1
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Willemze R. Cutaneous lymphoproliferative disorders: Back to the future. J Cutan Pathol 2024; 51:468-476. [PMID: 38499969 DOI: 10.1111/cup.14609] [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] [Received: 01/21/2024] [Revised: 03/04/2024] [Accepted: 03/07/2024] [Indexed: 03/20/2024]
Abstract
In the 1980s, immunohistochemistry and clonality analyses became instrumental in the recognition and definition of new types of cutaneous T-cell lymphoma (CTCL) and cutaneous B-cell lymphoma (CBCL) and the development of new classifications. By accepting loss of pan-T-cell antigens and clonal T-cell receptor gene rearrangements as important criteria to differentiate between benign and malignant T-cell proliferations, and monotypic immunoglobulin light-chain expression and clonal immunoglobulin gene rearrangements as crucial criteria to distinguish between benign and malignant B-cell proliferations, many cases, until then diagnosed as cutaneous lymphoid hyperplasia or pseudolymphoma, were reclassified as primary cutaneous CD4+ small/medium T-cell lymphoma (PCSM-TCL) or primary cutaneous marginal zone lymphoma (PCMZL), respectively. However, in recent years there is growing awareness that neither these immunohistochemical criteria nor demonstration of T-cell or B-cell clonality is specific for malignant lymphomas. In addition, many studies have reported that these low-grade malignant CTCL and CBCL have an indolent clinical behavior and an excellent prognosis with disease-specific survival rates of or close to 100%. As a result, recent classifications have downgraded several low-grade malignant cutaneous lymphomas to lymphoproliferative disorder (LPD). Both the 5th edition of the WHO classification (2022) and the 2022 International Consensus Classification (ICC) of mature lymphoid neoplasms reclassified PCSM-TCL as primary cutaneous CD4+ small/medium T-cell LPD and primary cutaneous acral CD8+ T-cell lymphoma as primary cutaneous acral CD8+ T cell LPD. While the 2022 ICC introduced the term "primary cutaneous marginal zone LPD," in the 5th edition of the WHO classification PCMZL is maintained. In this review we describe the background and rationale of the continually changing terminology of these conditions and discuss the clinical consequences of downgrading malignant lymphomas to LPDs.
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Affiliation(s)
- Rein Willemze
- Department of Dermatology, Leiden University Medical Center, Leiden, The Netherlands
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2
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Yousif ML, Zhao X, Andrews D. No Longer Cutaneous T-cell Lymphoma Dermal Nodule. Cureus 2023; 15:e50796. [PMID: 38239551 PMCID: PMC10796132 DOI: 10.7759/cureus.50796] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/19/2023] [Indexed: 01/22/2024] Open
Abstract
Primary cutaneous CD4+ small and medium pleomorphic T-cell lymphoproliferative disorder (PCSM-LPD) is a rare and typically asymptomatic proliferation of CD3+/CD4+ small and medium pleomorphic T-cells. In this case report, we share the details of a 41-year-old male presenting with a two-centimeter soft, mobile forehead nodule that was determined by clinical symptoms, histology, and immunostaining to be PCSM-LPD. We would like to emphasize the clinical resolution that was seen with minimal treatment.
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Affiliation(s)
- Miranda L Yousif
- Medicine, University of Arizona College of Medicine - Phoenix, Phoenix, USA
| | - Xiangfeng Zhao
- Pathology, Carl T. Hayden Veterans' Administration Medical Center, Phoenix, USA
| | - Debora Andrews
- Dermatology, Carl T. Hayden Veterans' Administration Medical Center, Phoenix, USA
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3
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Saleh JS, Subtil A, Hristov AC. Primary cutaneous T-cell lymphoma: a review of the most common entities with focus on recent updates. Hum Pathol 2023; 140:75-100. [PMID: 37802757 DOI: 10.1016/j.humpath.2023.09.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Revised: 06/01/2023] [Accepted: 06/07/2023] [Indexed: 10/08/2023]
Abstract
Cutaneous T-cell lymphomas are an heterogeneous group of uncommon lymphoid neoplasms that are challenging to diagnose and require close collaboration between dermatologists, pathologists and hematologists/oncologists. This article reviews the most common cutaneous T-cell lymphomas: mycosis fungoides (both classic and variant forms) as well as its leukemic counterpart Sézary syndrome, CD30+ T-cell lymphoproliferative disorders including the ever-expanding group of lymphomatoid papulosis and primary cutaneous anaplastic large cell lymphoma, and primary cutaneous CD4+ small/medium lymphoproliferative disorder. We discuss the classic clinical and histopathologic features of these lymphomas and review how they can be distinguished from reactive entities. In particularly, updates to these diagnostic categories and current controversies in classification are highlighted. Moreover, we review the prognosis and treatment for each entity. These lymphomas exhibit variable prognosis, and therefore it is important to correctly classify atypical cutaneous T-cell infiltrates for appropriate patient treatment and prognosis. Cutaneous T-cell lymphomas are at the interface of several medical specialties; this review seeks to summarize key features of these lymphomas and highlight new and emerging insights into these lymphomas.
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Affiliation(s)
- Jasmine S Saleh
- Department of Pathology, University of Michigan, Ann Arbor, MI, 48109, USA; Department of Dermatology, University of Michigan, Ann Arbor, MI, 48109, USA
| | - Antonio Subtil
- Department of Pathology, Royal Jubilee Hospital, University of British Columbia, Victoria, British Columbia, V8R1J8, Canada
| | - Alexandra C Hristov
- Department of Pathology, University of Michigan, Ann Arbor, MI, 48109, USA; Department of Dermatology, University of Michigan, Ann Arbor, MI, 48109, USA.
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4
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Saleh JS, Subtil A, Hristov AC. Primary cutaneous T-cell lymphoma: a review of the most common entities with focus on recent updates. Hum Pathol 2023; 138:76-102. [PMID: 37307932 DOI: 10.1016/j.humpath.2023.06.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Revised: 06/01/2023] [Accepted: 06/07/2023] [Indexed: 06/14/2023]
Abstract
Cutaneous T-cell lymphomas are an heterogeneous group of uncommon lymphoid neoplasms that are challenging to diagnose and require close collaboration between dermatologists, pathologists and hematologists/oncologists. This article reviews the most common cutaneous T-cell lymphomas: mycosis fungoides (both classic and variant forms) as well as its leukemic counterpart Sézary syndrome, CD30+ T-cell lymphoproliferative disorders including the ever-expanding group of lymphomatoid papulosis and primary cutaneous anaplastic large cell lymphoma, and primary cutaneous CD4+ small/medium lymphoproliferative disorder. We discuss the classic clinical and histopathologic features of these lymphomas and review how they can be distinguished from reactive entities. In particularly, updates to these diagnostic categories and current controversies in classification are highlighted. Moreover, we review the prognosis and treatment for each entity. These lymphomas exhibit variable prognosis, and therefore it is important to correctly classify atypical cutaneous T-cell infiltrates for appropriate patient treatment and prognosis. Cutaneous T-cell lymphomas are at the interface of several medical specialties; this review seeks to summarize key features of these lymphomas and highlight new and emerging insights into these lymphomas.
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Affiliation(s)
- Jasmine S Saleh
- Department of Pathology, University of Michigan, Ann Arbor, MI, 48109, USA; Department of Dermatology, University of Michigan, Ann Arbor, MI, 48109, USA
| | - Antonio Subtil
- Department of Pathology, Royal Jubilee Hospital, University of British Columbia, Victoria, British Columbia, V8R1J8, Canada
| | - Alexandra C Hristov
- Department of Pathology, University of Michigan, Ann Arbor, MI, 48109, USA; Department of Dermatology, University of Michigan, Ann Arbor, MI, 48109, USA.
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5
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Donzel M, Trecourt A, Balme B, Harou O, Mauduit C, Bachy E, Guesquières H, Fontaine J, Ortonne N, Perier-Muzet M, Dalle S, Traverse-Glehen A. Deciphering the spectrum of cutaneous lymphomas expressing TFH markers. Sci Rep 2023; 13:6500. [PMID: 37081015 PMCID: PMC10119163 DOI: 10.1038/s41598-023-33031-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2022] [Accepted: 04/06/2023] [Indexed: 04/22/2023] Open
Abstract
T-follicular helper (TFH) markers are expressed in the microenvironnement of marginal zone B-cell lymphoma (MZL), and in lymphomas arising from TFH-cells, sometimes making the differential diagnosis difficult. In the skin, the "TFH-spectrum" is poorly defined, going from primary cutaneous lymphoproliferative disorder with small/medium CD4+ T-cells (SMLPD) to cutaneous localizations of systemic angioimmunoblastic T-cell lymphoma (cAITL), and may pass through intermediate forms (primary cutaneous T-follicular helper derived lymphoma, not otherwise specified (PCTFHL,NOS)). We retrospectively analyzed 20 MZL, 13 SMLPD, 5 PCTFHL, and 11 cAITL clinically, histologically, and molecularly, to define tools to differentiate them. Characteristics that might favor the diagnosis of MZL over SMLPD are: multiple skin nodules (p < 0.001), nodular architecture (p < 0.01), residual germinal centers with follicular dendritic cell network (p < 0.001), monotypic plasma cells (p < 0.001), and few staining with PD1 (p = 0.016) or CXCL13 (p = 0.03). PCTFHL and cAITL presented as multiple (p < 0.01) lesions, in older patients (p < 0.01), with systemic symptoms and/or biological alterations (p < 0.01). Immunophenotypic loss of T-cell markers (p < 0.001), BCL6 (p = 0.023) and/or CD10 staining (p = 0.08), and a higher proliferative index (≥ 30%, p = 0.039) favoured these diagnoses over SMLPD. Pathogenic variants were observed by genomic sequencing in 47% of MZL (TNFAIP3 (32%), EP300 (21%), NOTCH2 (16%), KMT2D (16%), CARD11 (10.5%)), 8% of SMLPD (TET2), 40% of PCTFHL (SOCS1 (20%), ARID1A (20%)) and 64% of cAITL (TET2 (63.6%), RHOA (36.4%), NOTCH1 (9%)). This study characterizes the various clinical and histological features between cutaneous lymphomas expressing TFH markers and highlights the value of the interest of screening for genomic mutations in difficult cases.
