Cancer Immunotherapy and Gene Therapy Facility, Roger Williams Medical Center, Providence, RI. Dr MacLeod is Director of Cytogenetics at the Leibniz Institute, DSMZ - German Collection of Microorganisms and Cell Cultures, Braunschweig, Germany. Dr Van Natta is an Associate Clinical Professor, Department of Surgery, Indiana University School of Medicine, Indianapolis, IN. Dr Adams is an Associate Clinical Professor, Department of Plastic Surgery, University of Texas Southwestern Medical Center, Dallas, TX. Dr Brody is Professor Emeritus in the Division of Plastic Surgery, and Dr Epstein is a Professor of Pathology, University of Southern California Keck School of Medicine, Los Angeles, CA
| | - John Morgan
- Dr Kadin is a Professor of Dermatology, Boston University School of Medicine, Boston, MA; and a Staff Physician, Roger Williams Medical Center, Providence, RI. Dr Deva is an Associate Professor of Cosmetic, Plastic, and Reconstructive Surgery, Macquarie University, NSW, Australia. Ms Xu is a Research Assistant, Dr Morgan is Director of the Research Core Facility, and Dr Khare is Director of the Cancer Immunotherapy and Gene Therapy Facility, Roger Williams Medical Center, Providence, RI. Dr MacLeod is Director of Cytogenetics at the Leibniz Institute, DSMZ - German Collection of Microorganisms and Cell Cultures, Braunschweig, Germany. Dr Van Natta is an Associate Clinical Professor, Department of Surgery, Indiana University School of Medicine, Indianapolis, IN. Dr Adams is an Associate Clinical Professor, Department of Plastic Surgery, University of Texas Southwestern Medical Center, Dallas, TX. Dr Brody is Professor Emeritus in the Division of Plastic Surgery, and Dr Epstein is a Professor of Pathology, University of Southern California Keck School of Medicine, Los Angeles, CA
| | - Pranay Khare
- Dr Kadin is a Professor of Dermatology, Boston University School of Medicine, Boston, MA; and a Staff Physician, Roger Williams Medical Center, Providence, RI. Dr Deva is an Associate Professor of Cosmetic, Plastic, and Reconstructive Surgery, Macquarie University, NSW, Australia. Ms Xu is a Research Assistant, Dr Morgan is Director of the Research Core Facility, and Dr Khare is Director of the Cancer Immunotherapy and Gene Therapy Facility, Roger Williams Medical Center, Providence, RI. Dr MacLeod is Director of Cytogenetics at the Leibniz Institute, DSMZ - German Collection of Microorganisms and Cell Cultures, Braunschweig, Germany. Dr Van Natta is an Associate Clinical Professor, Department of Surgery, Indiana University School of Medicine, Indianapolis, IN. Dr Adams is an Associate Clinical Professor, Department of Plastic Surgery, University of Texas Southwestern Medical Center, Dallas, TX. Dr Brody is Professor Emeritus in the Division of Plastic Surgery, and Dr Epstein is a Professor of Pathology, University of Southern California Keck School of Medicine, Los Angeles, CA
| | - Roderick A F MacLeod
- Dr Kadin is a Professor of Dermatology, Boston University School of Medicine, Boston, MA; and a Staff Physician, Roger Williams Medical Center, Providence, RI. Dr Deva is an Associate Professor of Cosmetic, Plastic, and Reconstructive Surgery, Macquarie University, NSW, Australia. Ms Xu is a Research Assistant, Dr Morgan is Director of the Research Core Facility, and Dr Khare is Director of the Cancer Immunotherapy and Gene Therapy Facility, Roger Williams Medical Center, Providence, RI. Dr MacLeod is Director of Cytogenetics at the Leibniz Institute, DSMZ - German Collection of Microorganisms and Cell Cultures, Braunschweig, Germany. Dr Van Natta is an Associate Clinical Professor, Department of Surgery, Indiana University School of Medicine, Indianapolis, IN. Dr Adams is an Associate Clinical Professor, Department of Plastic Surgery, University of Texas Southwestern Medical Center, Dallas, TX. Dr Brody is Professor Emeritus in the Division of Plastic Surgery, and Dr Epstein is a Professor of Pathology, University of Southern California Keck School of Medicine, Los Angeles, CA
| | - Bruce W Van Natta
- Dr Kadin is a Professor of Dermatology, Boston University School of Medicine, Boston, MA; and a Staff Physician, Roger Williams Medical Center, Providence, RI. Dr Deva is an Associate Professor of Cosmetic, Plastic, and Reconstructive Surgery, Macquarie University, NSW, Australia. Ms Xu is a Research Assistant, Dr Morgan is Director of the Research Core Facility, and Dr Khare is Director of the Cancer Immunotherapy and Gene Therapy Facility, Roger Williams Medical Center, Providence, RI. Dr MacLeod is Director of Cytogenetics at the Leibniz Institute, DSMZ - German Collection of Microorganisms and Cell Cultures, Braunschweig, Germany. Dr Van Natta is an Associate Clinical Professor, Department of Surgery, Indiana University School of Medicine, Indianapolis, IN. Dr Adams is an Associate Clinical Professor, Department of Plastic Surgery, University of Texas Southwestern Medical Center, Dallas, TX. Dr Brody is Professor Emeritus in the Division of Plastic Surgery, and Dr Epstein is a Professor of Pathology, University of Southern California Keck School of Medicine, Los Angeles, CA
