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Williams JF, Lucas FM, Carrasco RD, Lovitch SB, Fisher DC, Kupper TS, Sadigh S. Primary cutaneous EBV+ extranodal NK/T-cell lymphoma of gamma/delta T-cell lineage in the posttransplantation setting. J Cutan Pathol 2024. [PMID: 38986680 DOI: 10.1111/cup.14677] [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: 08/19/2023] [Revised: 06/10/2024] [Accepted: 06/17/2024] [Indexed: 07/12/2024]
Abstract
Posttransplantation primary cutaneous T-cell lymphomas (PT-CTCL) are a rare complication of sustained immunosuppression in the posttransplant setting. When present, PT-CTCLs are typically EBV- and exhibit features of mycosis fungoides/Sézary syndrome or CD30+ lymphoproliferative disorders. We present a case of a 75-year-old individual who developed skin lesions 30 years after liver transplantation. Pathologic evaluation of the skin biopsy revealed involvement by a clonal, EBV+ T-cell population of gamma/delta lineage with no evidence of systemic disease. Comprehensive genomic profiling was performed, confirming focal one-copy loss of 6q23.3, altogether consistent with the extremely rare and unusual diagnosis of primary cutaneous EBV+ extranodal NK/T-cell lymphoma of gamma/delta T-cell lineage in the posttransplantation setting.
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Affiliation(s)
- Jessica F Williams
- Department of Pathology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Fabienne M Lucas
- Department of Pathology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
- Department of Laboratory Medicine and Pathology, University of Washington, Seattle, Washington, USA
| | - Ruben D Carrasco
- Department of Pathology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Scott B Lovitch
- Department of Pathology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - David C Fisher
- Department of Medical Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts, USA
| | - Thomas S Kupper
- Department of Dermatology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts, USA
| | - Sam Sadigh
- Department of Pathology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
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Adams PE, Ehyayee V, Ahmed A. A Case of CD4 + T-Cell Lymphoma With Gamma-Delta Phenotype, Incidentally Manifesting in a Wound Debridement Sample. Am J Dermatopathol 2024; 46:383-385. [PMID: 38574061 DOI: 10.1097/dad.0000000000002695] [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: 04/06/2024]
Abstract
ABSTRACT We report an 85-year-old male patient with a medical history significant for psoriasis who presented with a thigh wound that expanded slowly over the course of 9 months. The patient was previously treated with amputation of hand digits for osteomyelitis. Histologic examination of the tissue sample revealed a broad ulceration with large areas of necrosis extending into the subcutis. The edge of the specimen also revealed a nodular lymphoid infiltrate in the subcutaneous adipose tissue composed of atypical cells. These cells were only positive for CD3, CD4, and T-cell receptor (TCR) delta stains . The Ki-67 proliferation index of tumor cells was about 70%. The tumor cells were negative for CD30, CD8, CD56, TCR BF1, granzyme, TIA1, CD123, and Epstein-Barr encoding region (EBER)-ish stains. A diagnosis of gamma-delta T-cell lymphoma was made. Further imaging showed regional lymphadenopathy. The patient was started on mini-CHOP and filgrastim; however, the patient died within 1 month after the diagnosis. This is an interesting case of gamma-delta T-cell lymphoma that was incidentally diagnosed on a chronic wound. In addition, it showed a CD4 + , CD8 - phenotype that is exceedingly rare for T-cell lymphomas with gamma-delta phenotype.