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Affiliation(s)
- Marie Donzel
- Institut de Pathologie multisites, Hospices Civils de Lyon, Hôpital Lyon Sud, 165 Chemin du Grand Revoyet, 69310, Lyon, Pierre-Bénite, France.
| | - Alexis Trecourt
- Institut de Pathologie multisites, Hospices Civils de Lyon, Hôpital Lyon Sud, 165 Chemin du Grand Revoyet, 69310, Lyon, Pierre-Bénite, France
| | - Brigitte Balme
- Institut de Pathologie multisites, Hospices Civils de Lyon, Hôpital Lyon Sud, 165 Chemin du Grand Revoyet, 69310, Lyon, Pierre-Bénite, France
| | - Olivier Harou
- Institut de Pathologie multisites, Hospices Civils de Lyon, Hôpital Lyon Sud, 165 Chemin du Grand Revoyet, 69310, Lyon, Pierre-Bénite, France
| | - Claire Mauduit
- Institut de Pathologie multisites, Hospices Civils de Lyon, Hôpital Lyon Sud, 165 Chemin du Grand Revoyet, 69310, Lyon, Pierre-Bénite, France
| | - Emmanuel Bachy
- Hospices Civils de Lyon, Cancer Research Center of Lyon, INSERM U1052, CNRS UMR 5286, CLB, UCBL, Université Lyon 1, Lyon, France
- Hospices Civils de Lyon, Service d'Hématologie, Hôpital Lyon Sud, Lyon, France
| | - Hervé Guesquières
- Hospices Civils de Lyon, Cancer Research Center of Lyon, INSERM U1052, CNRS UMR 5286, CLB, UCBL, Université Lyon 1, Lyon, France
- Hospices Civils de Lyon, Service d'Hématologie, Hôpital Lyon Sud, Lyon, France
| | - Juliette Fontaine
- Institut de Pathologie multisites, Hospices Civils de Lyon, Hôpital Lyon Sud, 165 Chemin du Grand Revoyet, 69310, Lyon, Pierre-Bénite, France
| | - Nicolas Ortonne
- Biological Immunology, APHP Henri Mondor Hospital, Paris Est Creteil University (UPEC) and INSERM U955 Team Ortonne (NFL), Créteil, France
- Department of Dermatology, APHP Henri Mondor Hospital, Créteil, France
| | - Marie Perier-Muzet
- Hospices Civils de Lyon, Service de Dermatologie, Hôpital Lyon Sud, Lyon, France
| | - Stéphane Dalle
- Hospices Civils de Lyon, Cancer Research Center of Lyon, INSERM U1052, CNRS UMR 5286, CLB, UCBL, Université Lyon 1, Lyon, France
- Hospices Civils de Lyon, Service de Dermatologie, Hôpital Lyon Sud, Lyon, France
| | - Alexandra Traverse-Glehen
- Institut de Pathologie multisites, Hospices Civils de Lyon, Hôpital Lyon Sud, 165 Chemin du Grand Revoyet, 69310, Lyon, Pierre-Bénite, France
- Hospices Civils de Lyon, Cancer Research Center of Lyon, INSERM U1052, CNRS UMR 5286, CLB, UCBL, Université Lyon 1, Lyon, France
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Obiorah IE, Karrs J, Brown L, Wang HW, Karai LJ, Hoc-Tran T, Anh T, Xi L, Pittaluga S, Raffeld M, Jaffe ES. Overlapping Features of Primary Cutaneous Marginal Zone Lymphoproliferative Disorder and Primary Cutaneous CD4 + Small/Medium T-Cell Lymphoproliferative Disorder : A Diagnostic Challenge Examined by Genomic Analysis. Am J Surg Pathol 2023; 47:344-353. [PMID: 36598455 PMCID: PMC9974535 DOI: 10.1097/pas.0000000000001984] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Primary cutaneous marginal zone lymphoproliferative disorder (PCMZL) and primary cutaneous CD4 + small/medium T-cell lymphoproliferative disorder (CD4 + TLPD) are indolent lymphoproliferative disorders. However, cases with overlapping features can be challenging. We identified 56 CD4 + TLPD and 38 PCMZL cases from our pathology archives. Clinical, morphologic, and immunophenotypic features were reviewed. Polymerase chain reaction for immunoglobulin (IG) and T-cell receptor gamma (TRG) gene rearrangements were analyzed. Next-generation sequencing studies were performed on 26 cases with adequate material, 19 with CD4 + TLPD, and 7 with PCMZL. CD4 + TLPD presented mostly (91%) as solitary lesions, located in the head and neck area (64%), while PCMZL occurred mostly in the upper extremity (47%) and trunk (34%). Lesions were sometimes multiple (40%) and recurrences (67%) were more common. Cases of PCMZL had an increase in reactive CD3 + T cells, with frequent programmed cell death protein 1 expression, whereas cases of CD4 + TLPD often contained abundant reactive B cells. Twenty-five cases were identified as having overlapping features: 6 cases of PCMZL were clonal for both IG and TRG; 11 cases of CD4 + TLPD were clonal for IG and TRG and 6 cases of CD4 + TLPD had light chain-restricted plasma cells. By next-generation sequencing, 23 variants were detected in 15 genes, with PCMZL more likely to show alterations, most commonly affecting TNFAIP3 and FAS, altered in 5 cases. Both entities have an indolent clinical course with response to conservative therapy and management, and warrant interpretation as a lymphoproliferative disorder rather than overt lymphoma.
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Affiliation(s)
- Ifeyinwa E Obiorah
- Laboratory of Pathology, Center for Cancer Research, National Cancer Institute (NCI), National Institutes of Health (NIH), Bethesda, MD, USA
| | - Jeremiah Karrs
- Laboratory of Pathology, Center for Cancer Research, National Cancer Institute (NCI), National Institutes of Health (NIH), Bethesda, MD, USA
| | - Laura Brown
- Department of Laboratory Medicine, University of California San Francisco Medical Center, San Francisco, CA
| | - Hao-Wei Wang
- Laboratory of Pathology, Center for Cancer Research, National Cancer Institute (NCI), National Institutes of Health (NIH), Bethesda, MD, USA
| | | | - Trinh Hoc-Tran
- Laboratory of Pathology, Center for Cancer Research, National Cancer Institute (NCI), National Institutes of Health (NIH), Bethesda, MD, USA
| | - Thu Anh
- Laboratory of Pathology, Center for Cancer Research, National Cancer Institute (NCI), National Institutes of Health (NIH), Bethesda, MD, USA
| | - Liqiang Xi
- Laboratory of Pathology, Center for Cancer Research, National Cancer Institute (NCI), National Institutes of Health (NIH), Bethesda, MD, USA
| | - Stefania Pittaluga
- Laboratory of Pathology, Center for Cancer Research, National Cancer Institute (NCI), National Institutes of Health (NIH), Bethesda, MD, USA
| | - Mark Raffeld
- Laboratory of Pathology, Center for Cancer Research, National Cancer Institute (NCI), National Institutes of Health (NIH), Bethesda, MD, USA
| | - Elaine S. Jaffe
- Laboratory of Pathology, Center for Cancer Research, National Cancer Institute (NCI), National Institutes of Health (NIH), Bethesda, MD, USA
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7
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Chiang CT, Chuang SS, Lin HF, Li WH, Chiang YY, Chen BJ. Primary Cutaneous Peripheral T-Cell Lymphoma With Follicular Helper T-Cell Phenotype: Report of 2 Epstein-Barr Virus-Positive Cases. Am J Dermatopathol 2023; 45:73-80. [PMID: 36669068 DOI: 10.1097/dad.0000000000002254] [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: 01/22/2023]
Abstract
ABSTRACT Primary cutaneous T-cell lymphoma is distinct from nodal T-cell lymphoma clinically and pathologically. Recently, primary cutaneous follicular helper T-cell lymphoma (PC-TFHL) has been described as a peripheral T-cell lymphoma with T-follicular helper (TFH) cell phenotype. PC-TFHL usually presents as multiple plaques and nodules of skin with an indolent clinical course, but without association with Epstein-Barr virus. In this article, we report 2 rare cases of PC-TFHL which are Epstein-Barr virus-positive and with an aggressive clinical course. We discuss the challenges in the differential diagnoses, particularly with primary cutaneous extranodal NK/T-cell lymphoma, and nodal T-cell lymphoma of TFH origin with secondary cutaneous involvement.
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Affiliation(s)
- Chien-Ta Chiang
- Pathologist, Department of Pathology, Far Eastern Memorial Hospital, New Taipei City, Taiwan
| | - Shih-Sung Chuang
- Pathologist, Department of Pathology, Chi-Mei Medical Center, Tainan, Taiwan
| | - Hsuen-Fu Lin
- Hematologist Oncologist, Department of Hematology and Medical Oncology, Mennonite Christian Hospital, Hualien, Taiwan
| | - Wei-Hsuan Li
- Dermatologist, Department of Dermatology, Mennonite Christian Hospital, Hualien, Taiwan
| | - Ying-Yi Chiang
- Dermatologist, Department of Dermatology, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan
- Department of Dermatology, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Bo-Jung Chen
- Pathologist, Department of Pathology, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan ; and
- Department of Pathology, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
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8
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Ward J, Prince HM, McCormack C, Lade S, Buelens O, van der Weyden C, Bhabha F, Campbell BA. Excellent treatment outcomes from low dose radiation therapy for primary cutaneous CD4+ small/medium T-Cell lymphoproliferative disorder. Radiother Oncol 2023; 178:109430. [PMID: 36455687 DOI: 10.1016/j.radonc.2022.11.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2022] [Revised: 11/13/2022] [Accepted: 11/21/2022] [Indexed: 11/29/2022]
Abstract
BACKGROUND AND PURPOSE Primary cutaneous CD4 + small/medium T-cell lymphoproliferative disorder (PCSMLPD) is a benign behaving condition, typically manifesting as solitary head or neck papules, frequently creating cosmetic concerns. Optimal management of this rare disease is unclear. Herein, patterns of care and treatment outcomes are described, with particular focus on low-dose RT. MATERIALS AND METHODS Eligibility required biopsy-proven PCSMLPD on central review, diagnosed between 2007-2022. Patterns of care, treatment responses and relapse patterns were assessed. Freedom-from-progression (FFP) was compared between RT and surgery. RESULTS 41 patients were eligible. First-line treatments were: RT, 19 (46.3 %); surgery, 17 (41.5 %) (3 received adjuvant RT); watchful waiting, 5 (12.2 %). Median follow-up was 37.7 months. Overall, 24 patients received RT (19 definitive first-line, 3 adjuvant, 2 second-line). 10 (42 %) received 4 Gy in 2 fractions (with no acute toxicities); 14 (58 %) received 20-40 Gy. Complete response rate was 100 %. No post-RT relapses observed. After first-line surgery alone (n = 14, 3 with positive margins), 4 (28.5 %) experienced relapse (2 local, 2 distant). Watchful-waiting (n = 5) led to partial resolution post-biopsy in 4 patients; no complete resolution seen. 3-year FFP for RT alone was 100 % vs 61 % for surgery alone (p = 0.12). CONCLUSION RT is a successful, non-invasive option for PCSMLPD: 100 % achieved complete response, with no relapses, and FFP appearing numerically superior to surgery in this cohort. In this first series of low-dose RT for PCSMLPD, 4 Gy in 2 fractions appears an excellent treatment option, offering durable disease control, no acute toxicities and convenient treatment time of only 2 days.
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Affiliation(s)
- Jennifer Ward
- Department of Radiation Oncology, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia.
| | - H Miles Prince
- Department of Hematology, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia; The Sir Peter MacCallum Department of Oncology, The University of Melbourne, Parkville, Victoria, Australia
| | - Chris McCormack
- Department of Surgical Oncology, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia; The Sir Peter MacCallum Department of Oncology, The University of Melbourne, Parkville, Victoria, Australia
| | - Stephen Lade
- Department of Pathology, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - Odette Buelens
- Department of Hematology, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - Carrie van der Weyden
- Department of Hematology, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - Friyana Bhabha
- Department of Surgical Oncology, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - Belinda A Campbell
- Department of Radiation Oncology, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia; The Sir Peter MacCallum Department of Oncology, The University of Melbourne, Parkville, Victoria, Australia; Department of Clinical Pathology, The University of Melbourne, Parkville, Victoria, Australia.