| | - William P Adams
- Dr Kadin is a Professor of Dermatology, Boston University School of Medicine, Boston, MA; and a Staff Physician, Roger Williams Medical Center, Providence, RI. Dr Deva is an Associate Professor of Cosmetic, Plastic, and Reconstructive Surgery, Macquarie University, NSW, Australia. Ms Xu is a Research Assistant, Dr Morgan is Director of the Research Core Facility, and Dr Khare is Director of the Cancer Immunotherapy and Gene Therapy Facility, Roger Williams Medical Center, Providence, RI. Dr MacLeod is Director of Cytogenetics at the Leibniz Institute, DSMZ - German Collection of Microorganisms and Cell Cultures, Braunschweig, Germany. Dr Van Natta is an Associate Clinical Professor, Department of Surgery, Indiana University School of Medicine, Indianapolis, IN. Dr Adams is an Associate Clinical Professor, Department of Plastic Surgery, University of Texas Southwestern Medical Center, Dallas, TX. Dr Brody is Professor Emeritus in the Division of Plastic Surgery, and Dr Epstein is a Professor of Pathology, University of Southern California Keck School of Medicine, Los Angeles, CA
| | - Garry S Brody
- Dr Kadin is a Professor of Dermatology, Boston University School of Medicine, Boston, MA; and a Staff Physician, Roger Williams Medical Center, Providence, RI. Dr Deva is an Associate Professor of Cosmetic, Plastic, and Reconstructive Surgery, Macquarie University, NSW, Australia. Ms Xu is a Research Assistant, Dr Morgan is Director of the Research Core Facility, and Dr Khare is Director of the Cancer Immunotherapy and Gene Therapy Facility, Roger Williams Medical Center, Providence, RI. Dr MacLeod is Director of Cytogenetics at the Leibniz Institute, DSMZ - German Collection of Microorganisms and Cell Cultures, Braunschweig, Germany. Dr Van Natta is an Associate Clinical Professor, Department of Surgery, Indiana University School of Medicine, Indianapolis, IN. Dr Adams is an Associate Clinical Professor, Department of Plastic Surgery, University of Texas Southwestern Medical Center, Dallas, TX. Dr Brody is Professor Emeritus in the Division of Plastic Surgery, and Dr Epstein is a Professor of Pathology, University of Southern California Keck School of Medicine, Los Angeles, CA
| | - Alan L Epstein
- Dr Kadin is a Professor of Dermatology, Boston University School of Medicine, Boston, MA; and a Staff Physician, Roger Williams Medical Center, Providence, RI. Dr Deva is an Associate Professor of Cosmetic, Plastic, and Reconstructive Surgery, Macquarie University, NSW, Australia. Ms Xu is a Research Assistant, Dr Morgan is Director of the Research Core Facility, and Dr Khare is Director of the Cancer Immunotherapy and Gene Therapy Facility, Roger Williams Medical Center, Providence, RI. Dr MacLeod is Director of Cytogenetics at the Leibniz Institute, DSMZ - German Collection of Microorganisms and Cell Cultures, Braunschweig, Germany. Dr Van Natta is an Associate Clinical Professor, Department of Surgery, Indiana University School of Medicine, Indianapolis, IN. Dr Adams is an Associate Clinical Professor, Department of Plastic Surgery, University of Texas Southwestern Medical Center, Dallas, TX. Dr Brody is Professor Emeritus in the Division of Plastic Surgery, and Dr Epstein is a Professor of Pathology, University of Southern California Keck School of Medicine, Los Angeles, CA
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Vonderheid EC, Kadin ME, Telang GH. Commentary about papular mycosis fungoides, lymphomatoid papulosis and lymphomatoid pityriasis lichenoides: more similarities than differences. J Cutan Pathol 2015; 43:303-12. [PMID: 26566599 DOI: 10.1111/cup.12653] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2015] [Revised: 11/04/2015] [Accepted: 10/07/2015] [Indexed: 12/24/2022]
Affiliation(s)
- Eric C Vonderheid
- Sidney Kimmel Cancer Center, Johns Hopkins Medical Institutes, Baltimore, MD, USA
| | - Marshall E Kadin
- Department of Dermatology, Boston University and Roger Williams Medical Center, Providence, RI, USA
| | - Gladys H Telang
- Department of Dermatology, The Warren Alpert Medical School of Brown University, Providence, RI, USA
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Cordel N, Tressières B, D'Incan M, Machet L, Grange F, Estève É, Dalac S, Ingen-Housz-Oro S, Bagot M, Beylot-Barry M, Joly P. Frequency and Risk Factors for Associated Lymphomas in Patients With Lymphomatoid Papulosis. Oncologist 2015; 21:76-83. [PMID: 26668250 DOI: 10.1634/theoncologist.2015-0242] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2015] [Accepted: 10/09/2015] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Lymphomatoid papulosis (LyP) is classified as an indolent cutaneous lymphoma, but outcome dramatically worsens if LyP is associated with lymphoma. The frequency of this association remains unclear in the literature. Here, we assess the frequency and risk factors of association between LyP and another lymphoma in an 11-year retrospective study conducted in 8 dermatology departments belonging to the French Study Group on Cutaneous Lymphoma (FSGCL). PATIENTS AND METHODS Patients with LyP were identified and data