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Kulumani Mahadevan LS, Ozdemirli M. Subcutaneous panniculitis-like T cell lymphoma arising in association with chronic lymphocytic leukaemia. BMJ Case Rep 2021; 14:e243490. [PMID: 34580127 PMCID: PMC8477245 DOI: 10.1136/bcr-2021-243490] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/02/2021] [Indexed: 11/04/2022] Open
Abstract
Subcutaneous panniculitis-like T cell lymphoma (SPTCL) is a rare cutaneous T cell malignancy of cytotoxic T cell origin. It is frequently associated with autoimmune diseases. It is known to preferentially involve subcutaneous adipose tissue and histologically resembles lupus panniculitis. The aetiology and risk factors of SPTCL are unclear and there are limited studies available since this entity was initially described in 2001. There are even fewer case reports describing the association between SPTCL and chronic lymphocytic leukemia (CLL). In this article, we present a case of SPTCL arising during treatment for CLL. We conducted an extensive review of literature to delve into the possible risk factors for SPTCL development in association with CLL, including pre-existing haematological malignancies, autoimmune conditions, immunomodulation and immunosuppressive chemotherapy.
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Affiliation(s)
| | - Metin Ozdemirli
- Department of Anatomic and Clinical Pathology, Georgetown University Medical Center, Washington, DC, USA
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2
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Chang TW, Weaver AL, Shanafelt TD, Habermann TM, Wriston CC, Cerhan JR, Call TG, Brewer JD. Risk of cutaneous T-cell lymphoma in patients with chronic lymphocytic leukemia and other subtypes of non-Hodgkin lymphoma. Int J Dermatol 2017; 56:1125-1129. [PMID: 28685851 DOI: 10.1111/ijd.13653] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2016] [Revised: 03/28/2017] [Accepted: 04/17/2017] [Indexed: 11/29/2022]
Abstract
BACKGROUND Second hematologic cancers in patients with chronic lymphocytic leukemia/small lymphocytic lymphoma (CLL) are well documented and include Hodgkin lymphoma, therapy-related acute myeloid leukemia/myelodysplastic syndromes, and transformation to diffuse large B-cell lymphoma. Although cutaneous T-cell lymphoma (CTCL) has been reported in patients with CLL, the incidence and comparison to expected rates are unknown. We evaluated the incidence of CTCL among patients with CLL or other non-Hodgkin lymphoma (NHL) subtypes using data from the Surveillance, Epidemiology, and End Results (SEER) Program. METHODS We searched the SEER 13 registries for patients with a diagnosis of CLL and NHL between 1992 and 2008. Among patients identified, we evaluated the incidence of CTCL. RESULTS Among 31,286 patients with CLL, the incidence of CTCL was not significantly higher in men than women: 104.2 (95% CI, 50.0-191.8) and 28.1 (95% CI, 3.4-101.3) per 1,000,000 person-years, respectively (P = 0.06). Among 97,691 patients with NHL, the incidence of CTCL was similar in men and women (97.9 [95% CI, 62.0-146.9] and 92.0 [95% CI, 56.2-142.1] per 1,000,000 person-years, respectively; P = 0.84). The incidence of CTCL among males with CLL (standardized incidence ratio [SIR], 3.0 [95% CI, 1.4-5.5]), males with NHL (SIR, 3.7 [95% CI, 2.3-5.5]), and females with NHL (SIR, 5.9 [95% CI, 3.6-9.1]) was significantly higher than expected in the general population (all P < 0.001). CONCLUSION The risk of CTCL is greater in men with CLL than in the general population. In patients with NHL, both men and women are at greater risk for CTCL than in the general population.