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9
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Goodlad JR, Cerroni L, Swerdlow SH. Recent advances in cutaneous lymphoma-implications for current and future classifications. Virchows Arch 2023; 482:281-298. [PMID: 36278991 PMCID: PMC9852132 DOI: 10.1007/s00428-022-03421-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2022] [Revised: 08/27/2022] [Accepted: 09/27/2022] [Indexed: 01/24/2023]
Abstract
The Revised European-American Classification of mature lymphoid neoplasms published in 1994 and the 2001, 2008 and 2016 WHO classifications that followed, were the product of international collaboration and consensus amongst haematopathologists, geneticists, molecular scientists and clinicians. Primary cutaneous lymphomas were fully incorporated into this process following the publication of the WHO-EORTC classification of cutaneous lymphomas in 2005. The definition, diagnostic criteria and recommended studies for primary cutaneous lymphoma continue to be refined. The 2022 International Consensus Classification represents the most recent update and an overview of all the main entities presenting primarily in the skin, together with the major changes in classification, are summarized herein. Primary cutaneous marginal zone lymphoma is segregated from other extranodal marginal zone lymphomas of mucosa-associated lymphoid tissue (MALT lymphoma) and downgraded to a lymphoproliferative disorder in line with its markedly indolent behaviour. In addition, two subtypes are recognised, based largely but not exclusively on whether they are heavy chain class-switched or IgM positive. Similarly, in keeping with a trend to greater conservatism, primary cutaneous acral CD8 positive T cell lymphoma is now also classified as a lymphoproliferative disorder. In addition, significant new insights into the biology of primary cutaneous lymphoma have also recently been forthcoming and will be presented. These studies have enhanced our knowledge of genetic, epigenetic and transcriptional changes in this group of diseases. They not only identify potential targets for novel therapies, but also raise as yet unanswered questions as to how we categorise cutaneous lymphomas, particularly with respect to relationships with similar lymphomas at extracutaneous sites.
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Affiliation(s)
- JR Goodlad
- Department of Pathology, NHS Greater Glasgow and Clyde, Level 3 Laboratory Medicine Building Queen Elizabeth University Hospital, 1345 Govan Rd, Glasgow, G51 4TF UK
| | - L Cerroni
- Department of Dermatology, Medical University of Graz, Graz, Austria
| | - SH Swerdlow
- Department of Pathology, University of Pittsburgh School of Medicine, Pittsburgh, PA USA
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10
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Plumptre IR, Said JT, Sun T, Larocca C, Virgen CA, Kupper TS, Fisher DC, Devlin PM, Elco CP, Song JS, LeBoeuf NR. Clinical features and treatment outcomes for primary cutaneous CD4+ small/medium T-cell lymphoproliferative disorder: a retrospective cohort study from the Dana-Farber Cancer Institute and updated literature review. Leuk Lymphoma 2022; 63:2832-2846. [PMID: 35862569 DOI: 10.1080/10428194.2022.2098287] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Primary cutaneous CD4+ small/medium T-cell lymphoproliferative disorder (PCSM-TCLPD) was reclassified in 2016 as a rare benign entity with an excellent prognosis, yet its clinical features and best treatments remain poorly defined. We collected clinical data, treatments, and treatment-responses from our institution's patients with PCSM-TCLPD through September 2018 and an identical PubMed review through June 2021. Among 36 cases (median-age 54 years; 58.3% head/neck), diagnostic biopsy resulted in sustained complete remission (CR) in 13/33 punch/shave biopsies and 3/3 excisional biopsies. The remaining 20 patients further required topical corticosteroids (n = 5); intralesional corticosteroids (n = 1); surgical-excision (n = 5); electron-beam-radiation (n = 6); or brachytherapy (n = 3). All patients ultimately achieved CR, excluding one patient continuing treatment at end-of-study. 57/59 (96.6%) of institutional and literature-reported radiation-treated patients experienced CR. No institutional cases progressed beyond skin; 5/209 (2.4%) literature-reported cases progressed to systemic/extracutaneous involvement, all pre-reclassification. PCSM-TCLPD responds well to local-directed therapy including radiation, and only rarely if ever progresses.
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Affiliation(s)
| | - Jordan T Said
- Department of Dermatology, Brigham and Women's Hospital, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA
| | - Tiffany Sun
- Department of Dermatology, Brigham and Women's Hospital, Boston, MA, USA.,Center for Cutaneous Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Cecilia Larocca
- Department of Dermatology, Brigham and Women's Hospital, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA.,Center for Cutaneous Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Cesar A Virgen
- Department of Dermatology, Brigham and Women's Hospital, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA.,Center for Cutaneous Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Thomas S Kupper
- Department of Dermatology, Brigham and Women's Hospital, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA.,Center for Cutaneous Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
| | - David C Fisher
- Harvard Medical School, Boston, MA, USA.,Center for Cutaneous Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Philip M Devlin
- Harvard Medical School, Boston, MA, USA.,Center for Cutaneous Oncology, Dana-Farber Cancer Institute, Boston, MA, USA.,Department of Radiation Oncology, Brigham and Women's Hospital, Boston, MA, USA
| | - Christopher P Elco
- Harvard Medical School, Boston, MA, USA.,Department of Pathology, Brigham and Women's Hospital, Boston, MA, USA
| | - Johanna Sheu Song
- Department of Dermatology, Brigham and Women's Hospital, Boston, MA, USA.,Center for Cutaneous Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Nicole R LeBoeuf
- Department of Dermatology, Brigham and Women's Hospital, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA.,Center for Cutaneous Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
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11
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Wang L, Rocas D, Dalle S, Sako N, Pelletier L, Martin N, Dupuy A, Tazi N, Balme B, Vergier B, Beylot-Barry M, Carlotti A, Bagot M, Battistella M, Chaby G, Ingen-Housz-Oro S, Gaulard P, Ortonne N. Primary cutaneous peripheral T-cell lymphomas with a T-follicular helper phenotype: an integrative clinical, pathological and molecular case series study. Br J Dermatol 2022; 187:970-980. [PMID: 35895386 PMCID: PMC10087773 DOI: 10.1111/bjd.21791] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Revised: 07/04/2022] [Accepted: 07/22/2022] [Indexed: 12/24/2022]
Abstract
BACKGROUND Primary cutaneous peripheral T-cell lymphomas with a T-follicular helper phenotype (pcTFH-PTCL) are poorly characterized, and often compared to, but not corresponding with, mycosis fungoides (MF), Sézary syndrome, primary cutaneous CD4+ lymphoproliferative disorder, and skin manifestations of angioimmunoblastic T-cell lymphomas (AITL). OBJECTIVES We describe the clinicopathological features of pcTFH-PTCL in this original series of 23 patients, and also characterize these cases molecularly. METHODS Clinical and histopathological data of the selected patients were reviewed. Patient biopsy samples were also analysed by targeted next-generation sequencing. RESULTS All patients (15 men, eight women; median age 66 years) presented with skin lesions, without systemic disease. Most were stage T3b, with nodular (n = 16), papular (n = 6) or plaque (atypical for MF, n = 1) lesions. Three (13%) developed systemic disease and died of lymphoma. Nine (39%) patients received more than one line of chemotherapy. Histologically, the lymphomas were CD4+ T-cell proliferations, usually dense and located in the deep dermis (n = 14, 61%), with the expression of at least two TFH markers (CD10, CXCL13, PD1, ICOS, BCL6), including three markers in 16 cases (70%). They were associated with a variable proportion of B cells. Eight patients were diagnosed with an associated B-cell lymphoproliferative disorder (LPD) on biopsy, including Epstein-Barr virus (EBV)-positive diffuse large B-cell lymphoma (n = 3), EBV+ LPD (n = 1) and monotypic plasma cell LPD (n = 4). Targeted sequencing showed four patients to have a mutated TET2-RHOAG17V association (as frequently seen in AITL) and another a TET2/DNMT3A/PLCG1/SETD2 mutational profile. The latter patient, one with a TET2-RHOA association, and one with no detected mutations, developed systemic disease and died. Five other patients showed isolated mutations in TET2 (n = 1), PLCG1 (n = 2), SETD2 (n = 1) or STAT5B (n = 1). CONCLUSIONS Patients with pcTFH-PTCL have pathological and genetic features that overlap with those of systemic lymphoma of TFH derivation. Clinically, most remained confined to the skin, with only three patients showing systemic spread and death. Whether pcTFH-PTCL should be integrated as a new subgroup of TFH lymphomas in future classifications is still a matter of debate. What is already known about this topic? There is a group of cutaneous lymphomas that express T-follicular helper (TFH) markers that do not appear to correspond to existing World Health Organization diagnostic entities. These include mycosis fungoides, Sézary syndrome, or primary cutaneous CD4+ small/medium-sized T-cell lymphoproliferative disorder or cutaneous extensions of systemic peripheral T-cell lymphomas (PTCL) with TFH phenotype. What does this study add? This is the first large original series of patients with a diagnosis of primary cutaneous PTCL with a TFH phenotype (pcTFH-PTCL) to be molecularly characterized. pcTFH-PTCL may be a standalone group of cutaneous lymphomas with clinicopathological and molecular characteristics that overlap with those of systemic TFH lymphomas, such as angioimmunoblastic T-cell lymphoma, and does not belong to known diagnostic groups of cutaneous lymphoma. This has an impact on the treatment and follow-up of patients; the clinical behaviour needs to be better clarified in further studies to tailor patient management.