extracted from the FSGCL registry between 1991 and 2006. Patients were followed up to January 2014. Age, sex, number of skin lesions, histologic subtype, and genotype were recorded at baseline. Risk factors were determined using univariate and multivariate analysis. Cumulative probability of association was calculated using the Kaplan-Meier method. RESULTS We observed 52 cases of lymphomas (cutaneous, n = 38; systemic, n = 14) in 44 of 106 patients (41%). Lymphoma diagnosis was concomitant with or prior to LyP diagnosis in 31 cases and occurred during the course of LyP in 21 cases (cutaneous, n = 14; systemic, n = 7; median delay: 5 years; interquartile range: 1.5-7 years). In multivariate analysis, main prognostic factors for association between LyP and another lymphoma were older age (odds ratio [OR]: 1.05 per year; 95% confidence interval [CI]: 1.01-1.08; p = .011) and presence of a T-cell clone in LyP lesions (OR: 7.55; 95% CI: 2.18-26.18; p = .001). CONCLUSION Older age and presence of a T-cell clone in LyP lesions are risk factors for associated lymphomas in patients with LyP. These findings should help to identify patients who require close management in clinical practice. IMPLICATIONS FOR PRACTICE The management of lymphomatoid papulosis (LyP) is that of an indolent cutaneous lymphoma, based on its excellent prognosis. However, this good prognosis is altered if LyP is associated with lymphoma. Furthermore, risk factors for and frequency of this association remain unclear in the literature. The results presented here demonstrate a high rate of association between LyP and other lymphomas (41%) as well as a long median delay of occurrence (5 years), which emphasizes the need for prolonged follow-up of patients with LyP. Moreover, two main risk factors (i.e., older age and presence of a T-cell clone in LyP lesions) are highlighted, which should help clinical practitioners to identify patients who require close management.
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Affiliation(s)
- Nadège Cordel
- Unit of Dermatology and Internal Medicine, Guadeloupe University Hospital and EA 4546, Antilles University, Pointe-à-Pitre, Guadeloupe
| | - Benoît Tressières
- Centre d'investigation clinique Antilles-Guyane, INSERM CIC 1424, Pointe-à-Pitre, Guadeloupe
| | - Michel D'Incan
- Department of Dermatology, Clermont-Ferrand University Hospital, University of Auvergne, Clermond-Ferrand, France
| | - Laurent Machet
- Department of Dermatology, Tours University Hospital and François Rabelais University, Tours, France
| | - Florent Grange
- Department of Dermatology, Robert Debré Hospital and EA 7319, University of Reims Champagne-Ardennes, Reims, France
| | - Éric Estève
- Department of Dermatology, Orléans Regional Hospital, Orléans, France
| | - Sophie Dalac
- Department of Dermatology, Dijon University Hospital, Dijon, France
| | | | - Martine Bagot
- Department of Dermatology, Paris University Hospitals-St Louis and INSERM U 976, Denis Diderot University, Sorbonne Paris Cité, Paris, France
| | - Marie Beylot-Barry
- Department of Dermatology, Bordeaux University Hospital and EA 2406, University of Bordeaux, Bordeaux, France
| | - Pascal Joly
- Department of Dermatology, Rouen University Hospital and INSERM U 519, Institute for Research and Innovation in Biomedicine, Rouen University, Rouen, Normandy, France
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Inghirami G, Chan WC, Pileri S. Peripheral T-cell and NK cell lymphoproliferative disorders: cell of origin, clinical and pathological implications. Immunol Rev 2015; 263:124-59. [PMID: 25510275 DOI: 10.1111/imr.12248] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
T-cell lymphoproliferative disorders are a heterogeneous group of neoplasms with distinct clinical-biological properties. The normal cellular counterpart of these processes has been postulated based on functional and immunophenotypic analyses. However, T lymphocytes have been proven to be remarkably capable of modulating their properties, adapting their function in relationship with multiple stimuli and to the microenvironment. This impressive plasticity is determined by the equilibrium among a pool of transcription factors and by DNA chromatin regulators. It is now proven that the acquisition of specific genomic defects leads to the enforcement/activation of distinct pathways, which ultimately alter the preferential activation of defined regulators, forcing the neoplastic cells to acquire features and phenotypes distant from their original fate. Thus, dissecting the landscape of the genetic defects and their functional consequences in T-cell neoplasms is critical not only to pinpoint the origin of these tumors but also to define innovative mechanisms to re-adjust an unbalanced state to which the tumor cells have become addicted and make them vulnerable to therapies and targetable by the immune system. In our review, we briefly describe the pathological and clinical aspects of the T-cell lymphoma subtypes as well as NK-cell lymphomas and then focus on the current understanding of their pathogenesis and the implications on diagnosis and treatment.