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Affiliation(s)
| | - Amy L Weaver
- Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, MN, USA
| | | | | | - Cooper C Wriston
- Department of Dermatology, Mayo Clinic Health System, Owatonna, MN, USA
| | - James R Cerhan
- Department of Health Sciences Research, Mayo Clinic, Rochester, MN, USA
| | | | - Jerry D Brewer
- Department of Dermatology, Mayo Clinic, Rochester, MN, USA
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Wong E, Mahmood MN, Salopek TG. Concomitant B Hairy Cell Leukemia and Mycosis Fungoides in an Elderly Man. Case Rep Dermatol 2017; 9:103-107. [PMID: 28512405 PMCID: PMC5422730 DOI: 10.1159/000456650] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2016] [Accepted: 01/17/2017] [Indexed: 11/19/2022] Open
Abstract
The development of both a T- and B-cell lymphoproliferative disorder in one patient is an unlikely coincidence due to the low prevalence of each malignancy. We report a 65-year-old man with a previously documented history of B hairy cell leukemia, who presented with a new-onset acneiform eruption of his scalp, face, trunk, back, and extremities. Routine pathology of the skin lesions with immunohistochemical stains and molecular studies were consistent with a folliculotropic mycosis fungoides. B hairy cell leukemia and mycosis fungoides occurring in the same patient seems to be a rare phenomenon with only 5 cases reported in the literature.
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Affiliation(s)
- Eric Wong
- aDivision of Dermatology, Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Muhammad N. Mahmood
- bDepartment of Laboratory Medicine and Pathology, University of Alberta, Edmonton, Alberta, Canada
| | - Thomas G. Salopek
- aDivision of Dermatology, Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
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4
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Vonderheid EC, Kadin ME, Telang GH. Papular mycosis fungoides: Six new cases and association with chronic lymphocytic leukemia. World J Dermatol 2016; 5:136-143. [DOI: 10.5314/wjd.v5.i4.136] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2016] [Revised: 08/05/2016] [Accepted: 10/09/2016] [Indexed: 02/06/2023] Open
Abstract
Papular mycosis fungoides (MF) is a rare presentation of MF. Six illustrative cases of papular MF were retrospectively reviewed. Five of the cases studied by immunohistochemistry had variable numbers (range: 1%-20%) of CD30+ cells in the dermal infiltrate, a finding that is characteristic of lymphomatoid papulosis but may occasionally occur in typical early MF. Although none of our papular MF patients had progressive disease, lesions with relatively high numbers of CD30+ cells in 3 patients did not respond well to skin-directed treatments used for MF. Interestingly, these patients had evidence of co-existing clonal B cell populations in the blood (one with clonal B cell lymphocytosis and two with B-cell chronic lymphocytic leukemia). We conclude that: (1) papular MF may contain CD30+ cells, thereby causing confusion with lymphomatoid papulosis; and (2) papular MF, like more typical MF, may be associated with clonal B-cell proliferations including chronic lymphocytic leukemia.
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5
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Chang MB, Weaver AL, Brewer JD. Cutaneous T-cell lymphoma in patients with chronic lymphocytic leukemia: clinical characteristics, temporal relationships, and survival data in a series of 14 patients at Mayo Clinic. Int J Dermatol 2013; 53:966-70. [PMID: 24134412 DOI: 10.1111/ijd.12063] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND We examined the course of cutaneous T-cell lymphoma (CTCL), which has been associated with chronic lymphocytic leukemia (CLL) in patients with CLL. MATERIALS AND METHODS A search was conducted of the master diagnosis index at our institution to identify patients with both CLL and CTCL from 1980 to 2010. A retrospective chart review was then conducted. RESULTS Of the 14 patients with CTCL and CLL, eight had mycosis fungoides (MF; two with patch stage, two with plaque stage, two with tumor stage, and two with erythrodermic stage), four had Sézary syndrome, one had natural killer cell lymphoma involving the skin, and one had peripheral T-cell lymphoma involving the skin. Eight had concurrent diagnoses, five received a CLL diagnosis first, and one received a CTCL diagnosis first. Ten patients were deceased at the time of data abstraction due to unknown causes (n = 4), lymphoma (n = 2), pneumonia (n = 2), MF (n = 1), or respiratory failure (n = 1). Of the nine patients with concurrent or prior CTCL, seven were deceased, with a median time to death of 10.2 months (range, 6-89 months). Of the five patients with CLL prior to CTCL, three were deceased at 18, 27, and 47 months, respectively, after the CTCL diagnosis. The median survival for the two groups was 12 and 47 months, respectively. CONCLUSIONS Patients with CTCL concurrent with or prior to CLL have a worse overall survival than patients with CLL in whom CTCL later develops. Larger studies are needed.