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Affiliation(s)
- Luojun Wang
- Department of Pathology, Assistance Publique - Hôpitaux de Paris, Henri-Mondor Hospital, 94010, Créteil, France.,INSERM U955 Institut Mondor de Recherche Biomédicale (IMRB), Paris Est Créteil University, 94010, Créteil, France
| | - Delphine Rocas
- Department of Pathology, Lyon Sud, Pierre-Bénite Hospital, 69495, Lyon, France
| | - Stéphane Dalle
- Department of Dermatology, Lyon Sud, Pierre-Bénite Hospital, 69495, Lyon, France
| | - Nouhoum Sako
- INSERM U955 Institut Mondor de Recherche Biomédicale (IMRB), Paris Est Créteil University, 94010, Créteil, France
| | - Laura Pelletier
- INSERM U955 Institut Mondor de Recherche Biomédicale (IMRB), Paris Est Créteil University, 94010, Créteil, France
| | - Nadine Martin
- INSERM U955 Institut Mondor de Recherche Biomédicale (IMRB), Paris Est Créteil University, 94010, Créteil, France
| | - Aurélie Dupuy
- INSERM U955 Institut Mondor de Recherche Biomédicale (IMRB), Paris Est Créteil University, 94010, Créteil, France
| | - Nadia Tazi
- Department of Pathology, Assistance Publique - Hôpitaux de Paris, Henri-Mondor Hospital, 94010, Créteil, France
| | - Brigitte Balme
- Department of Pathology, Lyon Sud, Pierre-Bénite Hospital, 69495, Lyon, France
| | - Béatrice Vergier
- Department of Pathology, CHU de Bordeaux, Haut-Lévêque Hospital, 33600, Pessac, France.,INSERM, U1312, Université de Bordeaux, 33000, Bordeaux, France
| | - Marie Beylot-Barry
- INSERM, U1312, Université de Bordeaux, 33000, Bordeaux, France.,Department of Dermatology, CHU de Bordeaux, Saint-André Hospital, 33000, Bordeaux, France
| | - Agnès Carlotti
- Department of Pathology, Assistance Publique - Hôpitaux de Paris, Cochin Hospital, 75014, Paris, France
| | - Martine Bagot
- Department of Dermatology, Assistance Publique - Hôpitaux de Paris, Saint-Louis Hospital, 75010, Université Paris Cité, Paris, France
| | - Maxime Battistella
- Department of Pathology, Assistance Publique - Hôpitaux de Paris, Saint-Louis Hospital, 75010, Université Paris Cité, Paris, France
| | - Guillaume Chaby
- Department of Dermatology, CHU d'Amiens-Picardie, Hôpital Sud, 80054, Amiens, France
| | - Saskia Ingen-Housz-Oro
- Department of Dermatology, Assistance Publique - Hôpitaux de Paris, Henri-Mondor Hospital, 94010, Créteil, France
| | - Philippe Gaulard
- Department of Pathology, Assistance Publique - Hôpitaux de Paris, Henri-Mondor Hospital, 94010, Créteil, France.,INSERM U955 Institut Mondor de Recherche Biomédicale (IMRB), Paris Est Créteil University, 94010, Créteil, France
| | - Nicolas Ortonne
- Department of Pathology, Assistance Publique - Hôpitaux de Paris, Henri-Mondor Hospital, 94010, Créteil, France.,INSERM U955 Institut Mondor de Recherche Biomédicale (IMRB), Paris Est Créteil University, 94010, Créteil, France
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12
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Mark E, Sutton M, Gru A. Primary Cutaneous Anaplastic Large-Cell Lymphoma With Aberrant CD20 Expression: Case Report and Review of the Literature. Am J Dermatopathol 2022; 44:971-978. [PMID: 36066130 DOI: 10.1097/dad.0000000000002281] [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: 11/25/2022]
Abstract
ABSTRACT Cutaneous CD20 + T-cell lymphomas are exceedingly rare. Differentiating cases of T-cell lymphoma with aberrant expression of the B-cell marker CD20 from B-cell lymphoma may be associated with misdiagnosis or delays in diagnosis. We report, to the authors' knowledge, the first case of CD20 + primary cutaneous anaplastic large-cell lymphoma and review the literature to characterize published cases of CD20 + cutaneous T-cell lymphoma (n = 40). There is no accepted explanation for this phenomenon; however, it is suspected that these cases may be due to neoplastic transformation of CD20 + T cells or that CD20 may represent a T-cell activation marker. Expression of CD20 may have clinical significance in prognostication and consideration of treatment options with anti-CD20 therapies such as rituximab.
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Affiliation(s)
- Erica Mark
- Department of Dermatopathology, University of Virginia, Charlottesville, VA; and
| | - Mark Sutton
- Advanced Dermatology and Skin Cancer Specialists Temecula, Temecula, CA
| | - Alejandro Gru
- Department of Dermatopathology, University of Virginia, Charlottesville, VA; and
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13
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Ates Ozdemir D, Akdoğan N, Okay M, Uner A, Saglam A. Clonal B‐Cell Proliferations Developing in The Background of Primary Cutaneous
CD4
+ Small/Medium
T‐Cell
Lymphoproliferative Disorder: A Case Series. J Cutan Pathol 2022; 49:971-977. [DOI: 10.1111/cup.14296] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Revised: 07/16/2022] [Accepted: 07/21/2022] [Indexed: 11/29/2022]
Affiliation(s)
| | | | - Müfide Okay
- Department of Hematology Ministry of Health, Eskişehir City Hospital
| | | | - Arzu Saglam
- Department of Pathology Hacettepe University
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14
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Kim J, Jeong M, Jun D, Lee M, Shin D, Kim W, Choi H. Primary cutaneous CD4+ small/medium T-cell lymphoma: a case report. Arch Craniofac Surg 2021; 22:199-203. [PMID: 34474543 PMCID: PMC8413923 DOI: 10.7181/acfs.2021.00199] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Accepted: 08/11/2021] [Indexed: 12/30/2022] Open
Abstract
Primary cutaneous CD4+ small/medium T-cell lymphoproliferative disorder is a rare disease characterized by a single mass on the face or upper part of the trunk. It usually presents an asymptomatic and favorable progression, and its histopathologic findings include small and medium-sized lymphoid cells. The authors report a case of primary cutaneous CD4+ small/medium T-cell lymphoproliferative disorder on the forehead. A 51-year-old man presented with a protruding mass on his forehead that the patient had noted 1 month previously. Surgical excision and a permanent biopsy were performed under local anesthesia. Based on the biopsy results, the mass was diagnosed as a primary cutaneous CD4+ small/medium T-cell lymphoproliferative disorder. There was no evidence of recurrence at a 15-month follow-up visit.
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Affiliation(s)
- Jeenam Kim
- Department of Plastic and Reconstructive Surgery, Konkuk University Medical Center, Seoul, Korea
| | - Minkyoung Jeong
- Department of Plastic and Reconstructive Surgery, Konkuk University Medical Center, Seoul, Korea
| | - Dongkeun Jun
- Department of Plastic and Reconstructive Surgery, Konkuk University Medical Center, Seoul, Korea
| | - Myungchul Lee
- Department of Plastic and Reconstructive Surgery, Konkuk University Medical Center, Seoul, Korea
| | - Donghyeok Shin
- Department of Plastic and Reconstructive Surgery, Konkuk University Medical Center, Seoul, Korea
| | - Wookyoun Kim
- Department of Pathology, Konkuk University Medical Center, Seoul, Korea
| | - Hyungon Choi
- Department of Plastic and Reconstructive Surgery, Konkuk University Medical Center, Seoul, Korea
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15
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Stoll JR, Willner J, Oh Y, Pulitzer M, Moskowitz A, Horwitz S, Myskowski P, Noor SJ. Primary cutaneous T-cell lymphomas other than Mycosis Fungoides and Sezary Syndrome - Part I: Clinical and histologic features and diagnosis. J Am Acad Dermatol 2021; 85:1073-1090. [PMID: 33940098 DOI: 10.1016/j.jaad.2021.04.080] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Revised: 04/12/2021] [Accepted: 04/26/2021] [Indexed: 11/11/2022]
Abstract
Primary cutaneous T-cell lymphomas (CTCLs) are defined as lymphomas with a T-cell phenotype that present in the skin without evidence of systemic or extracutaneous disease at initial presentation. CTCLs other than Mycosis Fungoides (MF) and Sézary syndrome (SS) account for approximately one-third of CTCLs and encompass a heterogenous group of non-Hodgkin lymphomas ranging from indolent lymphoproliferative disorders to aggressive malignancies with a poor prognosis. The spectrum of CTCLs continues to broaden as new provisional entities are classified. Given the morphologic and histologic overlap among CTCLs and other diagnoses, a thorough clinical history, physical evaluation, and clinicopathologic correlation are essential in the workup and diagnosis of these rare entities. This article will summarize the epidemiologic, clinical, pathologic, and diagnostic features of CTCLs other than MF and SS.
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Affiliation(s)
| | | | - Yuna Oh
- Memorial Sloan Kettering Cancer Center, New York, NY
| | | | | | | | | | - Sarah J Noor
- Memorial Sloan Kettering Cancer Center, New York, NY.
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16
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New developments in non-Hodgkin lymphoid malignancies. Pathology 2021; 53:349-366. [PMID: 33685720 DOI: 10.1016/j.pathol.2021.01.002] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2020] [Revised: 01/08/2021] [Accepted: 01/11/2021] [Indexed: 12/23/2022]
Abstract
The revised fourth edition of the World Health Organization (WHO) Classification of Tumours of Haematopoietic and Lymphoid Tissues (2017) reflects significant advances in understanding the biology, genetic basis and behaviour of haematopoietic neoplasms. This review focuses on some of the major changes in B-cell and T-cell non-Hodgkin lymphomas in the 2017 WHO and includes more recent updates. The 2017 WHO saw a shift towards conservatism in the classification of precursor lesions of small B-cell lymphomas such as monoclonal B-cell lymphocytosis, in situ follicular and in situ mantle cell neoplasms. With more widespread use of next generation sequencing (NGS), special entities within follicular lymphoma and mantle cell lymphoma were recognised with recurrent genetic aberrations and unique clinicopathological features. The diagnostic workup of lymphoplasmacytic lymphoma and hairy cell leukaemia has been refined with the discovery of MYD88 L265P and BRAF V600E mutations, respectively, in these entities. Recommendations in the immunohistochemical evaluation of diffuse large B-cell lymphoma include determining cell of origin and expression of MYC and BCL2, so called 'double-expressor' phenotype. EBV-positive large B-cell lymphoma of the elderly has been renamed to recognise its occurrence amongst a wider age group. EBV-positive mucocutaneous ulcer is a newly recognised entity with indolent clinical behaviour that occurs in the setting of immunosuppression. Two lymphomas with recurrent genetic aberrations are newly included provisional entities: Burkitt-like lymphoma with 11q aberration and large B-cell lymphoma with IRF4 rearrangement. Aggressive B-cell lymphomas with MYC, BCL2 and/or BCL6 rearrangements, so called 'double-hit/triple-hit' lymphomas are now a distinct entity. Much progress has been made in understanding intestinal T-cell lymphomas. Enteropathy-associated T-cell lymphoma, type II, is now known to not be associated with coeliac disease and is hence renamed monomorphic epitheliotropic T-cell lymphoma. An indolent clonal T-cell lymphoproliferative disorder of the GI tract is a newly included provisional entity. Angioimmunoblastic T-cell lymphoma and nodal T-cell lymphomas with T-follicular helper phenotype are included in a single broad category, emphasising their shared genetic and phenotypic features. Anaplastic large cell lymphoma, ALK- is upgraded to a definitive entity with subsets carrying recurrent rearrangements in DUSP22 or TP63. Breast implant-associated anaplastic large cell lymphoma is a new provisional entity with indolent behaviour. Finally, cutaneous T-cell proliferations include a new provisional entity, primary cutaneous acral CD8-positive T-cell lymphoma, and reclassification of primary small/medium CD4-positive T-cell lymphoma as lymphoproliferative disorder.
