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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: 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: 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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2
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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: 0] [Impact Index Per Article: 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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3
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Jung JM, Lee MY, Won CH, Chang SE, Park CS, Lee MW, Lee WJ. Clinicopathological Factors Associated with the Prognosis and Chronicity of Lymphomatoid Papulosis: A Retrospective Cohort Study. CLINICAL LYMPHOMA, MYELOMA & LEUKEMIA 2022; 22:e541-e548. [PMID: 35307318 DOI: 10.1016/j.clml.2022.02.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/30/2021] [Revised: 02/09/2022] [Accepted: 02/20/2022] [Indexed: 06/14/2023]
Abstract
BACKGROUND The clinical and pathological features of lymphomatoid papulosis (LYP) are diverse. The objective of this study is to evaluate the clinical and pathological features associated with the prognosis and clinical course of LYP. PATIENTS AND METHODS The clinical and pathological features of LYP in a medical center database were retrospectively retrieved. RESULTS Overall, 58 LYP patients were included in the study. The mean age at diagnosis was 39.1 years and the female-to-male ratio was 1:1.2. More than two-thirds (40/58, 69.0%) of the patients showed a chronic and recurrent disease course. A longer pre-diagnosis duration (odds ratio (OR), 1.01; 95% confidence interval (CI), 1.00-1.03) was significantly associated with secondary lymphoma development. Lower extremity involvement (OR, 10.40; 95% CI, 1.17-92.28) and the absence of eosinophils in the lesions (OR, 11.28; 95% CI, 1.01-126.24) were found to be significantly associated with the chronic and recurrent course of LYP. CONCLUSION A longer pre-diagnosis duration is associated with secondary lymphoma, while a lower extremity involvement and the absence of lesional eosinophil infiltration are associated with the chronicity of LYP.
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Affiliation(s)
- Joon Min Jung
- Department of Dermatology, Asan Medical Center, University of Ulsan College of Medicine, 88, Songpa-gu, Seoul, Korea
| | - Mi Young Lee
- Department of Dermatology, Asan Medical Center, University of Ulsan College of Medicine, 88, Songpa-gu, Seoul, Korea
| | - Chong Hyun Won
- Department of Dermatology, Asan Medical Center, University of Ulsan College of Medicine, 88, Songpa-gu, Seoul, Korea
| | - Sung Eun Chang
- Department of Dermatology, Asan Medical Center, University of Ulsan College of Medicine, 88, Songpa-gu, Seoul, Korea
| | - Chan-Sik Park
- Department of Pathology, Asan Medical Center, University of Ulsan College of Medicine, 88, Songpa-gu, Seoul, Korea
| | - Mi Woo Lee
- Department of Dermatology, Asan Medical Center, University of Ulsan College of Medicine, 88, Songpa-gu, Seoul, Korea.
| | - Woo Jin Lee
- Department of Dermatology, Asan Medical Center, University of Ulsan College of Medicine, 88, Songpa-gu, Seoul, Korea.
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4
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Shi R, Koh MJA. Two Histologic Patterns of Lymphomatoid Papulosis Occurring in a Child: A Matter of Timing? J Pediatr Hematol Oncol 2022; 44:e775-e778. [PMID: 34862355 DOI: 10.1097/mph.0000000000002356] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Accepted: 09/17/2021] [Indexed: 11/25/2022]
Abstract
There are several histologic patterns seen in lymphomatoid papulosis, with the possibility of different subtypes occurring in the same patient. We report a case of lymphomatoid papulosis presenting with 2 histologic subtypes (types A and B) occurring concomitantly in a 10-year-old child, and postulate that the different subtypes occur dependent on the age of the lesion biopsied. Incidentally, one of the biopsies also shows a rarely seen pattern of pseudoepitheliomatous hyperplasia in a pediatric lymphomatoid papulosis patient.