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Affiliation(s)
| | - Vida Ehyayee
- Department of Pathology, Rush University Medical Center, Chicago, IL
| | - Aadil Ahmed
- Dermatopathology Section, Illinois Dermatology Institute, Park Ridge, IL; and
- Department of Pathology, Loyola Stritch School of Medicine, Maywood, IL 60153
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Sugimoto A, Fujimoto M, Fujii H, Takeuchi Y, Hirata M, Usui S, Nakamizo S, Ikezoe K, Ikeo S, Yamada Y, Minamiguchi S, Morinobu A, Haga H. A fatal case of methotrexate-associated primary cutaneous extranodal NK/T-cell lymphoma of gamma delta phenotype. Histopathology 2022; 81:849-852. [PMID: 36093627 DOI: 10.1111/his.14792] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2022] [Revised: 09/03/2022] [Accepted: 09/07/2022] [Indexed: 11/27/2022]
Affiliation(s)
- Akihiko Sugimoto
- Department of Diagnostic Pathology, Kyoto University Hospital, Kyoto, Japan
| | - Masakazu Fujimoto
- Department of Diagnostic Pathology, Kyoto University Hospital, Kyoto, Japan
| | - Hirotake Fujii
- Department of Diagnostic Pathology, Kyoto University Hospital, Kyoto, Japan
| | - Yasuhide Takeuchi
- Department of Diagnostic Pathology, Kyoto University Hospital, Kyoto, Japan
| | - Masahiro Hirata
- Department of Diagnostic Pathology, Kyoto University Hospital, Kyoto, Japan
| | - Shunya Usui
- Department of Dermatology, Kindai University Faculty of Medicine, Osaka, Sayama, Japan
| | - Satoshi Nakamizo
- Department of Dermatology, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Kohei Ikezoe
- Department of Respiratory Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Satoshi Ikeo
- Department of Respiratory Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Yosuke Yamada
- Department of Diagnostic Pathology, Kyoto University Hospital, Kyoto, Japan
| | | | - Akio Morinobu
- Department of Rheumatology and Clinical Immunology, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Hironori Haga
- Department of Diagnostic Pathology, Kyoto University Hospital, Kyoto, Japan
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A Previously Unrecognized Granulomatous Variant of Gamma-Delta T-Cell Lymphoma. Dermatopathology (Basel) 2021; 8:221-228. [PMID: 34204191 PMCID: PMC8293259 DOI: 10.3390/dermatopathology8020027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Revised: 06/14/2021] [Accepted: 06/15/2021] [Indexed: 11/17/2022] Open
Abstract
Primary cutaneous γδ T-cell lymphoma (PCGD-TCL) is an extremely rare and aggressive T-cell neoplasm with complex heterogeneity. We present a series of two patients who presented with firm, subcutaneous nodules and were diagnosed with PCGD-TCL. In both cases, biopsies demonstrated a both superficial and deep adnexotropic infiltrate comprised of angiocentric, medium- to large-sized atypical lymphocytes. The infiltrate extended into the panniculus. Immuno–histochemical stains highlighted atypical lymphocytes that expressed CD3, CD8 and CD56 but were negative for EBV ISH. A brisk histiocytic response with focal aggregation into granulomas was highlighted with a PG-M1 stain. The atypical lymphocytes were positive for gene rearrangements on a TCR delta stain and negative for βF-1. CT and PET scan in one of the two patients demonstrated diffuse, subcutaneous, ground-glass foci; hypermetabolic soft tissue nodules; and lymphadenopathy in the lungs, as well as splenomegaly. A diagnosis of histiocyte-rich PCGD-TCL was rendered. A histiocyte-rich, granulomatous variant of γδ T-cell lymphoma is extremely rare. Its potentially misleading resemblance to inflammatory granulomatous conditions could pose a diagnostic pitfall in this already challenging condition. This variant may resemble granulomatous mycosis fungoides and granulomatous slack skin syndrome, but it has a distinct, aggressive clinical outcome.