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17
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Takei I, Kawai K, Nakajima M, Ansai O, Anan T. Primary cutaneous CD4 + small/medium T-cell lymphoproliferative disorder with high Ki-67 proliferation index. J Dermatol 2021; 48:e212-e214. [PMID: 33624292 DOI: 10.1111/1346-8138.15821] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2021] [Accepted: 02/02/2021] [Indexed: 11/27/2022]
Affiliation(s)
- Izumi Takei
- Department of Dermatology, Kido Hospital, Niigata, Japan.,Division of Dermatology, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
| | - Kazuhiro Kawai
- Department of Dermatology, Kido Hospital, Niigata, Japan
| | - Mami Nakajima
- Division of Dermatology, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
| | - Osamu Ansai
- Division of Dermatology, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
| | - Takashi Anan
- Sapporo Dermatopathology Institute, Sapporo, Japan
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18
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Cutaneous Lymphomas — Part II: Other Cutaneous Lymphomas. ACTAS DERMO-SIFILIOGRAFICAS 2021. [DOI: 10.1016/j.adengl.2020.12.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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19
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Surmanowicz P, Doherty S, Sivanand A, Parvinnejad N, Deschenes J, Schneider M, Hardin J, Gniadecki R. The Clinical Spectrum of Primary Cutaneous CD4+ Small/Medium-Sized Pleomorphic T-Cell Lymphoproliferative Disorder: An Updated Systematic Literature Review and Case Series. Dermatology 2020; 237:618-628. [PMID: 33326960 DOI: 10.1159/000511473] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Accepted: 09/08/2020] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Primary cutaneous CD4+ small/medium pleomorphic T-cell lymphoproliferative disorder (SMPLPD) is a provisional entity within the 2016 World Health Organization classification of primary cutaneous lymphomas. The condition is currently classified as a lymphoproliferative disorder to emphasize its benign course and discourage aggressive, systemic treatment modalities. OBJECTIVE To provide a relevant synthesis for the dermatological practitioner on the prevalence, presentation, and treatment of SMPLPD. METHODS We conducted an updated systematic literature review and a retrospective chart review of diagnosed cases of SMPLPD from 2 Canadian academic cutaneous lymphoma centers. RESULTS A total of 23 studies with 136 cases were extracted from the systematic review and 24 patients from our retrospective chart review. SMPLPD proved relatively common accounting for 12.5% of all cutaneous T-cell lymphomas encountered in our cutaneous lymphoma clinics, second in frequency only to mycosis fungoides. The typical clinical presentation was that of an older individual (median age 59 years) with an asymptomatic solitary lesion on their upper extremity. The most common clinical differentials were cutaneous lymphoid hyperplasia, basal cell carcinoma, and lymphoma unspecified. T follicular helper markers were reliably detected. The main treatment modalities were surgical excision, local radiation therapy, and topical or intralesional steroids. Cure was achieved in the vast majority of cases. CONCLUSIONS SMPLPD is an underdiagnosed T-cell lymphoma with an overtly benign clinical course. The condition has an excellent prognosis and responds well to skin-directed therapies. Practitioners should be aware of this condition to avoid aggressive systemic treatments.
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Affiliation(s)
- Philip Surmanowicz
- Division of Dermatology, University of Alberta, Edmonton, Alberta, Canada
| | - Sean Doherty
- Division of Dermatology, University of Calgary, Calgary, Alberta, Canada
| | - Arunima Sivanand
- Division of Dermatology, University of Alberta, Edmonton, Alberta, Canada
| | - Nikoo Parvinnejad
- Department of Pathology and Laboratory Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Jean Deschenes
- Department of Pathology, Cross Cancer Institute, University of Alberta, Edmonton, Alberta, Canada
| | - Michelle Schneider
- Department of Pathology and Laboratory Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Jori Hardin
- Division of Dermatology, University of Calgary, Calgary, Alberta, Canada
| | - Robert Gniadecki
- Division of Dermatology, University of Alberta, Edmonton, Alberta, Canada,
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20
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Primary Cutaneous CD4+ Small/Medium T-Cell Lymphoproliferative Disorders: A Clinical, Pathologic, and Molecular Study of 60 Cases Presenting With a Single Lesion: A Multicenter Study of the French Cutaneous Lymphoma Study Group. Am J Surg Pathol 2020; 44:862-872. [PMID: 32271188 DOI: 10.1097/pas.0000000000001470] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Primary cutaneous CD4 small/medium T-cell lymphoproliferative disorder (PCSMLPD) is a recently recognized entity in the 2017 World Health Organization (WHO) classification. It belongs to the T-follicular helper (TFH) lymphoproliferations. The clinical, pathologic, and molecular features of this localized disease are underresearched. We conducted a retrospective multicentric study of 60 patients with a PCSMLPD that presented as a single cutaneous lesion. Clinical, pathologic, and targeted molecular analyses were performed. PCSMLPD presented mostly as a nodule (45%), located on the head and neck area (50%) in adults (mean age: 59 y [43.3 to 75.2]). All patients had an indolent disease course, either at initial staging or during follow-up (mean: 16.6 mo [1.3 to 31.9]). Spontaneous regression was reported in 31.9% of cases. The infiltrates were most often nodular and/or diffuse, expanding in the whole dermis (78%, Pattern 1), rather than subepidermal band-like in the superficial dermis (22%, Pattern 2). Epidermotropism, folliculotropism, and capillary hyperplasia were common. The expression of TFH lineage markers was more extensive in lesions with Pattern 2, but a substantial B-cell infiltrate was seen in both types of lesions. A clonal rearrangement of the TCR genes was identified in 68% of cases. One sample of the 13 tested revealed a mutation in the DNMT3A gene among the 9 genes studied (TET2, DNMT3A, IDH2, RHOA, SETD2, PLCG1, STAT3, STAT5B, and CD28). PCSMLPD follows a benign clinical course and can spontaneously regress after biopsy. Although PCSMLPD expresses TFH lineage markers, mutations usually found in angioimmunoblastic T-cell lymphomas are uncommon.
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21
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Cutaneous Lymphomas -Part II: Other Cutaneous Lymphomas. ACTAS DERMO-SIFILIOGRAFICAS 2020; 112:24-31. [PMID: 33045210 DOI: 10.1016/j.ad.2020.09.005] [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: 05/19/2020] [Revised: 09/22/2020] [Accepted: 09/26/2020] [Indexed: 11/20/2022] Open
Abstract
Primary cutaneous T-cell lymphomas other than mycosis fungoides, Sézary syndrome, and lymphoproliferative CD30+ disorders are few, accounting for less than 5% of all cutaneous lymphomas. A cytotoxic phenotype is characteristic of these tumors, and their clinical behavior is usually aggressive. Patients often present with extracutaneous symptoms or develop them shortly after diagnosis. Management is usually multidisciplinary, and intensive systemic therapy and bone marrow transplantation should be considered. Cutaneous B-cell lymphomas account for approximately 30% of primary cutaneous lymphomas. They make up a heterogeneous group of tumors that have different clinical and pathological features. Clinical course also varies. Presenting as papules, nodules, or tumors of variable reddish-violaceous coloring, the lesions may be solitary or multiple and occasionally form clusters. There may also be generalized lesions, present at multiple sites on the trunk, head, or extremities. Three well-defined groups of primary cutaneous lymphoma have been reported: follicle center lymphoma; marginal zone lymphoma, which follows an indolent course; and a diffuse large B-cell lymphoma, leg type, which follows an aggressive course.
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22
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Stähr K, Lang S, Mattheis S. [Primary cutaneous CD4+ small to medium-sized T-cell lymphoma in an adolescent patient]. HNO 2020; 68:695-697. [PMID: 32728760 DOI: 10.1007/s00106-020-00912-2] [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] [Indexed: 11/29/2022]
Abstract
A rare finding of primary cutaneous CD4+ small to medium-sized T‑cell lymphoma (SMPTCL) in a fifteen-year-old patient is reported. This is a rare tumor entity for which there is currently no standardized treatment recommendation. At the interdisciplinary tumor board, the decision was made to resect the tumor and reconstruct the defect with a nasolabial advancement flap in a two-stage process. Follow-up examinations, currently over 3 years, have shown the patient to be free of recurrences.
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Affiliation(s)
- K Stähr
- Klinik für Hals-Nasen-Ohrenheilkunde, Kopf- und Halschirurgie, Universitätsklinikum Essen, Hufelandstr. 55, 45147, Essen, Deutschland.
| | - S Lang
- Klinik für Hals-Nasen-Ohrenheilkunde, Kopf- und Halschirurgie, Universitätsklinikum Essen, Hufelandstr. 55, 45147, Essen, Deutschland
| | - S Mattheis
- Klinik für Hals-Nasen-Ohrenheilkunde, Kopf- und Halschirurgie, Universitätsklinikum Essen, Hufelandstr. 55, 45147, Essen, Deutschland
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23
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Dimassi AB, Howlett C, Phua CW. Multifocal CD4+ Primary Cutaneous Small/Medium Lymphoproliferative Disorder Successfully Treated With Low-Dose Oral Methotrexate: A Case Report. Cureus 2020; 12:e8534. [PMID: 32665881 PMCID: PMC7352792 DOI: 10.7759/cureus.8534] [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] [Indexed: 12/02/2022] Open
Abstract
Primary cutaneous CD4+ small/medium T-cell lymphoproliferative disorder (PCSM-LPD) is a rare indolent disorder often associated with a favourable prognosis. It typically presents as a solitary skin lesion, mainly in the head, neck, or upper trunk region. Multifocal PCSM-LPD is a rare entity, with no standard treatment approaches available. In this article, we present the case of a 56-year-old male patient with multifocal biopsy-proven PCSM-LPD that was treated with methotrexate orally at 10 mg/m2 body surface area weekly and successfully achieved full clinical resolution by the 10th week of therapy. A review of the literature indicates the efficacy of combination chemotherapy. However, due to the indolent nature of this disorder and the undesired side effects from combination chemotherapy, our treatment method involved oral methotrexate alone, and it was successful. Oral methotrexate is a potential therapeutic option in the management of multifocal PCSM-LPD and it warrants further investigations.