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Ting Liu, Mai He, Carlson DL, Hedvat C, Teruya-Feldstein J. ALK-Positive Anaplastic Large Cell Lymphoma in a Patient With Chronic Lymphocytic Leukemia. Int J Surg Pathol 2008; 18:424-8. [DOI: 10.1177/1066896908324259] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
This article reports the case of a 59-year-old patient with an 8-year history of chronic lymphocytic leukemia (CLL), prostate carcinoma, and squamous cell carcinoma who developed an ALK-positive anaplastic large cell lymphoma (ALCL). Lymph node and bone marrow biopsies showed 2 distinct morphologic populations: ( a) the CLL component showing a diffuse monomorphous infiltrate of small lymphocytes with the typical immunophenotype showing positive CD20, CD5, CD23, and κ light chain restriction and ( b) the ALCL component showing large anaplastic pleomorphic cells positive for CD30, CD45, ALK, CD45Ro, CD4, and vimentin. Polymerase chain reaction performed on the lymph node for immunoglobulin heavy chain and T-cell receptor γ and β showed gene rearrangements after macrodissection of morphologically distinct populations, indicating confirmed genetically distinct populations. Despite intensive chemotherapy, the patient died. This case represents the rare occurrence of an ALK-positive ALCL developing in a patient with CLL.
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Affiliation(s)
- Ting Liu
- Department of Pathology, Memorial Sloan-Kettering Cancer Center, New York, New York, Department of Pathology, Huntsman Cancer Hospital, University of Utah, Salt Lake City, Utah
| | - Mai He
- Department of Pathology, Memorial Sloan-Kettering Cancer Center, New York, New York
| | - Diane L. Carlson
- Department of Pathology, Memorial Sloan-Kettering Cancer Center, New York, New York
| | - Cyrus Hedvat
- Department of Pathology, Memorial Sloan-Kettering Cancer Center, New York, New York
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KIKUCHI A, ANZAI H, KOSUGE H, NAKA W, NISHIKAWA T. Aggressive B-cell lymphoma induced by Epstein-Barr virus infection in erythrodermic cutaneous T-cell lymphoma. Br J Dermatol 2008. [DOI: 10.1046/j.1365-2133.1997.d01-1158.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Karsai S, Hou JS, Telang G, Kantor GR, Nowell PC, Vonderheid EC. Sézary Syndrome Coexisting with B-Cell Chronic Lymphocytic Leukemia: Case Report and Review of the Literature. Dermatology 2007; 216:68-75. [DOI: 10.1159/000109362] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2007] [Accepted: 05/30/2007] [Indexed: 01/16/2023] Open
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Stokkermans-Dubois J, Beylot-Barry M, Vergier B, Bouabdallah K, Doutre M. Erythema annulare centrifugum revealing chronic lymphocytic leukaemia. Br J Dermatol 2007; 157:1045-7. [DOI: 10.1111/j.1365-2133.2007.08132.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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10
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Marschalkó M, Csomor J, Eros N, Szigeti A, Hársing J, Szakonyi J, Désaknai M, Matolcsy A, Demeter J, Kárpáti S. Coexistence of primary cutaneous anaplastic large cell lymphoma and mycosis fungoides in a patient with B-cell chronic lymphocytic leukaemia. Br J Dermatol 2007; 157:1291-3. [PMID: 17927791 DOI: 10.1111/j.1365-2133.2007.08226.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
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Hallermann C, Kaune KM, Kaune MK, Tiemann M, Kunze E, Griesinger F, Mitteldorf C, Bertsch HP, Neumann C. High frequency of primary cutaneous lymphomas associated with lymphoproliferative disorders of different lineage. Ann Hematol 2007; 86:509-15. [PMID: 17340135 DOI: 10.1007/s00277-007-0276-8] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2006] [Accepted: 02/15/2007] [Indexed: 12/13/2022]
Abstract
In patients suffering from primary cutaneous lymphomas, secondary malignancies of various origin may develop. However, the frequency of a second neoplasm deriving from another lymphoid lineage is still unclear and may be underestimated. We screened all our patients with primary cutaneous lymphomas from a 4-year recruitment period for a coexisting secondary lymphoproliferative disorder. The cohort comprised of a total of 82 patients with primary cutaneous lymphomas, 62 with primary cutaneous T-cell lymphoma (CTCL), 18 with primary cutaneous B-cell lymphomas, and two with CD4+/CD56+ hematodermic neoplasm/blastic lymphomas. Seven patients (8.5%) were identified with a coexisting lymphoma of a different lymphoid lineage. Four patients with Sézary syndrome (SS) suffered from systemic B-cell lymphoma. Two of these developed SS after chemotherapy of their B-cell lymphoma. The other three patients with various types of skin lymphomas (SS, Mycosis fungoides [MF], primary cutaneous marginal zone lymphoma) developed Hodgkin's disease (hairy cell leukemia). Our data indicate that patients with primary cutaneous lymphomas have an elevated risk for the development of a secondary lymphoproliferative disorder even without previous chemotherapy. Possible explanations for this association include a genetic predisposition, alterations in early progenitor cells, underlying viral infections, and/or stimulation of a B-cell clone by the malignant helper T cells of the primary CTCL and vice versa.