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Hrin M, Newsom M, Ghamrawi R, Niehaus A, Feldman S, Sigmon J, Strowd L. Primary cutaneous gamma-delta T-cell lymphoma: Two cases and a review of the literature. JOURNAL OF DERMATOLOGY & DERMATOLOGIC SURGERY 2021. [DOI: 10.4103/jdds.jdds_54_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Kamijo H, Miyagaki T, Norimatsu Y, Awaji K, Oka T, Suga H, Sugaya M, Sato S. Primary cutaneous γδ T-cell lymphoma with unusual immunophenotype: A case report and review of published work. J Dermatol 2020; 47:300-305. [PMID: 31912565 DOI: 10.1111/1346-8138.15215] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2019] [Accepted: 12/05/2019] [Indexed: 11/26/2022]
Abstract
Primary cutaneous γδ T-cell lymphoma (CGD-TCL) is a rare form of primary cutaneous lymphoma. The histopathological features of CGD-TCL are still unclear because of its rarity. Here, we report a case of a 77-year-old Japanese man who presented with a 9-month history of erythematous plaques on his left forearm. Skin biopsy specimens revealed the infiltration of atypical medium/large-sized lymphocytes from the epidermis to the deep dermis. Atypical lymphocytes were positive for CD3, CD5, CD8 and Vδ1, and negative for CD4, CD7, CD56, EBER-ISH, intracellular antigen-1, granzyme B and perforin. CD30 was partially expressed. We also reviewed 246 cases of CGD-TCL from the published work. CD4- CD8- double-negative cases were 113 of 196 cases (57.6%), followed by CD4- CD8+ cases (52/196, 26.5%). CD5 was expressed in 25.8% of the cases (34/132). At least one cytotoxic molecule marker was expressed in 150 of 160 cases (93.8%). Some cases showed an indolent clinical course, especially in mycosis fungoides-like CGD-TCL cases. CD5 positivity and lack of cytotoxic molecule expression could be associated with a better prognosis. In addition, CD30 expression was found in approximately half of CGD-TCL cases (51/112 cases), suggesting that brentuximab vedotin could be a good treatment option for such patients. Further studies with more cases with detailed clinical and pathological information are necessary to elucidate the etiology and prognostic markers of this entity.
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Affiliation(s)
- Hiroaki Kamijo
- Department of Dermatology, University of Tokyo Graduate School of Medicine, Tokyo, Japan
| | - Tomomitsu Miyagaki
- Department of Dermatology, University of Tokyo Graduate School of Medicine, Tokyo, Japan.,Department of Dermatology, St Marianna University School of Medicine, Kawasaki, Japan
| | - Yurie Norimatsu
- Department of Dermatology, University of Tokyo Graduate School of Medicine, Tokyo, Japan
| | - Kentaro Awaji
- Department of Dermatology, University of Tokyo Graduate School of Medicine, Tokyo, Japan
| | - Tomonori Oka
- Department of Dermatology, University of Tokyo Graduate School of Medicine, Tokyo, Japan
| | - Hiraku Suga
- Department of Dermatology, University of Tokyo Graduate School of Medicine, Tokyo, Japan
| | - Makoto Sugaya
- Department of Dermatology, University of Tokyo Graduate School of Medicine, Tokyo, Japan.,Department of Dermatology, International University of Health and Welfare, Chiba, Japan
| | - Shinichi Sato
- Department of Dermatology, University of Tokyo Graduate School of Medicine, Tokyo, Japan
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Cui H, Liu J, Li L, Ren J, Guo S, Bai L. Analysis of differential β variable region of T cell receptor expression and NAV3/TNFRSF1B gene mutation in mycosis fungoides. Oncotarget 2016; 7:17986-90. [PMID: 26918607 PMCID: PMC4951265 DOI: 10.18632/oncotarget.7673] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2015] [Accepted: 01/13/2016] [Indexed: 11/25/2022] Open
Abstract
Objective This study aimed to analyze the predominant expression of the variable region of T cell receptor (TRBV) and determine whether NAV3 or TNFRSF1B gene mutation involved in the pathogenesis of MF. Results TRBV5-7 expression increased from the normal, early-stage to advanced-stage lesion in MF patient. By contrast, TRBV2 decreased with the lesion developed. We found no mutations of NAV3 or TNFRSF1B in the lesions from this study. Materials and Methods Real-time PCR were used to screen differential expression of TRBV in different lesions. Mutational analyses were used to validate genetic alterations in the skin lesions. Conclusions The identification of TRBV gene expression differences between normal and different stages of MF lesions provide insight into promising new diagnostic and prognostic biomarkers. None of the reported genetic abnormalities suggests complexity of progress from a primary cytogenetic event to an advanced stage with poor prognosis in MF.
