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Statuto T, D'Auria F, Del Vecchio L, Mansueto GR, Villani O, Lalinga AV, Possidente L, Nozza F, Vona G, Rago L, Storto G, Gasparini VR, Zambello R, D'Arena G, Valvano L. Atypical Mature T-Cell Neoplasms: The Relevance of the Role of Flow Cytometry. Onco Targets Ther 2020; 13:7605-7614. [PMID: 32848413 PMCID: PMC7425660 DOI: 10.2147/ott.s258512] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Accepted: 06/23/2020] [Indexed: 12/26/2022] Open
Abstract
Lymphoproliferative disorders are a heterogeneous group of malignant clonal proliferations of lymphocytes whose diagnosis remains challenging, despite diagnostic criteria are now well established, due to their heterogeneity in clinical presentation and immunophenotypic profile. Lymphoid T-cell disorders are more rarely seen than B-cell entities and more difficult to diagnose for the absence of a specific immunophenotypic signature. Flow cytometry is a useful tool in diagnosing T-cell lymphoproliferative disorders since it is not only able to better characterize T-cell neoplasms but also to resolve some very complicated cases, in particular those in which a small size population of neoplastic cells is available for the analysis. Here, we report three patients with mature T-cell neoplasms with atypical clinical and biological features in which analysis of peripheral blood and bone marrow specimens by means of multicolor flow cytometry was very useful to identify and characterize three rare T-cell lymphoproliferative disorders, such as angioimmunoblastic T-cell lymphoma, peripheral T-cell lymphoma not otherwise specified and T-cell prolymphocytic leukemia. The aim of this case series report is not only to describe three rare cases of lymphoproliferative neoplasms but also to raise awareness that a fast, highly sensitive, and reproducible procedure, such as flow cytometry immunophenotyping, can have a determinant diagnostic role in these patients.
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Affiliation(s)
- Teodora Statuto
- Laboratory of Clinical Research and Advanced Diagnostics, Centro Di Riferimento Oncologico Della Basilicata (IRCCS-CROB), Rionero in Vulture, Pz, Italy
| | - Fiorella D'Auria
- Unit of Clinical Pathology, Centro Di Riferimento Oncologico Della Basilicata (IRCCS-CROB), Rionero in Vulture, Pz, Italy
| | - Luigi Del Vecchio
- CEINGE Biotecnologie Avanzate S.c.a.r.l, Federico II University, Naples, Italy.,Department of Molecular Medicine and Medical Biotechnology (DMMBM), Federico II University, Naples, Italy
| | - Giovanna Rosaria Mansueto
- Hematology Department of Basilicata, Centro Di Riferimento Oncologico Della Basilicata (IRCCS-CROB), Rionero in Vulture, Pz, Italy
| | - Oreste Villani
- Hematology Department of Basilicata, Centro Di Riferimento Oncologico Della Basilicata (IRCCS-CROB), Rionero in Vulture, Pz, Italy
| | - Anna Vittoria Lalinga
- Pathology Unit, Centro Di Riferimento Oncologico Della Basilicata (IRCCS-CROB), Rionero in Vulture, Pz, Italy
| | - Luciana Possidente
- Pathology Unit, Centro Di Riferimento Oncologico Della Basilicata (IRCCS-CROB), Rionero in Vulture, Pz, Italy