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12
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Barzilai A, Trau H, David M, Feinmesser M, Bergman R, Shpiro D, Schiby G, Rosenblatt K, Or R, Hodak E. Mycosis fungoides associated with B-cell malignancies. Br J Dermatol 2006; 155:379-86. [PMID: 16882178 DOI: 10.1111/j.1365-2133.2006.07346.x] [Citation(s) in RCA: 56] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND The coexistence of mycosis fungoides, a peripheral T-cell lymphoma, and B-cell malignancies or Hodgkin's lymphoma in the same patient is unusual. Most descriptions are isolated case reports and case series are strikingly sparse. OBJECTIVES To detect cases of mycosis fungoides associated with B-cell malignancies or Hodgkin's lymphoma and to analyse the characteristics of and the interplay between the lymphoproliferative neoplasms. METHODS Patients with mycosis fungoides who had B-cell malignancies or Hodgkin's lymphoma were selected from among 398 patients either treated or followed up in two tertiary medical centres during a 7-year period. RESULTS Eleven patients with mycosis fungoides and B-cell malignancy were detected (seven of non-Hodgkin's lymphoma, three of chronic lymphocytic leukaemia, one of multiple myeloma). No case of Hodgkin's lymphoma was found. In seven patients the mycosis fungoides preceded the B-cell malignancy whereas in four it was the B-cell malignancy which occurred first. The time elapsed between onset of the two malignancies ranged from 4 to 22 years (average: 12 years). Patients who had mycosis fungoides as the first neoplasm presented with earlier stages of mycosis fungoides (four of seven: IA, three of seven: IB) than those who had mycosis fungoides as their second neoplasm (of four, one: IB, one: folliculotropic, two: IIB). Among the four patients in whom the appearance of mycosis fungoides followed the B-cell malignancy, three had been treated with multiagent chemotherapy. Two patients who presented with early-stage mycosis fungoides (IA) as the first lymphoma developed mycosis fungoides tumours after becoming immunosuppressed. In two patients infiltrates composed of both malignant T- and B-cell populations were found in a single biopsy. One showed two distinct populations of the malignant cells in the skin tumour, thus constituting a classical composite lymphoma of mycosis fungoides and chronic lymphocytic leukaemia, while in the other patient the two malignant populations of marginal B-cell lymphoma and mycosis fungoides (as evidenced by both phenotypic and genotypic findings) were intermingled. CONCLUSIONS This case series indicates that while the coexistence of Hodgkin's lymphoma and mycosis fungoides is extremely rare, the association of mycosis fungoides and B-cell malignancies is not as rare as reflected in the literature, with non-Hodgkin's lymphoma constituting the most common associated B-cell malignancy. In this series as well as in the cases reported in the literature mycosis fungoides usually preceded the development of B-cell malignancies, which may be in accordance with previous reports of an increased risk of developing a second haematological neoplasm. The importance of a competent immune system for patients with mycosis fungoides is well demonstrated in these cases. It is suggested that for greater precision the criteria for diagnosis of composite lymphoma of the skin should include both phenotypic and genotypic features.
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Affiliation(s)
- A Barzilai
- Dermatology, Sheba Medical Center, Tel-Hashomer, Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
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13
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Süss A, Wetzig T, Sticherling M, Tannapfel A, Simon JC. Mycosis fungoides und chronisch lymphatische B-Zell-Leukämie. Hautarzt 2006; 57:888-92. [PMID: 16408218 DOI: 10.1007/s00105-005-1074-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
The simultaneous appearance of mycosis fungoides (MF) and B-cell chronic lymphocytic leukemia (B-CLL) in the same patient is extremely rare. Only seven cases have been described in literature. A 72-year-old patient was diagnosed with coincident MF, stage Ib, and B-CLL, Binet stage A. Hypotheses on simultaneous occurrence of B- and T-cell malignancies as well as a new therapeutic option are discussed.