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Affiliation(s)
- Ahmad B Dimassi
- Internal Medicine, Gilbert and Rose-Marie Chagoury School of Medicine, Lebanese American University Medical Center, Beirut, LBN
| | - Christopher Howlett
- Pathology and Laboratory Medicine, Schulich School of Medicine and Dentistry, Western University, London, CAN
| | - Chai W Phua
- Hematology, Schulich School of Medicine and Dentistry, Western University, London, CAN
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24
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Ponce S, Peñate Y, Montenegro T. Coincident Primary Cutaneous CD4+ Small/Medium-Sized Pleomorphic T-Cell Lymphoproliferative Disorder in Two Sisters. ACTAS DERMO-SIFILIOGRAFICAS 2020. [DOI: 10.1016/j.adengl.2018.09.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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25
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Ponce S, Peñate Y, Montenegro T. Coincident Primary Cutaneous CD4+ Small/Medium-Sized Pleomorphic T-Cell Lymphoproliferative Disorder in Two Sisters. ACTAS DERMO-SIFILIOGRAFICAS 2020; 111:271-273. [PMID: 31980130 DOI: 10.1016/j.ad.2018.09.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2018] [Revised: 09/10/2018] [Accepted: 09/18/2018] [Indexed: 10/25/2022] Open
Affiliation(s)
- S Ponce
- Servicio de Dermatología, Complejo Hospitalario Universitario Insular - Materno Infantil, Las Palmas de Gran Canaria, España.
| | - Y Peñate
- Servicio de Dermatología, Complejo Hospitalario Universitario Insular - Materno Infantil, Las Palmas de Gran Canaria, España
| | - T Montenegro
- Servicio de Anatomía Patológica, Complejo Hospitalario Universitario Insular - Materno Infantil, Las Palmas de Gran Canaria, España
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Piris MA, Rodriguez-Pinilla SM, Santonja C, Betancor I, Alonso-Alonso R, Gru AA, Rodriguez M. Update on peripheral T-cell lymphomas with T-helper phenotype: Are there too many subtypes? Semin Diagn Pathol 2019; 37:24-31. [PMID: 31870687 DOI: 10.1053/j.semdp.2019.12.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Follicular helper T (TFH) cells are the providers of T-cell help to B-cells in the development of germinal centers and for the generation of most class-switched antibodies. The markers most commonly associated with TFH activity are IL21, IL4, CD40L, BCL6, SAP, CXCR5/CXCL13, and ICOS. T-cell lymphoma genomic studies have shown that different T-cell lymphoma types express signatures typical for TFH cells, this including angioimmunoblastic T-cell lymphoma (AITL), a related condition termed peripheral T-cell lymphoma with TFH phenotype and primary cutaneous CD4+ small/medium T-cell lymphoproliferative disorder. Angioimmunoblastic T-cell lymphoma is a well-established entity, a clinically aggressive disease with a survival of 30% OS after 5 years. Molecular and clinical studies have confirmed this as a well-established clinicopathological entity with relatively specific gene mutations, including mutations found in hematopoietic precursor cells and others. Peripheral T-cell lymphoma with TFH phenotype is an associated disorder with histology of PTCL but a TFH phenotype, as defined by the expression of 2-3 immunohistochemical markers. Molecular studies on this entity are showing a partial overlap with AITL. Primary cutaneous CD4+ small/medium lymphoproliferative disorder is an entirely different process that takes place in the skin, showing frank cytologic atypia, monoclonal TCR rearrangement and TFH phenotype in the context of a clinically benign lesion. Here we review the main clinical, molecular and diagnostic features of these three lymphoproliferative processes.
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Affiliation(s)
- Miguel A Piris
- Servicio de Anatomía Patológica, Fundación Jiménez Díaz, CIBERONC, Madrid, Spain.
| | | | - Carlos Santonja
- Servicio de Anatomía Patológica, Fundación Jiménez Díaz, CIBERONC, Madrid, Spain
| | - Isabel Betancor
- Servicio de Anatomía Patológica, Fundación Jiménez Díaz, CIBERONC, Madrid, Spain
| | - Ruth Alonso-Alonso
- Servicio de Anatomía Patológica, Fundación Jiménez Díaz, CIBERONC, Madrid, Spain
| | - Alejandro A Gru
- Department of Pathology, University of Virginia, Charlottesville, VA, United States
| | - Marta Rodriguez
- Servicio de Anatomía Patológica, Fundación Jiménez Díaz, CIBERONC, Madrid, Spain
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27
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Escanilla C, Guavita Falla PM, Cevallos C, Ávalos Jobet N, Bobadilla Bruneau F. Primary cutaneous CD4-positive small/medium T-cell lymphoproliferative disorder: The first-reported Latin-American case with response to doxycycline. Clin Case Rep 2019; 7:2405-2409. [PMID: 31893069 PMCID: PMC6935602 DOI: 10.1002/ccr3.2454] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2019] [Revised: 08/12/2019] [Accepted: 08/22/2019] [Indexed: 12/18/2022] Open
Abstract
Primary cutaneous CD4+ small/medium T-cell lymphoproliferative disorder is a provisional entity according to the last WHO-EORTC classification. The treatment of choice has not yet been defined. Local therapies have been used with variable response. Doxycycline as a main treatment option is a potential low-cost and effective alternative for this disorder.
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Affiliation(s)
| | | | - Carolina Cevallos
- Departamento de DermatologíaUniversidad de Santiago de ChileSantiagoChile
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28
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Oishi N, Sartori-Valinotti JC, Bennani NN, Wada DA, He R, Cappel MA, Feldman AL. Cutaneous lesions of angioimmunoblastic T-cell lymphoma: Clinical, pathological, and immunophenotypic features. J Cutan Pathol 2019; 46:637-644. [PMID: 30980412 DOI: 10.1111/cup.13475] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2018] [Revised: 03/22/2019] [Accepted: 04/09/2019] [Indexed: 12/24/2022]
Abstract
BACKGROUND Angioimmunoblastic T-cell lymphoma (AITL) is a systemic peripheral T-cell lymphoma with a follicular helper T-cell (TFH ) immunophenotype that frequently involves the skin. However, the histopathology of cutaneous involvement by AITL has not been fully established. METHODS We reviewed the clinicopathological features of 19 patients seen at our institution with AITL involving the skin. Pan-T-cell and TFH marker expression was evaluated by immunohistochemistry. Epstein-Barr virus (EBV) was detected using in situ hybridization (ISH) for Epstein-Barr virus-encoded small RNA (EBER). T-cell receptor (TCR) gene rearrangement was evaluated by PCR. RESULTS AITL affected both trunk and extremities in 15/19 cases (79%). Perivascular infiltration by small and/or medium-sized lymphocytes was seen in 18/19 (95%). Granulomatous inflammation was identified in 4/19 (21%). Aberrant loss of CD2, CD5, or CD7 was identified in 1/18 (6%), 2/18 (11%), or 7/19 (37%) cases, respectively. Seventeen of eighteen evaluable cases (95%) expressed 2 to 3 TFH markers: PD-1 in 19/19 (100%), BCL6 in 94% (17/18), and CD10 in 37% (7/19). EBV-positive cells were detected in 3/18 (17%) with varying density. Clonal TCR gene rearrangement was identified in 9/11 (82%). CONCLUSIONS Cutaneous involvement by AITL shows relatively non-specific histopathological features. However, an immunohistochemical panel including TFH markers and EBER ISH is useful in differential diagnosis.
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Affiliation(s)
- Naoki Oishi
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota.,Department of Pathology, University of Yamanashi, Yamanashi, Japan
| | | | - N Nora Bennani
- Division of Hematology, Mayo Clinic, Rochester, Minnesota
| | - David A Wada
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota.,Department of Dermatology, Mayo Clinic, Rochester, Minnesota
| | - Rong He
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota
| | - Mark A Cappel
- Department of Dermatology, Mayo Clinic, Jacksonville, Florida
| | - Andrew L Feldman
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota
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29
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Cutaneous Lymphoproliferative Disorders: What's New in the Revised 4th Edition of the World Health Organization (WHO) Classification of Lymphoid Neoplasms. Adv Anat Pathol 2019; 26:93-113. [PMID: 30199396 DOI: 10.1097/pap.0000000000000208] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Cutaneous lymphoproliferative disorders remain a challenging aspect of dermatopathology, in part due to the rarity of the entities and extreme variability in clinical outcomes. Although many of the entities remain unchanged, the approach to some of them has changed in the new 2016 classification scheme of the World Health Organization. Chief among these are Epstein-Barr virus-associated lymphoproliferative disorders such as Epstein-Barr virus-associated mucocutaneous ulcer and hydroa vacciniforme-like lymphoproliferative disorder, primary cutaneous CD8+ aggressive epidermotropic cytotoxic T-cell lymphoma, primary cutaneous acral CD8+ T-cell lymphoma, primary cutaneous CD4+ small/medium T-cell lymphoproliferative disorder, and breast implant-associated anaplastic large cell lymphoma. In addition, translocations and gene rearrangements such as those involving the 6p25.3 locus have started to inform diagnosis and classification of anaplastic large cell lymphoma and lymphomatoid papulosis. In this review, we will examine what is new in the diagnostic toolbox of cutaneous lymphoproliferative disorders.
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30
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31
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Salah E. Primär kutane CD4+ klein- bis mittelgroßzellige pleomorphe T-Zell-Lymphoproliferation: Wo stehen wir? Eine systematische Übersicht. J Dtsch Dermatol Ges 2019; 17:123-137. [DOI: 10.1111/ddg.13691_g] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2017] [Accepted: 04/10/2018] [Indexed: 11/29/2022]
Affiliation(s)
- Eman Salah
- Department of Dermatology; Venereology & Andrology; Faculty of Medicine; Zagazig University; Zagazig Egypt
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32
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The 2018 update of the WHO-EORTC classification for primary cutaneous lymphomas. Blood 2019; 133:1703-1714. [PMID: 30635287 DOI: 10.1182/blood-2018-11-881268] [Citation(s) in RCA: 713] [Impact Index Per Article: 142.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2018] [Accepted: 01/07/2019] [Indexed: 12/13/2022] Open
Abstract
Primary cutaneous lymphomas are a heterogeneous group of T- and B-cell lymphomas that present in the skin with no evidence of extracutaneous disease at the time of diagnosis. The 2005 World Health Organization-European Organization for Research and Treatment of Cancer (WHO-EORTC) consensus classification has served as a golden standard for the diagnosis and classification of these conditions. In September 2018, an updated version of the WHO-EORTC was published in the fourth edition of the WHO Classification of Skin Tumours Blue Book. In this classification, primary cutaneous acral CD8+ T-cell lymphoma and Epstein-Barr virus positive (EBV+) mucocutaneous ulcer are included as new provisional entities, and a new section on cutaneous forms of chronic active EBV disease has been added. The term "primary cutaneous CD4+ small/medium T-cell lymphoma" was modified to "primary cutaneous CD4+ small/medium T-cell lymphoproliferative disorder" because of its indolent clinical behavior and uncertain malignant potential. Modifications have also been made in the sections on lymphomatoid papulosis, increasing the spectrum of histologic and genetic types, and primary cutaneous marginal zone lymphomas recognizing 2 different subtypes. Herein, the characteristic features of these new and modified entities as well as the results of recent molecular studies with diagnostic, prognostic, and/or therapeutic significance for the different types of primary cutaneous lymphomas are reviewed. An update of the frequency and survival of the different types of primary cutaneous lymphomas is provided.
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Abstract
There are a number of rare T-cell lymphoma subtypes that may be encountered in clinical practice. In recent years, improved immunohistochemical techniques and molecular tumor profiling have permitted refinement of some of the diagnostic categories in this group, as well as the recognition of distinct conditions not previously well elucidated. In this chapter, we cover the diagnostic and clinical features of some of the more common of these conditions, including subcutaneous panniculitis-like T-cell lymphoma, cutaneous gamma-delta T-cell lymphoma, enteropathy-associated T-cell lymphoma, monomorphic epitheliotropic intestinal T-cell lymphoma, primary cutaneous CD8-positive aggressive epidermotropic cytotoxic T-cell lymphoma, CD4-positive small/medium T-cell lymphoproliferative disorder, and acral CD8-positive T-cell lymphoma. Given the rarity of these conditions, optimal treatments approaches are not always well established, not least as data from large-scale clinical trials are lacking. In this chapter, we aim to provide a summation of current thinking around best treatment, as well as highlighting some controversies in the management of these diagnoses.