| | - Filomena Nozza
- Laboratory of Clinical Research and Advanced Diagnostics, Centro Di Riferimento Oncologico Della Basilicata (IRCCS-CROB), Rionero in Vulture, Pz, Italy
| | - Gabriella Vona
- Laboratory of Clinical Research and Advanced Diagnostics, Centro Di Riferimento Oncologico Della Basilicata (IRCCS-CROB), Rionero in Vulture, Pz, Italy
| | - Luciana Rago
- Radiotherapy Unit, Centro Di Riferimento Oncologico Della Basilicata (IRCCS-CROB), Rionero in Vulture, Pz, Italy
| | - Giovanni Storto
- Department of Nuclear Medicine, Centro Di Riferimento Oncologico Della Basilicata (IRCCS-CROB), Rionero in Vulture, Pz, Italy
| | - Vanessa Rebecca Gasparini
- Department of Medicine, University of Padova - Veneto Institute of Molecular Medicine, VIMM, Padova, PD, Italy
| | - Renato Zambello
- Hematology and Clinical Immunology, Department of Medicine, Padua School of Medicine, Padova, PD, Italy
| | - Giovanni D'Arena
- Hematology Department of Basilicata, Centro Di Riferimento Oncologico Della Basilicata (IRCCS-CROB), Rionero in Vulture, Pz, Italy
| | - Luciana Valvano
- Laboratory of Clinical Research and Advanced Diagnostics, Centro Di Riferimento Oncologico Della Basilicata (IRCCS-CROB), Rionero in Vulture, Pz, Italy
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Kuwahara N, Kodaka T, Zushi Y, Sasaki M, Goka T, Maruoka H, Aoyama Y, Tsunemine H, Yamane T, Kobayashi J, Kawakami T, Ishida F, Itoh T, Takahashi T. T-cell large granular lymphocytic (LGL) leukemia consists of CD4 +/CD8 dim and CD4 -/CD8 + LGL populations in association with immune thrombocytopenia, autoimmune neutropenia, and monoclonal B-cell lymphocytosis. J Clin Exp Hematop 2020; 59:202-206. [PMID: 31866622 PMCID: PMC6954171 DOI: 10.3960/jslrt.19030] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Abstract
CD3+/CD57+ T-cell large granular lymphocyte leukemia (T-LGLL) is an indolent neoplasm, exhibiting mostly CD8+, less frequently CD4+ phenotypes, and T-LGLL consisting of 2 populations with CD8+ and CD4+ phenotypes is markedly rare. An 87-year-old female was admitted under a diagnosis of immune thrombocytopenia (ITP) with a platelet count of 5.0×109/L and increased number of LGL with unknown etiology. Her neutrophil count also decreased to 0.27×109/L and she was positive for antineutrophil antibody. The WBC count was 2.7×109/L with 34.7% LGL and flow cytometry (FCM) analysis revealed 16% CD3+/CD4+/CD8dim/CD57+ and 20.9% CD3+/CD8+/CD57+ populations. These populations also expressed granzyme B and perforin. Circulating mononuclear cells were found to be clonal by PCR analysis of T-cell receptor β-chain gene. Serum immunofixation and bone marrow FCM analyses demonstrated 2 clonal B-cells producing IgG-λ and IgA-λ. Deep amplicon sequencing of STAT3 and STAT5B genes revealed a STAT3 R302G mutation with an allele burden of 2.6%. The thrombocytopenia and neutropenia were successfully treated by prednisolone and romiplostim with negative conversion of antineutrophil antibody. This is the first reported case of T-LGLL with dual components of CD4+/CD8dim and CD4-/CD8+ populations in terms of multiple comorbidities related to the respective CD8+ and CD4+ T-LGLLs.