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Affiliation(s)
- Hongzhou Cui
- Department of Dermatology, The First Hospital, Shanxi Medical University, Taiyuan, Shanxi 030001, PR China
| | - Jie Liu
- Jiangxi Provincial Center for Disease Control and Prevention, Nanchang, Jiangxi 330029, PR China
| | - Li Li
- Department of Dermatology, The First Hospital, Shanxi Medical University, Taiyuan, Shanxi 030001, PR China
| | - Jingyu Ren
- Department of Dermatology, The First Hospital, Shanxi Medical University, Taiyuan, Shanxi 030001, PR China
| | - Shuping Guo
- Department of Dermatology, The First Hospital, Shanxi Medical University, Taiyuan, Shanxi 030001, PR China
| | - Li Bai
- Department of Dermatology, The First Hospital, Shanxi Medical University, Taiyuan, Shanxi 030001, PR China
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Duncan JR, Carr D, Kaffenberger BH. The utility of positron emission tomography with and without computed tomography in patients with nonmelanoma skin cancer. J Am Acad Dermatol 2016; 75:186-96. [PMID: 26992283 DOI: 10.1016/j.jaad.2016.01.045] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2015] [Revised: 01/16/2016] [Accepted: 01/20/2016] [Indexed: 10/22/2022]
Abstract
Combined positron emission tomography (PET) and computed tomography (CT) scans are widely used in the staging and monitoring of most malignancies. The differential for PET-positive cutaneous lesions includes primary skin cancers, infections, cutaneous metastases from distant malignancies, and benign neoplasms. In dermatology, PET/CT scans have been most widely studied in patients with melanoma and Merkel cell carcinoma. The role of PET/CT scans in the management of other cutaneous malignancies is less clear, but it has shown great promise in the management of patients with squamous cell carcinoma and cutaneous lymphoma. This review seeks to address the usefulness of PET/CT scans in nonmelanoma skin cancer and to provide guidance regarding the management of patients with incidental PET-positive nodules. Currently, there is limited experience with PET/CT scans for staging and monitoring of non-head and neck metastatic basal cell and squamous cell carcinomas, and results show limited sensitivity and specificity. We also address the evidence for management of an incidental PET-positive cutaneous nodule and recommend obtaining a biopsy specimen in patients with a known noncutaneous malignancy, a history of primary skin cancer, or a high risk of either cutaneous or noncutaneous malignancy.
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Affiliation(s)
| | - David Carr
- Division of Dermatology, Wexner Medical Center at Ohio State University, Ghanna, Ohio
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11
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Shalom G, Gurion R, Benharroch D. Primary cutaneous γ/δ T-cell lymphoma. An atypical case with bone marrow granulomas. J Dermatol Case Rep 2015; 9:15-8. [PMID: 25932058 DOI: 10.3315/jdcr.2015.1191] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2014] [Accepted: 01/06/2015] [Indexed: 11/11/2022]
Abstract
BACKGROUND Primary cutaneous γ/δ T-cell lymphoma is a rare variant of peripheral T-cell lymphoma which has been only recently set apart from subcutaneous panniculitis-like T-cell lymphoma and is known for its aggressive nature. MAIN OBSERVATION We hereby report a case of primary cutaneous γ/δ T-cell lymphoma in a 35-year-old man with bone marrow granulomas, an unexpected feature in this lymphoma. The patient was treated with combination chemotherapy. Partial response was obtained, followed by relapse. Allogeneic stem cell transplantation was then carried out, and full remission was achieved. CONCLUSION Bone marrow granulomas can be an accompanying feature in primary cutaneous γ/δ T-cell lymphoma.