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Affiliation(s)
- Giorgio Inghirami
- Department of Molecular Biotechnology and Health Science and Center for Experimental Research and Medical Studies (CeRMS), University of Torino, Torino, Italy; Department of Pathology, and NYU Cancer Center, New York University School of Medicine, New York, NY, USA; Department of Pathology and Laboratory Medicine, Weill Cornell Medical College, New York, NY, USA
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Anaplastic large cell lymphoma occurring in women with breast implants: analysis of 173 cases. Plast Reconstr Surg 2015; 135:695-705. [PMID: 25490535 DOI: 10.1097/prs.0000000000001033] [Citation(s) in RCA: 235] [Impact Index Per Article: 26.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND The first silicone breast implant was inserted in 1962. In 1997, the first case of anaplastic large cell lymphoma (ALCL) in association with a silicone breast implant was reported. The authors reviewed 37 articles in the world literature reporting on 79 patients and collected another 94 unreported cases as of the date of submission. METHODS The world literature was reviewed. Missing clinical and laboratory information was solicited from the authors and treating physicians. As several different specialties were involved, information was not in one place. Many (but not all) authors and treating physicians were responsive, resulting in incomplete data. RESULTS ALCL lesions first presented as late peri-implant seromas, a mass attached to the capsule, tumor erosion through the skin, in a regional node, or discovered during revision surgery. The clinical course varied widely from a single positive cytology result followed by apparent spontaneous resolution, to disseminated treatment-resistant tumor and death. There was no preference for saline or silicone fill or for cosmetic or reconstructive indications. Where implant history was known, the patient had received at least one textured-surface device. Extracapsular dissemination occurred in 18 cases; nine of those were fatal. Histochemical markers were primarily CD-30 and Alk-1. Other markers occurred at a lower frequency. Risk estimates ranged from one in 500,000 to one in 3 million women with implants. CONCLUSION Breast implant-associated ALCL is a novel manifestation of site- and material-specific lymphoma originating in a specific scar location, presenting a wide array of diverse characteristics and suggesting a multifactorial cause.
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de la Garza Bravo MM, Patel KP, Loghavi S, Curry JL, Torres Cabala CA, Cason RC, Gangar P, Prieto VG, Medeiros LJ, Duvic M, Tetzlaff MT. Shared clonality in distinctive lesions of lymphomatoid papulosis and mycosis fungoides occurring in the same patients suggests a common origin. Hum Pathol 2015; 46:558-69. [DOI: 10.1016/j.humpath.2014.12.008] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2014] [Revised: 12/11/2014] [Accepted: 12/17/2014] [Indexed: 11/28/2022]
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31
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Huang CH, Hsu CK, Lee JYY. Lymphomatoid papulosis in association with mycosis fungoides: A clinical and histopathologic review of five Taiwanese cases. DERMATOL SIN 2014. [DOI: 10.1016/j.dsi.2013.09.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
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SATB1 overexpression promotes malignant T-cell proliferation in cutaneous CD30+ lymphoproliferative disease by repressing p21. Blood 2014; 123:3452-61. [PMID: 24747435 DOI: 10.1182/blood-2013-10-534693] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
Cutaneous CD30(+) lymphoproliferative disease (CD30(+)LPD), characterized by the presence of CD30(+) anaplastic large T cells, comprises the second most common group of cutaneous T-cell lymphoma (CTCL). However, little is known about the pathobiology of the CD30(+) lymphoma cells, as well as the mechanisms of disease progression. Here we report that Special AT-rich region binding protein 1 (SATB1), a thymocyte specific chromatin organizer, is over-expressed in CD30(+) lymphoma cells in most CD30(+)LPDs, and its expression is upregulated during disease progression. Our findings show that SATB1 silencing in CD30(+)LPD cells leads to G1 cell cycle arrest mediated by p21 activation. Using chromatin immunoprecipitation, luciferase assays, and mutational analysis, we demonstrate that SATB1 directly regulates the transcription of p21 in a p53-independent manner. Moreover, DNA demethylation on a specific CpG-rich region of the SATB1 promoter is associated with the upregulation of SATB1 during disease progression. These experiments define a novel SATB1-p21 pathway in malignant CD30(+) T lymphocytes, which provides novel molecular insights into the pathogenesis of CD30(+)LPDs and possibly leads to new therapies.
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Marchesi A, Parodi PC, Brioschi M, Marchesi M, Bruni B, Cangi MG, Vaienti L. Tattoo ink-related cutaneous pseudolymphoma: a rare but significant complication. Case report and review of the literature. Aesthetic Plast Surg 2014; 38:471-8. [PMID: 24570180 DOI: 10.1007/s00266-014-0287-5] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2013] [Accepted: 01/31/2014] [Indexed: 11/24/2022]
Abstract
BACKGROUND The demand for decorative tattoos is steadily growing worldwide, and in the US it is estimated that up to 24% of adults has one or more tattoos. Subsequently, the number of tattoo-related complications is increasing. Among these, lymphoproliferative disorders play a minor but important role. The aim of this article is to arouse the awareness of plastic surgeons and dermatologists about this rare but serious complication and to stimulate stricter clinical control of their tattooed patients. METHODS We report a new case of tattoo-related cutaneous pseudolymphoma (CPL) and perform a review of the last 30 years of literature on the topic in PubMed. RESULTS Apart from this new case, only 18 cases of CPL have been reported in PubMed so far. In contrast to the classic knowledge, the T cell was the predominant phenotype in 68% of cases. Red is confirmed to be the most involved ink. Topical and intralesional steroids, laser therapy, and surgery were used for treatment of CPL. CONCLUSIONS Even if CPL is a very rare and benign complication, we should not forget that in rare cases pseudolymphoma may evolve into a true lymphoma. Diagnosis is still difficult and is based on anamnestic, clinical, and histopathological data. From the review of the literature, the T cell predominance suggests a reclassification of tattoo-induced CPL and there is not a gold standard treatment yet. Finally, once a pseudolymphoma is diagnosed, there must be a long follow-up because of the possibility to transform into a malignancy. LEVEL OF EVIDENCE V This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .