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Affiliation(s)
- C van der Weyden
- Department of Haematology, Peter MacCallum Cancer Centre, Melbourne, Australia.
| | - C McCormack
- Department of Surgical Oncology, Peter MacCallum Cancer Centre, Melbourne, Australia
- Department of Dermatology, St Vincent's Hospital, Fitzroy, Australia
- Department of Oncology, Sir Peter MacCallum, The University of Melbourne, Parkville, Australia
| | - S Lade
- Department of Oncology, Sir Peter MacCallum, The University of Melbourne, Parkville, Australia
- Department of Anatomical Pathology, Peter MacCallum Cancer Centre, Melbourne, Australia
| | - R W Johnstone
- Department of Oncology, Sir Peter MacCallum, The University of Melbourne, Parkville, Australia
- Research Division, Peter MacCallum Cancer Centre, Melbourne, Australia
| | - H M Prince
- Department of Haematology, Peter MacCallum Cancer Centre, Melbourne, Australia
- Department of Oncology, Sir Peter MacCallum, The University of Melbourne, Parkville, Australia
- Epworth Healthcare, Melbourne, Australia
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34
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Kim EJ, Aria AB, Wilmas K, Lewis DJ, Torres-Cabala CA, Nunez C, Dabaja BS, Duvic M. Primary cutaneous CD4+ small- to medium-sized pleomorphic T-cell lymphoproliferative disorder in a pediatric patient successfully treated with low-dose radiation. Pediatr Dermatol 2019; 36:e23-e26. [PMID: 30548331 DOI: 10.1111/pde.13728] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
Primary cutaneous CD4+ small- to medium-sized pleomorphic T-cell lymphoproliferative disorder (PCSM-LPD) is a rare and low-grade form of cutaneous T-cell proliferation with the average age of diagnosis of 54 years. Because of its rarity, the etiology or exact clinicopathology of PCSM-LPD remains unclear, with < 10 pediatric cases reported. A 13-year-old boy presented to our clinic with a raised tumor with PCSM-LPD histology and was successfully treated with ultra-low-dose radiation therapy. While no standard of care has been established for pediatric PCSM-LPD, this report represents an example of achieving remission in a pediatric tumor with minimal potential for therapy-related long-term toxicity.
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Affiliation(s)
- Esther J Kim
- School of Medicine, Baylor College of Medicine, Houston, Texas.,Department of Dermatology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Alexander B Aria
- Department of Dermatology, The University of Texas MD Anderson Cancer Center, Houston, Texas.,McGovern Medical School, University of Texas Health Science Center, Houston, Texas
| | - Kelly Wilmas
- Department of Dermatology, The University of Texas MD Anderson Cancer Center, Houston, Texas.,McGovern Medical School, University of Texas Health Science Center, Houston, Texas
| | - Daniel J Lewis
- School of Medicine, Baylor College of Medicine, Houston, Texas.,Department of Dermatology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Carlos A Torres-Cabala
- Department of Dermatology, The University of Texas MD Anderson Cancer Center, Houston, Texas.,Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Cesar Nunez
- Department of Pediatrics, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Bouthaina S Dabaja
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Madeleine Duvic
- Department of Dermatology, The University of Texas MD Anderson Cancer Center, Houston, Texas
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35
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Gilson D, Whittaker S, Child F, Scarisbrick J, Illidge T, Parry E, Mohd Mustapa M, Exton L, Kanfer E, Rezvani K, Dearden C, Morris S, McHenry P, Leslie T, Wakelin S, Hunasehally R, Cork M, Johnston G, Chiang N, Worsnop F, Salim A, Buckley D, Petrof G, Callachand N, Flavell T, Salad A. British Association of Dermatologists and U.K. Cutaneous Lymphoma Group guidelines for the management of primary cutaneous lymphomas 2018. Br J Dermatol 2018; 180:496-526. [DOI: 10.1111/bjd.17240] [Citation(s) in RCA: 71] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/14/2018] [Indexed: 02/07/2023]
Affiliation(s)
- D. Gilson
- Leeds Cancer Centre St James's University Hospital Leeds LS9 7TF U.K
| | - S.J. Whittaker
- St John's Institute of Dermatology Guy's and St Thomas NHS Foundation Trust St Thomas’ Hospital London SE1 7EH U.K
| | - F.J. Child
- St John's Institute of Dermatology Guy's and St Thomas NHS Foundation Trust St Thomas’ Hospital London SE1 7EH U.K
| | - J.J. Scarisbrick
- Queen Elizabeth Hospital University Hospital Birmingham Birmingham B15 2TH U.K
| | - T.M. Illidge
- Institute of Cancer Sciences University of Manchester The Christie NHS Foundation Trust Manchester M20 4BX U.K
| | - E.J. Parry
- Tameside Hospital Integrated Care NHS Foundation Trust Ashton‐under‐Lyne OL6 9RW U.K
| | - M.F. Mohd Mustapa
- British Association of Dermatologists Willan House, 4 Fitzroy Square London W1T 5HQ U.K
| | - L.S. Exton
- British Association of Dermatologists Willan House, 4 Fitzroy Square London W1T 5HQ U.K
| | - E. Kanfer
- Haematology Department Hammersmith Hospital Du Cane Road London W12 0HS U.K
| | - K. Rezvani
- The University of Texas MD Anderson Cancer Centre Houston TX U.S.A
| | - C.E. Dearden
- Chronic Lymphocytic Leukaemia (CLL) Unit The Royal Marsden NHS Foundation Trust Sutton SW3 6JJ U.K
| | - S.L. Morris
- Guy's and St Thomas’ NHS Foundation Trust Guy's Hospital London SE1 9RT U.K
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36
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Salah E. Primary cutaneous CD4+ small/medium pleomorphic T-cell lymphoproliferative disorder: Where do we stand? A systematic review. J Dtsch Dermatol Ges 2018; 17:123-136. [DOI: 10.1111/ddg.13691] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2017] [Accepted: 04/10/2018] [Indexed: 12/18/2022]
Affiliation(s)
- Eman Salah
- Department of Dermatology; Venereology & Andrology; Faculty of Medicine; Zagazig University; Zagazig Egypt
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37
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Fujii K. New Therapies and Immunological Findings in Cutaneous T-Cell Lymphoma. Front Oncol 2018; 8:198. [PMID: 29915722 PMCID: PMC5994426 DOI: 10.3389/fonc.2018.00198] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2018] [Accepted: 05/17/2018] [Indexed: 01/08/2023] Open
Abstract
Primary cutaneous lymphomas comprise a group of lymphatic malignancies that occur primarily in the skin. They represent the second most common form of extranodal non-Hodgkin’s lymphoma and are characterized by heterogeneous clinical, histological, immunological, and molecular features. The most common type is mycosis fungoides and its leukemic variant, Sézary syndrome. Both diseases are considered T-helper cell type 2 (Th2) diseases. Not only the tumor cells but also the tumor microenvironment can promote Th2 differentiation, which is beneficial for the tumor cells because a Th1 environment enhances antitumor immune responses. This Th2-dominant milieu also underlies the infectious susceptibility of the patients. Many components, such as tumor-associated macrophages, cancer-associated fibroblasts, and dendritic cells, as well as humoral factors, such as chemokines and cytokines, establish the tumor microenvironment and can modify tumor cell migration and proliferation. Multiagent chemotherapy often induces immunosuppression, resulting in an increased risk of serious infection and poor tolerance. Therefore, overtreatment should be avoided for these types of lymphomas. Interferons have been shown to increase the time to next treatment to a greater degree than has chemotherapy. The pathogenesis and prognosis of cutaneous T-cell lymphoma (CTCL) differ markedly among the subtypes. In some aggressive subtypes of CTCLs, such as primary cutaneous gamma/delta T-cell lymphoma and primary cutaneous CD8+ aggressive epidermotropic cytotoxic T-cell lymphoma, hematopoietic stem cell transplantation should be considered, whereas overtreatment should be avoided with other, favorable subtypes. Therefore, a solid understanding of the pathogenesis and immunological background of cutaneous lymphoma is required to better treat patients who are inflicted with this disease. This review summarizes the current knowledge in the field to attempt to achieve this objective.
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Affiliation(s)
- Kazuyasu Fujii
- Department of Dermatology, Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima, Japan
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38
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Abstract
This article focuses on cutaneous hematopoietic neoplasms that are more likely to be encountered in the pediatric age-group and includes both lymphoproliferative and histiocytic disorders. The cutaneous hematologic disorders in children have a different epidemiologic profile to what is seen during adulthood. Although mycosis fungoides is the most frequent form of cutaneous lymphoma in adults, it is very rare in children. Because lymphoblastic leukemias and lymphomas are more frequent in the pediatric setting, cutaneous leukemic infiltrates are relatively common in this age-group. Similarly, histiocytic disorders are more common in children, particularly Langerhans cell histiocytosis and juvenile xanthogranuloma. Notably, the histiocytic disorders have undergone significant modifications on their nomenclature in the basis of the molecular characteristics that are present in them. A summary of the most frequent cutaneous hematopoietic disorders in children will be discussed further in this review.
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Affiliation(s)
- Alejandro A Gru
- 1 Department of Pathology, University of Virginia, Charlottesville, Virginia
| | - Louis P Dehner
- 2 Lauren V. Ackerman Laboratory of Surgical Pathology, St. Louis Children's Hospital and Dermatopathology, Washington University Medical Center, St. Louis, Missouri
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39
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Jain G, Aiyer HM. Primary cutaneous CD4 positive small/medium T cell lymphoma. Indian J Dermatol Venereol Leprol 2018; 84:186-188. [PMID: 29363627 DOI: 10.4103/ijdvl.ijdvl_91_17] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
- Gaurav Jain
- Department of Clinical Pathology Lab, NHMC and H, New Delhi, India
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40
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Davick JJ, Gaughan E, Barry M, Gru AA. Primary Cutaneous Small/Medium CD4+ T-CELL Lymphoproliferative Disorder Occurring in a Patient With Metastatic Melanoma. Am J Dermatopathol 2018; 40:60-63. [PMID: 28719434 DOI: 10.1097/dad.0000000000000960] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Therapeutic agents designed to stimulate the immune system are now cornerstones in the treatment of metastatic melanoma. These drugs promote lymphocyte growth and survival, which could plausibly result in clinical lymphoproliferative disorders. We report the case of a 62-year-old female with metastatic melanoma who developed primary cutaneous small/medium CD4 T-cell lymphoproliferative disorder (PC-SMTCL) after treatment with vemurafenib and recombinant high-dose interleukin-2 (IL-2). The patient developed a painless red papule behind the ear. A biopsy showed a dense population of CD4 lymphocytes with a T-follicular helper cell phenotype. Molecular studies confirmed the presence of a clonal population of T cells, and the process was classified as PC-SMTCL. The patient was diagnosed with metastatic melanoma approximately 3 years before the development of the cutaneous lymphoma and had been treated with vemurafenib followed by 2 courses of IL-2. The patient's last course of IL-2 was completed in April of 2013. She developed the cutaneous lymphoma behind her ear in December of 2015. An association between PC-SMTCL and vemurafenib treatment for advanced melanoma has been reported previously in one patient; however, an association between PC-SMTCL and IL-2 treatment has not been documented. The immunostimulatory properties of IL-2 or vemurafenib may be responsible for the development of PC-SMTCL in our patient. Additionally, antigenic stimulation of the immune system by melanoma itself could contribute to clonal selection of lymphocytes.