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Affiliation(s)
- Ruoyu Shi
- Department of Pathology and Laboratory Medicine
| | - Mark Jean-Aan Koh
- Dermatology Service, KK Women's & Children's Hospital, Singapore, Singapore
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5
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Bergqvist C, Beylot-Barry M, Ram-Wolff C, Vergier B, Bagot M, Battistella M, Dalle S, Balme B, Merlio JP, Durupt F, Le Corre Y, Bonnet N, Le Bozec P, Skowron F, Vivard-Wallee I, Dereure O, Brunet-Possenti F, Ingen-Housz-Oro S, Ortonne N. Lymphomatoid papulosis types D and E: a multicentre series of the French Cutaneous Lymphomas Study Group. Clin Exp Dermatol 2021; 46:1441-1451. [PMID: 33987864 DOI: 10.1111/ced.14730] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/10/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND Lymphomatoid papulosis (LyP) type D (LyP D) and type E (LyP E) have recently been described in small series of cases or isolated case reports. AIM To further describe the clinical and histological features of LyP D and E based on a retrospective multicentre study. METHODS The clinical and histopathological features of 29 patients with an initial diagnosis of LyP D or LyP E were retrospectively assessed using standardized forms. RESULTS After exclusion of 5 cases, 24 patients (14 LyP D, 10 LyP E) were enrolled in the study. The median follow-up was 2.5 years (range 1 month to 13 years). LyP D was characterized by multiple recurrent self-regressing small papules that developed central erosion or necrosis, whereas LyP E presented as papulonodular lesions that rapidly evolved into necrotic eschar-like lesions > 10 mm in size. Epidermal changes were more frequent in LyP D, whereas dermal infiltrates were deeper in LyP E. Anaplastic cytology was rare and the DUSP22 rearrangement was never observed. Two patients (8%) had an associated cutaneous lymphoma. CONCLUSION LyP D and E have distinct clinical findings and may be associated with other cutaneous lymphomas.
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Affiliation(s)
- C Bergqvist
- Department of, Dermatology, AP-HP, Hôpital Henri Mondor, Créteil, France
| | - M Beylot-Barry
- Department of, Dermatology, Bordeaux University Hospital, Bordeaux, France.,Cutaneous Lymphoma Oncogenesis Team, INSERM U1053 Bordeaux Research in Translational Oncology (BaRITOn), Bordeaux University, Bordeaux, France.,French Cutaneous Lymphomas Study Group, Paris, France
| | - C Ram-Wolff
- French Cutaneous Lymphomas Study Group, Paris, France.,Department of, Dermatology, AP-HP, Hôpital Saint-Louis, Université de Paris, Paris, France
| | - B Vergier
- Department of, Pathology, Bordeaux University Hospital, Bordeaux, France.,French Cutaneous Lymphomas Study Group, Paris, France
| | - M Bagot
- French Cutaneous Lymphomas Study Group, Paris, France.,Department of, Dermatology, AP-HP, Hôpital Saint-Louis, Université de Paris, Paris, France
| | - M Battistella
- French Cutaneous Lymphomas Study Group, Paris, France.,Department of, Pathology, AP-HP, Hôpital Saint-Louis, Université de Paris, Paris, France
| | - S Dalle
- French Cutaneous Lymphomas Study Group, Paris, France.,Department of, Dermatology, University Hospital of Lyon-Sud, Lyon, France
| | - B Balme
- French Cutaneous Lymphomas Study Group, Paris, France.,Department of, Dermatology, University Hospital of Lyon-Sud, Lyon, France.,Department of, Pathology, University Hospital of Lyon-Sud, Lyon, France
| | - J P Merlio
- Cutaneous Lymphoma Oncogenesis Team, INSERM U1053 Bordeaux Research in Translational Oncology (BaRITOn), Bordeaux University, Bordeaux, France.,French Cutaneous Lymphomas Study Group, Paris, France
| | - F Durupt
- Department of Dermatology, Hôpital de la Croix Rousse, Hospices Civils de Lyon, Lyon, France
| | - Y Le Corre
- French Cutaneous Lymphomas Study Group, Paris, France.,Department of Dermatology, CHU Angers, Angers, France
| | - N Bonnet
- French Cutaneous Lymphomas Study Group, Paris, France.,Department of Dermatology, Hôpitaux de Marseille, Marseille, France
| | - P Le Bozec
- Department of Dermatology, AP-HP, Hôpital Beaujon, Clichy, France
| | - F Skowron
- French Cutaneous Lymphomas Study Group, Paris, France.,Department of Dermatology, Centre Hospitalier de Valence, Valence, France
| | | | - O Dereure
- French Cutaneous Lymphomas Study Group, Paris, France.,Department of Dermatology, CHU de Montpellier, Montpellier, France
| | - F Brunet-Possenti
- French Cutaneous Lymphomas Study Group, Paris, France.,Department of Dermatology, AP-HP, Hôpital Bichat, Paris, France
| | - S Ingen-Housz-Oro