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Affiliation(s)
- Andrea Marchesi
- Dipartimento di Chirurgia Plastica Ricostruttiva, I.R.C.C.S. Policlinico San Donato, Università degli Studi di Milano, Via Morandi 30, San Donato Milanese, 20097, Milan, Italy,
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McQuitty E, Curry JL, Tetzlaff MT, Prieto VG, Duvic M, Torres-Cabala C. The differential diagnosis of CD8-positive (“type D”) lymphomatoid papulosis. J Cutan Pathol 2013; 41:88-100. [DOI: 10.1111/cup.12243] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2012] [Revised: 05/12/2013] [Accepted: 06/09/2013] [Indexed: 11/28/2022]
Affiliation(s)
- Elizabeth McQuitty
- Department of Pathology and Immunology; Baylor College of Medicine; Houston TX USA
| | - Jonathan L. Curry
- Department of Pathology; MD Anderson Cancer Center; Houston TX USA
- Department of Dermatology; MD Anderson Cancer Center; Houston TX USA
| | | | - Victor G. Prieto
- Department of Pathology; MD Anderson Cancer Center; Houston TX USA
- Department of Dermatology; MD Anderson Cancer Center; Houston TX USA
| | - Madeleine Duvic
- Department of Dermatology; MD Anderson Cancer Center; Houston TX USA
| | - Carlos Torres-Cabala
- Department of Pathology; MD Anderson Cancer Center; Houston TX USA
- Department of Dermatology; MD Anderson Cancer Center; Houston TX USA
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Fernández-Guarino M, Carrillo-Gijón R, Jaén-Olasolo P. [Lymphomatoid papulosis: clinical and pathological findings in 18 patients]. ACTAS DERMO-SIFILIOGRAFICAS 2012; 103:388-93. [PMID: 22261676 DOI: 10.1016/j.ad.2011.08.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2011] [Revised: 07/16/2011] [Accepted: 08/28/2011] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Lymphomatoid papulosis (LyP) is a CD30(+) lymphoproliferative skin disease that has been described in association with Hodgkin lymphoma. It has also been reported to progress to mycosis fungoides or cutaneous anaplastic large-cell lymphoma. OBJECTIVE To study the clinical and histologic features of LyP and response to treatment in a patient series. MATERIALS AND METHODS For this retrospective, descriptive, observational study of patients with histologically confirmed LyP and sufficient follow-up data on record, we extracted histologic findings on skin biopsy, clinical presentation, clinical course, and response to treatments. RESULTS Eighteen patients (10 male, 8 female) were identified. Most biopsies (14/18, 78%) showed a wedge-shaped lymphocytic infiltrate with CD30(+), CD3(+), and CD56(-) cells. A type A histologic pattern was present in the biopsies of 83% of the patients. The most common presentation (83%) consisted of papules on the trunk; for 62% LyP resolved after a single episode. Twelve percent of the patients developed mycosis fungoides (mean follow-up, 7 years); no other associations were noted. DISCUSSION Although few series of patients with LyP have been published in recent years, the findings reported generally coincide with our observations. CONCLUSION LyP is typically a CD30(+) lymphoproliferative disorder that usually runs a benign course and responds well to treatment.
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Affiliation(s)
- M Fernández-Guarino
- Servicio de Dermatología, Hospital Ramón y Cajal, Universidad de Alcalá de Henares, Madrid, Spain.
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Wong HK, Mishra A, Hake T, Porcu P. Evolving insights in the pathogenesis and therapy of cutaneous T-cell lymphoma (mycosis fungoides and Sezary syndrome). Br J Haematol 2011; 155:150-66. [PMID: 21883142 DOI: 10.1111/j.1365-2141.2011.08852.x] [Citation(s) in RCA: 101] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Cutaneous T-cell lymphomas (CTCL) are a heterogeneous group of malignancies derived from skin-homing T cells. The most common forms of CTCL are Mycosis Fungoides (MF) and Sezary Syndrome (SS). Accurate diagnosis remains a challenge due to the heterogeneity of presentation and the lack of highly characteristic immunophenotypical and genetic markers. Over the past decade molecular studies have improved our understanding of the biology of CTCL. The identification of gene expression differences between normal and malignant T-cells has led to promising new diagnostic and prognostic biomarkers that now need validation to be incorporated into clinical practice. These biomarkers may also provide insight into the mechanism of development of CTCL. Additionally, treatment options have expanded with the approval of new agents, such as histone deacetylase inhibitors. A better understanding of the cell biology, immunology and genetics underlying the development and progression of CTCL will allow the design of more rational treatment strategies for these malignancies. This review summarizes the clinical epidemiology, staging and natural history of MF and SS; discusses the immunopathogenesis of MF and the functional role of the malignant T-cells; and reviews the latest advances in MF and SS treatment.
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Affiliation(s)
- Henry K Wong
- Division of Dermatology, The Ohio State University, Columbus, OH 43221, USA.