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Affiliation(s)
- Jonathan J Davick
- Department of Pathology, University of Virginia Medical Center, Charlottesville, VA
| | - Elizabeth Gaughan
- Division of Hematology and Oncology, Department of Medicine, University of Virginia Medical Center, Charlottesville, VA
| | | | - Alejandro A Gru
- Department of Pathology, University of Virginia Medical Center, Charlottesville, VA
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41
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Kim HJ, Han JH, Min SK. Differential diagnosis of primary cutaneous CD4+ small/medium T-cell lymphoproliferative lesions: A report of three cases. Blood Res 2017; 52:326-329. [PMID: 29333414 PMCID: PMC5762748 DOI: 10.5045/br.2017.52.4.326] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2017] [Revised: 06/05/2017] [Accepted: 08/18/2017] [Indexed: 11/21/2022] Open
Affiliation(s)
- Hyun-Jung Kim
- Department of Pathology, Inje University Sanggye Paik Hospital, Seoul, Korea
| | - Jae-Ho Han
- Department of Pathology, Ajou University Hospital, Suwon, Korea
| | - Soo Kee Min
- Department of Pathology, Hallym University Sacred Heart Hospital, Seoul, Korea
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42
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CD30 + T cell enriched primary cutaneous CD4 + small/medium sized pleomorphic T cell lymphoma: A distinct variant of indolent CD4 + T cell lymphoproliferative disease. Ann Diagn Pathol 2017; 30:52-58. [DOI: 10.1016/j.anndiagpath.2017.04.009] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2017] [Accepted: 04/25/2017] [Indexed: 02/07/2023]
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43
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Rodríguez-Lomba E, Molina-López I, Pulido-Pérez A, Ciudad-Blanco C. Ultrasound features of Primary Cutaneous CD4+ Small/Medium-Sized T-Cell Lymphoproliferative Disorder. ACTAS DERMO-SIFILIOGRAFICAS 2017. [DOI: 10.1016/j.adengl.2017.07.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
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44
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Keeling BH, Gavino ACP, Admirand J, Soldano AC. Primary cutaneous CD4-positive small/medium-sized pleomorphic T-cell lymphoproliferative disorder: Report of a case and review of the literature. J Cutan Pathol 2017; 44:944-947. [DOI: 10.1111/cup.13011] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2016] [Revised: 07/17/2017] [Accepted: 07/24/2017] [Indexed: 12/22/2022]
Affiliation(s)
- Brett H. Keeling
- Department of Pathology and Laboratory Medicine; The Medical University of South Carolina; Charleston South Carolina
| | | | - Joan Admirand
- Division of Hematopathology; Clinical Pathology Associates; Austin Texas
| | - Anthony C. Soldano
- Division of Dermatology; Dell Medical School at The University of Texas at Austin; Austin Texas
- Division of Dermatopathology; Clinical Pathology Associates; Austin Texas
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45
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Wehkamp U, Weichenthal M. [Treatment of rare cutaneous T‑cell lymphoma and blastic plasmacytoid dendritic cell neoplasm]. Hautarzt 2017; 68:711-715. [PMID: 28795194 DOI: 10.1007/s00105-017-4024-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Among the group of primary cutaneous lymphomas several subtypes have very low incidence rates. Based on the revision of the WHO classification for lymphoid neoplasms (2016), an overview of rare cutaneous T‑cell lymphoma (CTCL) subtypes is given and therapeutic approaches are detailed. The prognosis of the different subtypes is highly variable underlining the importance of adequate stage and subtype adapted treatment. In cases of indolent subtypes topical treatment, e. g. topical corticosteroids or UV phototherapy are often sufficient. For aggressive variants, early discussion of more aggressive systemic treatment options is warranted.
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Affiliation(s)
- U Wehkamp
- Klinik für Dermatologie, Universitätsklinikum Schleswig-Holstein, Campus Kiel, Rosalind-Franklin-Str. 7, 24105, Kiel, Deutschland.
| | - M Weichenthal
- Klinik für Dermatologie, Universitätsklinikum Schleswig-Holstein, Campus Kiel, Rosalind-Franklin-Str. 7, 24105, Kiel, Deutschland
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Maurelli M, Colato C, Gisondi P, Girolomoni G. Primary Cutaneous CD4+ Small/Medium Pleomorphic T-Cell Lymphoproliferative Disorder: A Case Series. J Cutan Med Surg 2017; 21:502-506. [DOI: 10.1177/1203475417715209] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Background: Primary cutaneous CD4+ small/medium T-cell lymphoproliferative disorder (CD4+ PCSM-LPD) is defined by a predominance of small- to medium-sized CD4+ pleomorphic T cells and a favorable clinical course. Objective: We performed a retrospective analysis of 6 patients with CD4+ PCSM-LPD and reviewed the literature to address questions about its diagnosis, treatment, and prognosis. Methods: Patients were 3 men and 3 women with a median age of 50 years. All patients presented with a single erythematous nodule, localised on the head in 4 patients and the upper trunk in 2 cases. No patients showed extracutaneous disease at any evaluation. Histopathologic features were characterised by nodular, diffuse, or, in 1 case, a superficial dense infiltrate of small/medium-sized pleomorphic CD4+/PD1+ T lymphocytes. T-cell receptor clonality was demonstrated in 5 cases. Treatment was surgical excision in 5 cases and radiotherapy in 1 case. Results: All patients achieved complete resolution without relapses, during a median follow-up of 3 years. A review of the literature confirmed that CD4+ PCSM-LPD presents predominantly with a solitary nodular lesion on the face, neck, or upper trunk in adult patients. Surgical excision is the preferred treatment. Spontaneous resolution after biopsy may occur. Conclusions: CD4+ PCSM-LPD is a rare disorder with a favorable course.
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Affiliation(s)
- Martina Maurelli
- Section of Dermatology, Department of Medicine, University of Verona, Verona, Italy
| | - Chiara Colato
- Section of Pathology, Department of Diagnostics and Public Health, University of Verona, Verona, Italy
| | - Paolo Gisondi
- Section of Dermatology, Department of Medicine, University of Verona, Verona, Italy
| | - Giampiero Girolomoni
- Section of Dermatology, Department of Medicine, University of Verona, Verona, Italy
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Rodríguez-Lomba E, Molina-López I, Pulido-Pérez A, Ciudad-Blanco C. Ultrasound Appearance of Primary Cutaneous CD4+ Small/Medium-Sized T-Cell Lymphoproliferative Disorder. ACTAS DERMO-SIFILIOGRAFICAS 2017; 108:792-794. [PMID: 28388988 DOI: 10.1016/j.ad.2016.11.022] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2016] [Revised: 11/15/2016] [Accepted: 11/29/2016] [Indexed: 02/02/2023] Open
Affiliation(s)
- E Rodríguez-Lomba
- Servicio de Dermatología, Hospital General Universitario Gregorio Marañón, Madrid, España.
| | - I Molina-López
- Servicio de Dermatología, Hospital General Universitario Gregorio Marañón, Madrid, España
| | - A Pulido-Pérez
- Servicio de Dermatología, Hospital General Universitario Gregorio Marañón, Madrid, España
| | - C Ciudad-Blanco
- Servicio de Dermatología, Hospital General Universitario Gregorio Marañón, Madrid, España
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Jiang M, Bennani NN, Feldman AL. Lymphoma classification update: T-cell lymphomas, Hodgkin lymphomas, and histiocytic/dendritic cell neoplasms. Expert Rev Hematol 2017; 10:239-249. [PMID: 28133975 DOI: 10.1080/17474086.2017.1281122] [Citation(s) in RCA: 79] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
INTRODUCTION Lymphomas are classified based on the normal counterpart, or cell of origin, from which they arise. Because lymphocytes have physiologic immune functions that vary both by lineage and by stage of differentiation, the classification of lymphomas arising from these normal lymphoid populations is complex. Recent genomic data have contributed additional depth to this complexity. Areas covered: Lymphoma classification follows the World Health Organization (WHO) system, which reflects international consensus and is based on pathological, genetic, and clinical factors. The present review focuses on the classification of T-cell lymphomas, Hodgkin lymphomas, and histiocytic and dendritic cell neoplasms, summarizing changes reflected in the 2016 revision to the WHO classification. These changes are critical to hematologists and other clinicians who care for patients with these disorders. Expert commentary: Lymphoma classification is a continually evolving field that needs to be responsive to new clinical, pathological, and molecular understanding of lymphoid neoplasia. Among the entities covered in this review, the 2016 revisions in the WHO classification particularly impact T-cell lymphomas, including a new umbrella category of T-follicular helper cell-derived lymphomas and evolving recognition of indolent T-cell lymphomas and lymphoproliferative disorders.
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Affiliation(s)
- Manli Jiang
- a Department of Laboratory Medicine and Pathology , Mayo Clinic , Rochester , MN , USA
| | - N Nora Bennani
- b Division of Hematology , Mayo Clinic , Rochester , MN , USA
| | - Andrew L Feldman
- a Department of Laboratory Medicine and Pathology , Mayo Clinic , Rochester , MN , USA
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Alberti-Violetti S, Torres-Cabala CA, Talpur R, Corti L, Fanoni D, Venegoni L, Berti E, Duvic M. Clinicopathological and molecular study of primary cutaneous CD4+ small/medium-sized pleomorphic T-cell lymphoma. J Cutan Pathol 2016; 43:1121-1130. [DOI: 10.1111/cup.12806] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2015] [Revised: 08/11/2016] [Accepted: 08/17/2016] [Indexed: 12/25/2022]
Affiliation(s)
| | - Carlos A Torres-Cabala
- Department of Pathology, Dermatopathology Section; University of Texas, MD Anderson Cancer Center; Houston TX USA
- Department of Dermatology; University of Texas, MD Anderson Cancer Center; Houston TX USA
| | - Rakhshandra Talpur
- Department of Dermatology; University of Texas, MD Anderson Cancer Center; Houston TX USA
| | - Laura Corti
- UOC Dermatologia; Fondazione IRCCS Ca' Granda - Ospedale Maggiore Policlinico; Milan Italy
| | - Daniele Fanoni
- UOC Dermatologia; Fondazione IRCCS Ca' Granda - Ospedale Maggiore Policlinico; Milan Italy
| | - Luigia Venegoni
- Dipartimento di Fisiopatologia Medico-Chirurgica e dei Trapianti; Università degli Studi di Milano; Milan Italy
| | - Emilio Berti
- UOC Dermatologia; Fondazione IRCCS Ca' Granda - Ospedale Maggiore Policlinico; Milan Italy
- Dipartimento di Scienze della Salute; Università degli Studi di Milano-Bicocca; Milan Italy
| | - Madeleine Duvic
- Department of Dermatology; University of Texas, MD Anderson Cancer Center; Houston TX USA
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