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Affiliation(s)
- A Süss
- Klinik und Poliklinik für Dermatologie, Allergologie und Venerologie, Universitätsklinikum Leipzig, Germany.
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Ohmatsu H, Saeki H, Fujita H, Toyoma K, Sugaya M, Asahina A, Masuda S, Hirai H, Watanabe T, Nagawa H, Tamaki K. Mycosis fungoides associated with intestinal mucosa-associated lymphoid tissue lymphoma. Int J Dermatol 2005; 44:878-80. [PMID: 16207197 DOI: 10.1111/j.1365-4632.2005.02247.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
Coexistence of cutaneous T-cell lymphoma (CTCL) and a B-cell malignancy is rare. We report a case of mycosis fungoides (MF) associated with intestinal mucosa-associated lymphoid tissue (MALT) lymphoma, which is a low-grade B-cell lymphoma of marginal cell origin. To the best of our knowledge, there have been only two cases of coexistent CTCL and MALT lymphoma, and this is the first case with typical MF and intestinal MALT lymphoma. The coexistence in our case might be coincidental, but genetic predisposition and the immunoregulatory capacity of neoplastic T lymphocytes may be factors contributing to this association.
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MESH Headings
- Antigens, CD20/analysis
- CD3 Complex/analysis
- CD4 Antigens/analysis
- CD8 Antigens/analysis
- Chromosomes, Human, Pair 11/genetics
- Chromosomes, Human, Pair 18/genetics
- Gene Rearrangement
- Humans
- Immunoglobulin Heavy Chains/genetics
- Immunohistochemistry
- Intestinal Neoplasms/complications
- Intestinal Neoplasms/genetics
- Intestinal Neoplasms/metabolism
- Leukocyte Common Antigens/analysis
- Lymphoma, B-Cell, Marginal Zone/complications
- Lymphoma, B-Cell, Marginal Zone/genetics
- Lymphoma, B-Cell, Marginal Zone/metabolism
- Male
- Middle Aged
- Mycosis Fungoides/complications
- Mycosis Fungoides/genetics
- Mycosis Fungoides/metabolism
- Receptors, Antigen, T-Cell, alpha-beta/genetics
- Skin Neoplasms/complications
- Skin Neoplasms/genetics
- Skin Neoplasms/metabolism
- Translocation, Genetic
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Affiliation(s)
- Hanako Ohmatsu
- Department of Dermatology, Faculty of Medicine, University of Tokyo, Tokyo, Japan.
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Martinez A, Pittaluga S, Villamor N, Colomer D, Rozman M, Raffeld M, Montserrat E, Campo E, Jaffe ES. Clonal T-cell Populations and Increased Risk for Cytotoxic T-cell Lymphomas in B-CLL Patients. Am J Surg Pathol 2004; 28:849-58. [PMID: 15223953 DOI: 10.1097/00000478-200407000-00002] [Citation(s) in RCA: 58] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Chronic lymphocytic leukemia (CLL) is associated with increased risk of malignancy, but the occurrence of other lymphomas, in particular T-cell lymphomas, is rare. We identified 7 cases of peripheral T-cell malignancy associated with B-cell-derived CLL from the files of two institutions over a 20-year period. The presence of both B and T lymphoproliferative disorders was confirmed in all cases by immunophenotype and in 6 cases by gene rearrangements. Six patients developed peripheral T-cell lymphoma (PTCL), unspecified, during the course of CLL (10-168 months). In all 5 evaluable cases, the cells had a cytotoxic T-cell phenotype; the sixth case was CD56+, but TIA-1 and Granzyme B could not be studied. A seventh patient with CLL developed mycosis fungoides, and an aggressive NK cell leukemia. To investigate possible risk factors for the development of PTCL, we screened 100 unselected peripheral blood samples from newly diagnosed CLL patients by PCR for the presence of clonal T cell populations. We found evidence of clonal T-cell expansion in 8 patients and increased lymphocytes with large granular lymphocyte morphology in 7 of 8 cases. The immunophenotype was assessed by multicolor flow cytometry and in 4 cases the T-cell expansion was composed of either CD3+/CD8+ or CD3+/CD4-/CD8- cells. The cytotoxic nature of the clonal T-cell expansions in the peripheral blood correlates with the cytotoxic nature of the PTCLs, but their role in the subsequent development of T-cell lymphomas is still unclear. PTCL following CLL should be distinguished from typical Richter syndrome, which it can mimic clinically.