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Secondary ALK Negative Anaplastic Large Cell Lymphoma in a Patient With Lymphomatoid Papulosis of 40 Years Duration. Am J Dermatopathol 2010; 32:708-12. [DOI: 10.1097/dad.0b013e3181d46eba] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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39
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Kunishige JH, McDonald H, Alvarez G, Johnson M, Prieto V, Duvic M. Lymphomatoid papulosis and associated lymphomas: a retrospective case series of 84 patients. Clin Exp Dermatol 2009; 34:576-81. [DOI: 10.1111/j.1365-2230.2008.03024.x] [Citation(s) in RCA: 78] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
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40
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Humme D, Lukowsky A, Steinhoff M, Beyer M, Walden P, Sterry W, Assaf C. Dominance of Nonmalignant T-Cell Clones and Distortion of the TCR Repertoire in the Peripheral Blood of Patients with Cutaneous CD30+ Lymphoproliferative Disorders. J Invest Dermatol 2009; 129:89-98. [DOI: 10.1038/jid.2008.204] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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41
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Matsumoto N, Ohki H, Mukae S, Amano Y, Harada D, Nishimura S, Komiyama K. Anaplastic large cell lymphoma in gingiva: case report and literature review. ACTA ACUST UNITED AC 2008; 106:e29-34. [DOI: 10.1016/j.tripleo.2008.05.037] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2007] [Revised: 05/09/2008] [Accepted: 05/16/2008] [Indexed: 10/21/2022]
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42
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Agarwal M, Shenjere P, Blewitt RW, Hall G, Sloan P, Pigadas N, Banerjee SS. CD30-Positive T-Cell Lymphoproliferative Disorder of the Oral Mucosa—An Indolent Lesion: Report of 4 Cases. Int J Surg Pathol 2008; 16:286-90. [DOI: 10.1177/1066896907313755] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Four cases of CD30-positive T-cell lymphoproliferative disorder (CD30+ LPD) of the oral mucosa are described. This article aims to draw attention to this entity and to emphasize its usual benign clinical behavior despite its resemblance to T-cell lymphoma. All the patients were adults. Three of the lesions were on the dorsal surface of the tongue and 1 affected the buccal mucosa. All biopsies showed a dense lymphoid infiltrate composed of CD30+ atypical T cells with a polymorphous infiltrate in the background, which included eosinophils. In 1 case, monoclonal T-cell expansion was detected by molecular techniques. Three cases tested for Epstein—Barr virus were all negative. It is concluded that primary CD30+ T-cell LPD of the oral mucosa can be regarded as the oral counterpart of cutaneous CD30+ LPD such as lymphomatoid papulosis or anaplastic large cell lymphoma. Recognition of the condition is important to avoid overtreatment.
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Affiliation(s)
- Monica Agarwal
- University Hospitals of Morecambe Bay NHS Trust, Lancaster
| | | | | | - Gillian Hall
- Central Manchester and Manchester Children's University Hospitals NHS Trust, Manchester, United Kingdom
| | - Philip Sloan
- Central Manchester and Manchester Children's University Hospitals NHS Trust, Manchester, United Kingdom
| | - N. Pigadas
- Central Manchester and Manchester Children's University Hospitals NHS Trust, Manchester, United Kingdom
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Kamstrup M, Ralfkiaer E, Skovgaard G, Gniadecki R. Potential involvement of Notch1 signalling in the pathogenesis of primary cutaneous CD30-positive lymphoproliferative disorders. Br J Dermatol 2008; 158:747-53. [DOI: 10.1111/j.1365-2133.2007.08427.x] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Korpusik D, Ruzicka T. [Clinical course and therapy of lymphomatoid papulosis. Experience with 17 cases and literature review]. Hautarzt 2008; 58:870-81. [PMID: 17486304 DOI: 10.1007/s00105-007-1295-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Lymphomatoid papulosis is a rare disease with a worldwide incidence of 1.2 to 1.9 per 1 million. It affects all age groups with a peak incidence between 30 and 40 years and an apparent male predominance. Occurrence in childhood has also been described. Both the etiology and pathogenesis of the disease are unknown. The clinical presentation is extremely variable and frequently uncharacteristic. A papulonodular eruption, characterized by self-healing skin lesions appearing in crops can often be seen, particularly on extremities. We report on 17 patients, including 2 children. By detailing 6 cases we point out the variable morphologic manifestations, the different courses of disease and therapeutic options.
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MESH Headings
- Aged
- Biopsy
- Cell Transformation, Neoplastic/pathology
- Child
- Child, Preschool
- Diagnosis, Differential
- Eosinophils/pathology
- Female
- Follow-Up Studies
- Histiocytes/pathology
- Humans
- Ki-1 Antigen/analysis
- Lymphocytes/pathology
- Lymphoma, Large-Cell, Anaplastic/classification
- Lymphoma, Large-Cell, Anaplastic/diagnosis
- Lymphoma, Large-Cell, Anaplastic/pathology
- Lymphoma, Large-Cell, Anaplastic/therapy
- Lymphomatoid Papulosis/classification
- Lymphomatoid Papulosis/diagnosis
- Lymphomatoid Papulosis/pathology
- Lymphomatoid Papulosis/therapy
- Male
- Middle Aged
- Mitosis/physiology
- Neutrophils/pathology
- Skin/pathology
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Affiliation(s)
- D Korpusik
- Hautklinik des Universitätsklinikums Düsseldorf, Moorenstrasse 5, 40225, Düsseldorf, Germany.