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MESH Headings
- Aged, 80 and over
- Amino Acid Substitution
- B-Lymphocytes/metabolism
- B-Lymphocytes/pathology
- CD4-Positive T-Lymphocytes/metabolism
- CD4-Positive T-Lymphocytes/pathology
- CD8-Positive T-Lymphocytes/metabolism
- CD8-Positive T-Lymphocytes/pathology
- Female
- Humans
- Immunoglobulin lambda-Chains/genetics
- Immunoglobulin lambda-Chains/metabolism
- Leukemia, Large Granular Lymphocytic/genetics
- Leukemia, Large Granular Lymphocytic/metabolism
- Leukemia, Large Granular Lymphocytic/pathology
- Lymphocytosis/genetics
- Lymphocytosis/metabolism
- Lymphocytosis/pathology
- Mutation, Missense
- Neoplasm Proteins/genetics
- Neoplasm Proteins/metabolism
- Neutropenia/genetics
- Neutropenia/metabolism
- Neutropenia/pathology
- Purpura, Thrombocytopenic, Idiopathic/genetics
- Purpura, Thrombocytopenic, Idiopathic/metabolism
- Purpura, Thrombocytopenic, Idiopathic/pathology
- STAT3 Transcription Factor/genetics
- STAT3 Transcription Factor/metabolism
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3
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Prochorec-Sobieszek M, Chełstowska M, Rymkiewicz G, Majewski M, Warzocha K, Maryniak R. Biclonal T-cell receptor gammadelta+ large granular lymphocyte leukemia associated with rheumatoid arthritis. Leuk Lymphoma 2008; 49:828-31. [PMID: 18398755 DOI: 10.1080/10428190801895337] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Karasawa M, Mitsui T, Isoda A, Tsumita Y, Irisawa H, Yokohama A, Handa H, Matsushima T, Tsukamoto N, Murakami H, Nojima Y. TCR Vβ repertoire analysis in CD56+
CD16dim/−
T-cell large granular lymphocyte leukaemia: association with CD4 single and CD4/CD8 double positive phenotypes. Br J Haematol 2003; 123:613-20. [PMID: 14616964 DOI: 10.1046/j.1365-2141.2003.04665.x] [Citation(s) in RCA: 9] [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 10 patients with T-cell large granular lymphocyte (LGL) leukaemia: four patients had CD16+ CD56- LGL lymphocytes (typical for LGL leukaemia), and six patients had CD56+ CD16(dim/-) LGL lymphocytes (atypical). Among the CD56+ CD(dim/-) patients, LGL lymphocytes were CD4+ CD8- in one patient, CD4/CD8 double positive (DP) in three, and CD4- CD8+ in two. The CD4+ CD8dim DP cells expressed a CD8alphaalpha homodimer. T-cell receptor (TCR) Vbeta complementarity-determining region 3 (CDR3) size distribution analysis and direct sequencing identified at least 1 in-frame clonal TCR Vbeta transcript in each patient; three patients had two or three different clonal sequences. To determine whether these transcripts were translated into cell surface TCR, we performed flow cytometric analysis using Vbeta monoclonal antibodies (mAbs). A single Vbeta protein was identified in patients, even those with multiple in-frame transcripts. Previous and present results suggest that CD56+ CD16(dim/-) LGL leukaemia is more common than previously thought, and is associated with unusual phenotypes. When assessed using only molecular techniques, the monoclonal status of this disease may be misinterpreted as oligoclonal; thus, flow cytometric analysis using Vbeta mAb is quite useful. Because mAbs do not cover the entire Vbeta repertoire, assessing clonality using a combination of molecular methods and mAbs is preferable.
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Affiliation(s)
- Masamitsu Karasawa
- Blood Transfusion Service, University Hospital, Faculty of Medicine, Gunma University, Maebashi, Japan.
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Granjo E, Lima M, Lopes JM, Cunha N, Teixeira MDA, Santos F, Candeias J, Resende C, Santos AH, Balanzategui A, Orfão A, Matutes E. Intraclonal diversity in a Sezary syndrome with a differential response to 2-deoxycoformycin of the two lymphoma cell populations. Br J Haematol 2002; 119:629-33. [PMID: 12437636 DOI: 10.1046/j.1365-2141.2002.03889.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
We report a case of Sezary syndrome with two abnormal CD4+ T-cell populations detected in the peripheral blood by flow cytometry immunophenotyping and DNA cell content, suggesting a biclonal T-cell lymphoproliferative disorder. Despite these findings, molecular analysis of the T-cell receptor genes was consistent with a monoclonal T-cell proliferation, supporting the existence of intraclonal diversity rather than a true biclonal disease. The patient achieved a transient response with 2-deoxycoformycin, with a selective decrease of the larger/hyperploid T-cell population; later on, an increased representation of this T-cell population was observed concomitantly with clinical relapse.
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Affiliation(s)
- Elisa Granjo
- Department of Clinical Haematology, Hospital Geral de São João, Porto, Portugal.
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