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Affiliation(s)
- Antonio Martinez
- Laboratory of Pathology, National Cancer Institute, National Institutes of Health, Bethesda, MD 20892, USA
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16
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Ohmatsu H, Saeki H, Fujita H, Toyoma K, Sugaya M, Asahina A, Masuda S, Hirai H, Watanabe T, Nagawa H, Tamaki K. Mycosis fungoides associated with intestinal mucosa-associated lymphoid tissue lymphoma. Int J Dermatol 2004. [DOI: 10.1111/j.1365-4632.2004.02247.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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17
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Sidwell RU, McLaughlin JE, Jones A, Whittaker SJ. Hodgkin Lymphoma in a patient with mycosis fungoides: molecular evidence for separate cellular origins. Br J Dermatol 2003; 148:810-2. [PMID: 12752144 DOI: 10.1046/j.1365-2133.2003.05295.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
We report the case of a man with mycosis fungoides (MF), who, 11 years after diagnosis, developed Hodgkin's disease. Although MF is associated with a higher than expected prevalence of other malignancies, including Hodgkin lymphoma, analysis of cells from the skin and lymph nodes showed findings that suggest a separate cellular origin for the two diseases.
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Affiliation(s)
- R U Sidwell
- Department of Dermatology, Royal Free Hospital, Pond Street, London NW3 2QG, UK
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18
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Carrozza PM, Kempf W, Kazakov DV, Dummer R, Burg G. A case of Sézary's syndrome associated with granulomatous lesions, myelodysplastic syndrome and transformation into CD30-positive large-cell pleomorphic lymphoma. Br J Dermatol 2002; 147:582-6. [PMID: 12207606 DOI: 10.1046/j.1365-2133.2002.04839.x] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Sézary's syndrome (SS) is a leukaemic variant of mycosis fungoides, a cutaneous T-cell lymphoma showing distinct clinical, histological, immunological, and genotypic features. We report a 10-year follow-up of a patient with SS exhibiting unusual features such as granulomatous skin lesions, transformation to a CD30-positive large-cell pleomorphic T-cell lymphoma, and development of myelodysplastic syndrome and review the cases of SS reported in the literature with these unusual and rare complications.
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Affiliation(s)
- P M Carrozza
- Department of Dermatology, University of Zurich Medical School, Gloriastr. 31, CH-8091 Zurich, Switzerland
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19
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Christopoulos C, Tassidou A, Golfinopoulou S, Anastasiadis G, Manetas S, Anagnostou D. Concomitant angioimmunoblastic T-cell lymphoma and low grade B-cell lymphoproliferative disorder. CLINICAL AND LABORATORY HAEMATOLOGY 2001; 23:139-42. [PMID: 11488855 DOI: 10.1046/j.1365-2257.2001.00384.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
The presence of a rearranged immunoglobulin gene, in addition to the expected T-cell receptor gene rearrangement, is a frequent, albeit poorly understood, finding in the setting of angioimmunoblastic lymphadenopathy. A case of an angioimmunoblastic T-cell lymphoma is presented, where this apparently paradoxical dual gene rearrangement could be ascribed to the coexistence of an occult B-cell lymphoproliferative disorder.
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Affiliation(s)
- C Christopoulos
- Second Department of Internal Medicine, Thriasio General Hospital, Athens, Greece.