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Droc C, Cualing HD, Kadin ME. Need for an improved molecular/genetic classification for CD30+ lymphomas involving the skin. Cancer Control 2007; 14:124-32. [PMID: 17387297 DOI: 10.1177/107327480701400205] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND The spectrum of diseases that constitute the CD30+ lymphomas, with lymphomatoid papulosis (LyP) at one end, and anaplastic large-cell lymphoma (ALCL) at the other end, shows variable morphology, immunophenotype, and clinical behavior. The border between these diseases is sometimes difficult to establish and there are many grey zones in their classification. METHODS We reviewed the clinical and research literature and guided by our experiences attempted to discern molecular and phenotypic criteria to improve the classification and identify molecular targets for therapy of CD30-positive cutaneous lymphomas. RESULTS Functional studies of ALCL cell lines clonally derived from LyP have revealed loss of growth inhibition by transforming growth factor beta (TGF-beta), due to TGF-beta receptor mutations. Studies of genetic variants of the CD30 promoter showed distinct microsatellite alleles associated with development of LyP and lymphoma progression. Studies of LyP and cutaneous ALCL tissues and cell lines suggest a dual role for CD30/CD30 ligand interactions in regression of LyP and progression to lymphoma. CD30 signaling activates NF-kappaB in cell lines derived from cutaneous ALCL but not anaplastic lymphoma kinase (ALK)-positive systemic ALCL in which growth arrest occurs through cell cycle inhibitor p21WAF1/Cip1. Other likely biomarkers of disease progression include differential expression of Bcl-2, fascin, cutaneous lymphocyte antigen, and T-cell receptor clonality. These may lead to improved classification, diagnoses, and therapeutic targets. CONCLUSIONS The current clinicopathologic classification of CD30+ cutaneous lymphoproliferative disorders is insufficient. Incorporating genetic and molecular criteria would better define the borders between benign/ malignant and aggressive/nonaggressive disorders.
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Affiliation(s)
- Claudia Droc
- Hematopathology and Laboratory Medicine Program, H. Lee Moffitt Cancer Center & Research Institute, 12902 Magnolia Drive, Tampa, FL 33612, USA
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Assaf C, Hirsch B, Wagner F, Lucka L, Grünbaum M, Gellrich S, Lukowsky A, Sterry W, Stein H, Dürkop H. Differential expression of TRAF1 aids in the distinction of cutaneous CD30-positive lymphoproliferations. J Invest Dermatol 2007; 127:1898-904. [PMID: 17392826 DOI: 10.1038/sj.jid.5700800] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Lymphomatoid papulosis (LyP), primary cutaneous anaplastic large T-cell lymphoma (cALCL), and cutaneous infiltrates of systemic anaplastic large cell lymphoma (sALCL) are CD30-positive lymphoproliferative disorders of the skin that overlap clinically, histopathologically, immunophenotypically, and genetically but differ considerably in their prognosis. In particular, lesions of LyP regress spontaneously, whereas those of cALCL and sALCL persist and may progress and spread to extracutaneous sites. In contrast to patients with cALCL, LyP patients do not benefit from an aggressive radio- and/or chemotherapeutic approach. We generated a novel tumor necrosis factor receptor (TNFR)-associated factor 1 (TRAF1) antibody that recognizes a formalin-resistant epitope (Ber-TRAF1A) and investigated the expression of TRAF1, an intracellular component of TNFR signaling, in LyP and ALCL. We could show a strong TRAF1 expression in the tumor cells of most LyP cases (42/49, 84%). In contrast, tumor cells of primary and secondary cALCL revealed TRAF1 expression in only a few cases (3/41, 7%) as shown for sALCL without skin manifestation. The data indicate that TRAF1 expression reliably distinguishes LyP from primary or secondary cALCL. This might be of crucial diagnostic importance and has a strong impact on the treatment decision for patients with cALCL and LyP.
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Affiliation(s)
- Chalid Assaf
- Department of Dermatology and Allergy, Skin Cancer Center Charité, CBF, Charité-Universitätsmedizin Berlin, Berlin, Germany
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Greisser J, Palmedo G, Sander C, Kutzner H, Kazakov DV, Roos M, Burg G, Kempf W. Detection of clonal rearrangement of T-cell receptor genes in the diagnosis of primary cutaneous CD30+lymphoproliferative disorders. J Cutan Pathol 2006; 33:711-5. [PMID: 17083688 DOI: 10.1111/j.1600-0560.2006.00560.x] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND Detection of clonality has been reported to be a helpful tool in the diagnosis of cutaneous lymphomas. Monoclonal rearrangement of T-cell receptor genes (TCR) was reported in fresh frozen tissue of lymphomatoid papulosis (LyP) and primary cutaneous anaplastic large-cell lymphoma (ALCL), but the diagnostic value of T-cell clonality in formalin-fixed, paraffin-embedded biopsies has so far not been assessed. METHODS Detection of clonal rearrangement of TCRgamma genes by highly sensitive polymerase chain reaction-based automated high-resolution fragment analysis (AHRFA) in archival LyP (n = 18) and ALCL (n = 17) tissue. RESULTS Detection of clonality differed significantly among the histologic forms of LyP as well as between LyP and ALCL with clonality found in none of the 10 biopsies of LyP type A and B, in 4/8 (50%) of the LyP type C specimens, and in 11/17 (65%) of ALCL cases. CONCLUSIONS T-cell clonality can only be found in a minority (four of 18; 22%) of archival LyP specimens, even when employing a highly sensitive detection method and is thus of limited diagnostic value. Final diagnosis of LyP has to be based mainly on clinical, histologic, and immunohistochemical findings rather than on results of clonality studies.