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Affiliation(s)
- Guy Shalom
- Department of Dermatology and Venereology, Soroka Medical Center, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Ronit Gurion
- Institute of Hematology, Davidoff Center, Beilinson Hospital, Rabin Medical Center, Petah Tikva, Israel
| | - Daniel Benharroch
- Department of Pathology, SorokaMedical Center, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
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Kempf W, Kazakov DV, Belousova IE, Mitteldorf C, Kerl K. Paediatric cutaneous lymphomas: a review and comparison with adult counterparts. J Eur Acad Dermatol Venereol 2015; 29:1696-709. [PMID: 25715748 DOI: 10.1111/jdv.13044] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2014] [Accepted: 01/16/2015] [Indexed: 11/30/2022]
Abstract
Primary cutaneous lymphomas (CL) in children is rare. Only a few studies focused specifically on paediatric CL and therefore little is known whether primary CL in children are similar to or different from their adult counterparts with respect to the clinicopathological presentation, behaviour and prognosis. An extensive literature search using PubMed/MEDLINE from January 1995 through July 2014 was undertaken for articles reporting cases of paediatric CL. In addition, we identified 31 children with CL in our institutions. Mycosis fungoides and lymphomatoid papulosis are the two most prevalent lymphoma forms in children. A few entities of cutaneous lymphomas such as cutaneous diffuse large B-cell lymphoma leg type, and Sézary syndrome have not been reported so far in children. Other lymphoma entities such as hydroa vacciniforme-like lymphoma are mostly seen in certain geographic areas (Asia, Central and South America). In the paediatric population, low-malignant indolent forms such as primary cutaneous marginal zone lymphoma and primary cutaneous follicle centre lymphoma are very rare, whereas the more aggressive forms of B-cell lymphomas, precursor lymphoblastic lymphomas, and blastic plasmacytoid dendritic cell neoplasm are the most common forms in children, mostly involving the skin secondarily. Most paediatric lymphomas have similar clinicopathological features and course as their adults counterparts, particularly in the group of cutaneous T-cell lymphomas. The spectrum of cutaneous B-cell lymphomas in children significantly differs from the one in adults. Diagnostic work-up and treatment of paediatric patients with lymphomas are best achieved in close collaboration with paediatric haematopathologists and oncologists.
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Affiliation(s)
- W Kempf
- Kempf und Pfaltz, Histologische Diagnostik, Zürich, Switzerland.,Department of Dermatology, University Hospital Zürich, Zürich, Switzerland
| | - D V Kazakov
- Kempf und Pfaltz, Histologische Diagnostik, Zürich, Switzerland.,Department of Pathology, Medical Faculty in Pilsen, Charles University in Prague, Prague, Czech Republic
| | - I E Belousova
- Department of Dermatology, Medical Military Academy, Saint-Petersburg, Russia
| | - C Mitteldorf
- Department of Dermatology, HELIOS-Klinikum, Hildesheim, Germany
| | - K Kerl
- Department of Dermatology, University Hospital Zürich, Zürich, Switzerland
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Abstract
The cytotoxic T-cell and natural killer (NK)-cell lymphomas and related disorders are important but relatively rare lymphoid neoplasms that frequently are a challenge for practicing pathologists. This selective review, based on a meeting of the International Lymphoma Study Group, briefly reviews T-cell and NK-cell development and addresses questions related to the importance of precise cell lineage (αβ-type T cell, γδ T cell, or NK cell), the implications of Epstein-Barr virus infection, the significance of anatomic location including nodal disease, and the question of further categorization of enteropathy-associated T-cell lymphomas. Finally, developments subsequent to the 2008 World Health Organization Classification, including the recognition of indolent NK-cell and T-cell disorders of the gastrointestinal tract are presented.