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20
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Väkevä L, Pukkala E, Ranki A. Increased risk of secondary cancers in patients with primary cutaneous T cell lymphoma. J Invest Dermatol 2000; 115:62-5. [PMID: 10886509 DOI: 10.1046/j.1523-1747.2000.00011.x] [Citation(s) in RCA: 46] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
As putative etiologic factors of primary cutaneous T cell lymphomas may have a general cancerogenic effect, we wanted to assess the risk of secondary malignancies in 319 patients diagnosed with histopathologically verified cutaneous T cell lymphomas and reported to the Finnish Cancer Registry during the years 1953-95. Standardized incidence ratios were defined as the ratio of observed to expected numbers of cases. To obtain the expected numbers of cancer, age-, sex-, and period-specific Finnish incidence rates were applied to the appropriate person-years under observation. Ninety-five percent confidence intervals were calculated assuming a Poisson distribution. For the whole period, we detected 36 secondary cancers whereas 26 were expected (standardized incidence ratios 1.4, 95% confidence intervals 1.0-1.9). The overall risk of lung cancer was significantly increased (standardized incidence ratio was 2.7, 95% confidence intervals were 1.4-4.8); and in particular small-cell lung cancer showed high standardized incidence ratios (standardized incidence ratio was 8.5, 95% confidence intervals were 2.8-20). Also, the risk of lymphomas was elevated (standardized incidence ratios for Hodgkin and non-Hodgkin lymphomas combined were 7.0, 95% confidence intervals were 1.9-18). The incidence of other cancers was similar to the national ratios. An increased risk of secondary cancers and in particular small-cell cancer of the lung and lymphomas among patients with primary cutaneous T cell lymphoma is demonstrated. In clinical practice, lung cancer and lymphomas must be kept in mind when following up patients with cutaneous T cell lymphomas.
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Affiliation(s)
- L Väkevä
- Helsinki University Central Hospital, Department of Dermatology, Helsinki, Finland.
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Scarisbrick JJ, Child F, Spittle M, Calonje E, Russell-Jones R. Systemic Hodgkin's lymphoma in a patient with Sézary syndrome. Br J Dermatol 2000; 142:771-5. [PMID: 10792230 DOI: 10.1046/j.1365-2133.2000.03424.x] [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: 11/20/2022]
Abstract
We report a case of a 71-year-old male with Sézary syndrome diagnosed in 1996 who subsequently developed systemic Hodgkin's lymphoma. His only past treatment was bath psoralen plus ultraviolet A. He has since been treated with multiagent chemotherapy (ChlVPP/PABLOE) which induced a remission in his Hodgkin's disease. Eighteen months later he remains in remission from Hodgkin's disease but the Sézary syndrome remains active. He has also developed a squamous cell carcinoma on the upper lip. Sézary syndrome is a primary cutaneous T-cell lymphoma characterized by a malignant proliferation of CD4-positive cells in the skin and peripheral circulation. The CD4 count may be markedly elevated but this results from expansion of a neoplastic T-cell clone and there is a relative lymphopenia of normal T cells leading to a degree of immunoparesis. Immunosuppression is known to be associated with an increased rate of malignancies and this may account for the occurrence of Hodgkin's disease and squamous cell carcinoma in this patient with Sézary syndrome.
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Affiliation(s)
- J J Scarisbrick
- Skin Tumour Unit, St John's Institute of Dermatology, St Thomas' Hospital, Lambeth Palace Rd, Westminster, London SE1 7EH, UK
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23
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KIKUCHI A, ANZAI H, KOSUGE H, NAKA W, NISHIKAWA T. Aggressive B-cell lymphoma induced by Epstein-Barr virus infection in erythrodermic cutaneous T-cell lymphoma. Br J Dermatol 1997. [DOI: 10.1111/j.1365-2133.1997.tb08762.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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24
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Demiroğlu H, Dündar S. T-cell acute lymphoblastic leukaemic transformation of B-cell chronic lymphocytic leukaemia. Eur J Haematol Suppl 1996; 56:184-5. [PMID: 8598241 DOI: 10.1111/j.1600-0609.1996.tb01341.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
MESH Headings
- Cell Lineage
- Clone Cells/pathology
- Disease Progression
- Fatal Outcome
- Gene Rearrangement, T-Lymphocyte