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MESH Headings
- Adult
- Aged
- Aged, 80 and over
- DNA/genetics
- DNA Fragmentation
- DNA, Neoplasm/genetics
- Female
- Gene Rearrangement, T-Lymphocyte/genetics
- Humans
- Ki-1 Antigen/genetics
- Lymphoma, Large B-Cell, Diffuse/diagnosis
- Lymphoma, Large B-Cell, Diffuse/genetics
- Lymphoma, T-Cell, Cutaneous/diagnosis
- Lymphoma, T-Cell, Cutaneous/genetics
- Lymphomatoid Papulosis/diagnosis
- Lymphomatoid Papulosis/genetics
- Lymphoproliferative Disorders/diagnosis
- Lymphoproliferative Disorders/genetics
- Male
- Middle Aged
- Receptors, Antigen, T-Cell/genetics
- Skin Diseases, Genetic/diagnosis
- Skin Diseases, Genetic/genetics
- Skin Neoplasms/diagnosis
- Skin Neoplasms/genetics
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Vonderheid EC, Kadin ME. Papular mycosis fungoides: a variant of mycosis fungoides or lymphomatoid papulosis? J Am Acad Dermatol 2006; 55:177-80. [PMID: 16781328 DOI: 10.1016/j.jaad.2006.01.030] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2005] [Revised: 01/06/2006] [Accepted: 01/06/2006] [Indexed: 11/22/2022]
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Abstract
CD30+ cutaneous lymphoproliferative disorders include lymphomatoid papulosis (LyP) and anaplastic large cell lymphoma (ALCL). LyP is associated with development of lymphoma in nearly 20% of patients. Herein is reviewed the clonal relationship of LyP to malignant lymphoma, the concept of a common stem cell for LyP and associated lymphomas, and the role of genetic instability in lymphomagenesis. The possible role of the CD30+ cell as a regulatory T-cell is introduced and a model for progression of LyP to ALCL is illustrated.
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Affiliation(s)
- Marshall E Kadin
- Laboratory Medicine, Yamins 309, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA 02215, USA.
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Lo WYF, Li JYW, Chan YK, Lai LSW, Yeung YW, Lo STH, Tsui WMS, Ng CS. Instability of clonality in gastric lymphoid infiltrates: a study with emphasis on serial biopsies. Am J Surg Pathol 2006; 29:1582-92. [PMID: 16327430 DOI: 10.1097/01.pas.0000188031.40836.00] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
The evolution of low-grade B-cell mucosa-associated lymphoid-tissue (MALT) lymphoma of the stomach is a multistage process, reflected in the histologic continuum from Helicobacter pylori-chronic gastritis, to low-grade and high-grade lymphoma. Interestingly, in daily gastric biopsy sign-out, the authors observed that some biopsies showed monoclonality on polymerase chain reaction (PCR) even though there were no definite histologic features of malignancy and vice versa. To address the question, the authors studied the endoscopic gastric biopsies at first presentation of 46 patients to examine any clonality differences among various histologic patterns within the spectrum of MALT lymphoma evolution. The gastric biopsies were reviewed histologically and graded according to the Wotherspoon-Isaacson histologic scoring system from grade 0 (normal) to grade 5 (MALT lymphoma). The clonality of cases in each grade was determined by performing nested PCR for immunoglobulin heavy chain (IgH) gene rearrangement using FR2/JH and FR3/JH primer sets. The monoclonality rates among different grades were as follows: grade 2, 6.3% (1 of 16); grade 3, 27.3% (3 of 11); grade 4, 83.3% (5 of 6); grade 5, 69.2% (9 of 13). Statistically significant difference of monoclonality rate is demonstrated in histologic grade 4 versus grades 2 and 3, and grade 5 versus grade 2 (P < 0.05, Fisher exact test). The authors went on to examine the progress of disease by following up the clinical status, histologic changes, and clonality fluctuation of these cases. Four of the 8 patients with monoclonality on PCR, but no definite lymphoma at first presentation later progressed to frank MALT lymphoma. Our study shows that, during the progression to MALT lymphoma, there is an instability of clonality. Clonality can fluctuate between polyclonality, oligoclonality, and monoclonality, none of which defines an irreversible stage for progression to MALT lymphoma. Monoclonality is a risk factor for development of MALT lymphoma. Those cases with dense gastric mucosal lymphoid infiltrate (without definite MALT lymphoma) and monoclonality on PCR need to be closely monitored and Helicobacter infection promptly treated if present. In combination with clinicohistologic examination, PCR can serve as a complementary tool in arriving at a definite diagnosis of MALT lymphoma in cases with borderline histologic features.
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Affiliation(s)
- William Y F Lo
- Pathology Service, Caritas Medical Centre, Kowloon, Hong Kong, China.
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