- Department of, Dermatology, AP-HP, Hôpital Henri Mondor, Créteil, France.,French Cutaneous Lymphomas Study Group, Paris, France
| | - N Ortonne
- Department of, Pathology, AP-HP, Hôpital Henri Mondor, Créteil, France.,French Cutaneous Lymphomas Study Group, Paris, France.,Paris Est Creteil University (UPEC) and IMRB, INSERM U955 Team Ortonne (NFL), Créteil, France
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6
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Sica A, Vitiello P, Sorriento A, Ronchi A, Calogero A, Sagnelli C, Troiani T, Fasano M, Dodaro CA, Franco R, Casale B, Santangelo M, Ciccozzi M, Ciardiello F, Argenziano G, Moscarella E. Lymphomatoid papulosis. Minerva Med 2020; 111:166-172. [PMID: 31958921 DOI: 10.23736/s0026-4806.19.06395-x] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Lymphomatoid papulosis (LyP) is a non-aggressive skin disorder characterized by papulonodular injuries, sometimes necrotic, often scattered, relapsing, which frequently regress spontaneously. LyP represents about 12% of cutaneous lymphomas. The etiology of LyP is unknown. Based on its histopathology, in 2018, the World Health Organization (WHO) classified LyP into six types with similar prognosis (A,B,C,D,E and DUSP22). Once the diagnosis of LyP has been made, having an excellent prognosis, this pathology must be managed mainly with a "watch and wait" strategy. Treatment should be given only in the presence of diffuse, symptomatic lesions with disfiguring evolution, with the aim of reducing time of resolution and preventing recurrences or the formation of new lesions.
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Affiliation(s)
- Antonello Sica
- Department of Precision Medicine, Luigi Vanvitelli University of Campania, Naples, Italy -
| | - Paola Vitiello
- Unit of Dermatology, University of Campania, Naples, Italy
| | - Antonio Sorriento
- Department of Heart Surgery and Transplantations, AO Dei Colli - V. Monaldi, Naples, Italy
| | - Andrea Ronchi
- Division of Pathology, Department of Mental Health And Preventive Medicine, Luigi Vanvitelli University of Campania, Naples, Italy
| | - Armando Calogero
- Department of Advanced Biomedical Sciences, Federico II University, Naples, Italy
| | - Caterina Sagnelli
- Department of Mental Health and Public Medicine, Luigi Vanvitelli University of Campania, Naples, Italy
| | - Teresa Troiani
- Department of Precision Medicine, Luigi Vanvitelli University of Campania, Naples, Italy
| | - Morena Fasano
- Department of Precision Medicine, Luigi Vanvitelli University of Campania, Naples, Italy
| | - Concetta A Dodaro
- Department of Advanced Biomedical Sciences, Federico II University, Naples, Italy
| | - Renato Franco
- Division of Pathology, Department of Mental Health And Preventive Medicine, Luigi Vanvitelli University of Campania, Naples, Italy
| | - Beniamino Casale
- Department of Pneumology And Tisiology, AO Dei Colli - V. Monaldi, Naples, Italy
| | - Michele Santangelo
- Department of Advanced Biomedical Sciences, Federico II University, Naples, Italy
| | - Massimo Ciccozzi
- Unit of Medical Statistics and Molecular Epidemiology, Campus Bio-Medico University, Rome, Italy
| | - Fortunato Ciardiello
- Department of Precision Medicine, Luigi Vanvitelli University of Campania, Naples, Italy
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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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8
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How I treat primary cutaneous CD30+ lymphoproliferative disorders. Blood 2019; 134:515-524. [DOI: 10.1182/blood.2019000785] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2019] [Accepted: 05/14/2019] [Indexed: 12/12/2022] Open
Abstract
Abstract
The primary cutaneous CD30+ lymphoproliferative disorders are a family of extranodal lymphoid neoplasms that arise from mature postthymic T cells and localize to the skin. Current classification systems recognize lymphomatoid papulosis (LyP), primary cutaneous anaplastic large cell lymphoma, and borderline cases. In the majority of patients, the prognosis of primary cutaneous CD30+ lymphoproliferative disorders is excellent; however, relapses are common, and complete cures are rare. Skin-directed and systemic therapies are used as monotherapy or in combination to achieve the best disease control and minimize overall toxicity. We discuss 3 distinct presentations of primary cutaneous CD30+ lymphoproliferative disorder and present recommendations for a multidisciplinary team approach to diagnosis, evaluation, and management of these conditions in keeping with existing consensus guidelines.
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