- Humans
- Immunophenotyping
- Leukemia, Lymphocytic, Chronic, B-Cell/complications
- Leukemia, Lymphocytic, Chronic, B-Cell/pathology
- Leukemia-Lymphoma, Adult T-Cell/complications
- Leukemia-Lymphoma, Adult T-Cell/pathology
- Lupus Erythematosus, Systemic/complications
- Male
- Middle Aged
- Neoplastic Stem Cells/pathology
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25
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Metzman MS, Stevens SR, Griffiths CE, Ross CW, Barnett JM, Cooper KD. A clinical and histologic mycosis fungoides simulant occurring as a T-cell infiltrate coexisting with B-cell leukemia cutis. J Am Acad Dermatol 1995; 33:341-5. [PMID: 7615882 DOI: 10.1016/0190-9622(95)91430-7] [Citation(s) in RCA: 22] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
One year after the onset of chronic lymphocytic leukemia, an elderly man had scaly cutaneous plaques on the thighs that clinically and histologically resembled the mycosis fungoides type of cutaneous T-cell lymphoma. Two years later the patient had indurated, red dermal nodules on the face that clinically and histologically were characteristic of cutaneous chronic lymphocytic leukemia. Immunophenotyping results from a facial nodule confirmed the presence of a B-cell infiltrate (CD20+). Immunophenotyping of a lesion on the right thigh showed that half the cells were composed of a CD2+, CD45RO+ (UCHL-1+) upper dermal and focally epidermotropic population of T cells consistent with mycosis fungoides; however, these T cells coexisted with an equal number of CD20+ B cells arranged in distinct clusters. DNA from the thigh lesion exhibited a B-cell immunoglobulin gene rearrangement, but the T-cell receptor gene rearrangements were germline. In this case, the evidence favors a mycosis fungoides simulant occurring as a reactive T-cell infiltrate to an underlying B-cell chronic lymphocytic leukemia.
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MESH Headings
- Aged
- Aged, 80 and over
- Diagnosis, Differential
- Gene Rearrangement
- Humans
- Immunohistochemistry
- Immunophenotyping
- Leukemia, Lymphocytic, Chronic, B-Cell/complications
- Leukemia, Lymphocytic, Chronic, B-Cell/genetics
- Leukemia, Lymphocytic, Chronic, B-Cell/pathology
- Male
- Mycosis Fungoides/etiology
- Mycosis Fungoides/genetics
- Mycosis Fungoides/pathology
- Skin Neoplasms/etiology
- Skin Neoplasms/genetics
- Skin Neoplasms/pathology
- T-Lymphocytes
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Affiliation(s)
- M S Metzman
- Cutaneous Lymphoma Program, University of Michigan Comprehensive Cancer Center, Ann Arbor, USA
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Peñas PF, Jones-Caballero M, Daudén E, Fraga J, García-Díez A. Cutaneous T-cell lymphoma and myelodysplastic syndrome. J Am Acad Dermatol 1994; 31:1065-7. [PMID: 7962764 DOI: 10.1016/s0190-9622(09)80090-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Affiliation(s)
- P F Peñas
- Department of Dermatology, Hospital de la Princesa, Universidad Autónoma, Madrid, Spain
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27
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Grange F, Avril MF, Esteve E, Joly P, Bosq J, de Murets A, Thomine E, Ortoli JC, Duvillard P, Vaillant L. Coexistent cutaneous T-cell lymphoma and B-cell malignancy. French Study Group on Cutaneous Lymphomas. J Am Acad Dermatol 1994; 31:724-31. [PMID: 7929916 DOI: 10.1016/s0190-9622(94)70232-2] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
BACKGROUND The coexistence of cutaneous T-cell lymphoma (CTCL) and a B-cell malignancy (BCM) is rare. OBJECTIVE Our aim was to assess the clinical and pathologic aspects of coexistent CTCL and BCM and to examine potential explanations for this association. METHODS We report six cases of concurrent CTCL and BCM in which B- and T-cell lineages were demonstrated by immunologic studies. The literature includes 13 additional cases. All 19 CTCL-BCM cases are reviewed. RESULTS CTCL either preceded or followed the BCM, which was a low-grade malignancy in most cases (16 of 19). Possible explanations for the association include a genetic predisposition, underlying viral infection, chemotherapy-induced carcinogenesis, stimulation of a B-cell clone by malignant helper T cells, and alterations in progenitor cells before determination of B- and T-cell lineage. CONCLUSION An alteration in progenitor cells, with subsequent oncogenic activation of variable origin, might account for most cases of coexistent CTCL and BCM.
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Affiliation(s)
- F Grange
- Institut Gustave Roussy, Villejuif, France
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