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Two Cases of Primary Cutaneous Lymphoma With a γ/δ+ Phenotype and an Indolent Course. Am J Dermatopathol 2014; 36:570-7. [DOI: 10.1097/dad.0000000000000029] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Abstract
Primary cutaneous γδ T-cell lymphomas (PCGD-TCLs) are considered a subgroup of aggressive cytotoxic T-cell lymphomas (CTCLs). We have taken advantage of a new, commercially available antibody that recognizes the T-cell receptor-γ (TCR-γ) subunit of the TCR in paraffin-embedded tissue. We have analyzed a series of 146 primary cutaneous T-cell lymphomas received for consultation or a second opinion in the CNIO Pathology Department. Cases were classified according to the World Health Organization 2008 classification as mycosis fungoides (MF; n=96), PCGD-TCLs (n=5), pagetoid reticulosis (n=6), CD30(+) primary cutaneous anaplastic large cell lymphomas (n=5), primary cutaneous CD8 aggressive epidermotropic CTCLs (n=3), primary cutaneous CTCL, not otherwise specified (n=4), and extranodal nasal-type NK/T-cell lymphomas primarily affecting the skin or subcutaneous tissue (n=11). Sixteen cases of the newly named lymphomatoid papulosis type D (LyP-D; n=16) were also included. In those cases positive for TCR-γ, a further panel of 13 antibodies was used for analysis, including TIA-1, granzyme B, and perforin. Clinical and follow-up data were recorded in all cases. Twelve cases (8.2%) were positive for TCR-γ, including 5 PCGD-TCLs, 2 MFs, and 5 LyP-Ds. All 5 PCGD-TCL patients and 1 MF patient died of the disease, whereas the other MF patient and all those with LyP-D were alive. All cases expressed cytotoxic markers, were frequently CD3(+)/CD8(+), and tended to lose CD5 and CD7 expressions. Eight of 12 and 5 of 11 cases were CD30(+) and CD56(+), respectively. Interestingly, 5/12 TCR-γ-positive cases also expressed TCR-BF1. All cases analyzed were negative for Epstein-Barr virus-encoded RNA. In conclusion, TCR-γ expression seems to be rare and is confined to cytotoxic primary cutaneous TCLs. Nevertheless, its expression is not exclusive to PCGD-TCLs, as TCR-γ protein can be found in other CTCLs. Moreover, its expression does not seem to be associated with bad prognosis by itself, as it can be found in cases with good and bad outcomes.
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Cutaneous γδ T-cell lymphomas: a spectrum of presentations with overlap with other cytotoxic lymphomas. Am J Surg Pathol 2013; 36:1656-65. [PMID: 23073324 DOI: 10.1097/pas.0b013e31826a5038] [Citation(s) in RCA: 108] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
We reviewed our multicenter experience with gamma-delta (γδ) T-cell lymphomas first presenting in the skin. Fifty-three subjects with a median age of 61 years (range, 25 to 91 y) were diagnosed with this disorder. The median duration of the skin lesions at presentation was 1.25 years (range, 1 mo to 20 y). The most common presentation was deep plaques (38 cases) often resembling a panniculitis, followed by patches resembling psoriasis or mycosis fungoides (10 cases). These lesions tended to ulcerate overtime (27 cases). Single lesions or localized areas of involvement resembling cellulitis or pyoderma were reported in 8 cases. The most common anatomic site of involvement was the legs (40 cases), followed by the torso (30 cases) and arms (28 cases). Constitutional symptoms were reported in 54% (25/46) of the patients, including some with limited skin involvement. Significant comorbidities included autoimmunity (12 cases), other lymphoproliferative disorders (5 cases), internal carcinomas (4 cases), and viral hepatitis (2 cases). Lymphadenopathy (3/42 cases) and bone marrow involvement (5/28 cases) were uncommon, but serum lactose dehydrogenase (LDH) was elevated in 55% (22/39) of the patients. Abnormal positron emission tomography and/or computed tomography scans in 20/37 subjects mostly highlighted soft tissue or lymph nodes. Disease progression was associated with extensive ulcerated lesions resulting in 27 deaths including complications of hemophagocytic syndrome (4) and cerebral nervous system involvement (3). Median survival time from diagnosis was 31 months. Skin biopsies varied from a pagetoid pattern to purely dermal or panniculitic infiltrates composed of intermediate-sized lymphocytes with tissue evidence of cytotoxicity. The most common immunophenotype was CD3+/CD4⁻/CD5⁻/CD8⁻/BF1⁻/γ-M1+/TIA-1+/granzyme-B+/CD45RA-/CD7-, and 4 cases were Epstein-Barr virus positive. This is the largest study to date of cutaneous γδ T-cell lymphomas and demonstrates a variety of clinical and pathologic presentations with a predictable poor outcome.
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Hocker TL, Wada DA, el-Azhary R, Gibson LE. Expression of T-cell receptor-γδ in normal human skin, inflammatory dermatoses and mycosis fungoides. J Cutan Pathol 2012; 39:419-24. [DOI: 10.1111/j.1600-0560.2011.01859.x] [Citation(s) in RCA: 9] [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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