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Jairath NK, Bardhi R, Runge JS, Bledea R, Jairath R, Wang Y, Patrick M, Wilcox RA, Hristov AC, Tsoi LC, Tejasvi T. Predictors of large cell transformation in patients with Sezary Syndrome-A retrospective analysis. PLoS One 2022; 17:e0277655. [PMID: 36383618 PMCID: PMC9668185 DOI: 10.1371/journal.pone.0277655] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2022] [Accepted: 11/01/2022] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Large cell transformation (LCT) of Sezary Syndrome (SS) is a rare phenomenon. To date, there are no rigorous studies identifying risk factors for its development. OBJECTIVES Here, we seek to characterize the clinicopathologic risk factors that predispose patients with SS to develop LCT. METHODS We retrospectively evaluated all SS patient records available in the Michigan Medicine Cancer Registry from 2010-2021. Clinical and pathologic variables were compared between groups. The Kaplan-Meier method and log-rank test were used to assess overall survival. RESULTS Of 28 SS patients identified, eight patients experienced LCT, and 20 did not (NLCT). Peak lactate dehydrogenase (LDH) before LCT (p = 0.0012), maximum total body surface area (TBSA) involvement before LCT (p = 0.0114), absolute CD8+ cell count measured on flow cytometry at diagnosis of SS (p = 0.0455) and at the most recent blood draw (p = 0.00736), and ulceration on biopsy (p = 0.0034) were significant clinicopathologic variables identified between the SS patients that developed LCT versus those that did not. CONCLUSIONS Maximum TBSA involvement, peak LDH, presence of ulceration, and decreased levels of CD8+ cells in the peripheral blood may predict the development of LCT in patients with SS.
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Affiliation(s)
- Neil K. Jairath
- Department of Dermatology, University of Michigan, Ann Arbor, MI, United States of America
| | - Redina Bardhi
- Department of Dermatology, Wayne State University, Detroit, MI, United States of America
| | - John S. Runge
- Department of Dermatology, University of Michigan, Ann Arbor, MI, United States of America
| | - Ramona Bledea
- Department of Dermatology, University of Michigan, Ann Arbor, MI, United States of America
| | - Ruple Jairath
- Department of Dermatology, University of Michigan, Ann Arbor, MI, United States of America
| | - Yang Wang
- Department of Dermatology and Venereology, Peking University First Hospital, Beijing, China
| | - Matthew Patrick
- Department of Dermatology, University of Michigan, Ann Arbor, MI, United States of America
| | - Ryan A. Wilcox
- Department of Hematology and Oncology, University of Michigan, Ann Arbor, MI, United States of America
| | - Alexandra C. Hristov
- Department of Dermatology, University of Michigan, Ann Arbor, MI, United States of America
- Department of Pathology, University of Michigan, Ann Arbor, MI, United States of America
| | - Lam C. Tsoi
- Department of Dermatology, University of Michigan, Ann Arbor, MI, United States of America
- Department of Computational Medicine and Bioinformatics, Department of Biostatistics, University of Michigan, Ann Arbor, MI, United States of America
| | - Trilokraj Tejasvi
- Department of Dermatology, University of Michigan, Ann Arbor, MI, United States of America
- Veteran Affairs Health System, Ann Arbor, MI, United States of America
- * E-mail:
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Robertson JC, Jafry MA, Soma L, Shustov A, Shinohara MM. Fatal Microangiopathic Hemolytic Anemia Due to Sézary Syndrome. Cureus 2021; 13:e15482. [PMID: 34262820 PMCID: PMC8260342 DOI: 10.7759/cureus.15482] [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] [Accepted: 06/06/2021] [Indexed: 11/23/2022] Open
Abstract
Sézary syndrome (SS) is a form of cutaneous T-cell lymphoma (CTCL), demonstrating leukemic involvement of malignant T-cells. Known systemic sequelae of SS include hemophagocytic syndrome-induced anemia, normocytic anemia secondary to bone marrow infiltration, and pancytopenia. We report a patient with SS, initially demonstrating widespread morbilliform eruption, who presented with malignancy-related microangiopathic hemolytic anemia (MAHA). Our findings represent a novel presentation of SS that will inform the differential diagnosis and treatment of future SS patients presenting with anemia and thrombocytopenia.
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Affiliation(s)
| | | | - Lori Soma
- Division of Hematopathology, Department of Pathology, University of Washington, Seattle, USA
| | - Andrei Shustov
- Division of Hematology, Department of Medicine, University of Washington, Seattle, USA
| | - Michi M Shinohara
- Division of Dermatology, Department of Medicine, University of Washington, Seattle, USA
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Zinzani PL, Quaglino P, Violetti SA, Cantonetti M, Goteri G, Onida F, Paulli M, Rupoli S, Barosi G, Pimpinelli N. Critical concepts and management recommendations for cutaneous T-cell lymphoma: A consensus-based position paper from the Italian Group of Cutaneous Lymphoma. Hematol Oncol 2021; 39:275-283. [PMID: 33855728 DOI: 10.1002/hon.2832] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2020] [Revised: 12/07/2020] [Accepted: 12/08/2020] [Indexed: 01/25/2023]
Abstract
In this paper, we present a review of critical concepts, and produce recommendations on management issues in cutaneous T-cell lymphomas (CTCLs) of adults. A panel of nine experts was selected for their expertise in research and clinical practice of CTCLs. During an initial meeting, the areas of major concern in the management of CTCLs were selected by generating and rank-ordering clinical key questions using the criterion of clinical relevance, through group discussion. Recommendations were achieved by multiple-step formalized procedures to reach a consensus after a comprehensive analysis of the scientific literature. The panel produced recommendations on how to facilitate the clinical suspicion of CTCL; indication of cutaneous biopsy; optimal histological diagnosis, immunohistochemistry and genetic markers; and staging pathway and up-to-date therapeutics (with particular focus on new treatments). The critical concept of integration of the different medical expertise in the management of the patients with CTCL was thoroughly examined. These recommendations are intended for use not only by expert centers but above all by "not experienced" dermatologists and hematologists as well as general practitioners.
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Affiliation(s)
- Pier Luigi Zinzani
- IRCCS, Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy.,Institute of Hematology "L. e A. Seràgnoli", DIMES University of Bologna, Bologna, Italy
| | - Pietro Quaglino
- Department Medical Sciences, Dermatologic Clinic, University of Turin, Italy
| | - Silvia Alberti Violetti
- UOC Dermatology, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, University of Milano, Milano, Italy
| | - Maria Cantonetti
- Onco-Hematology Department, University "Tor Vergata", Roma, Italy
| | - Gaia Goteri
- Anatomo-Pathology Unit, DISBSP University Politecnica delle Marche, Ospedali Riuniti di Ancona, Ancona, Italy
| | - Francesco Onida
- Hematology-Bone Marrow Transplantation Center, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico - University of Milan, Italy
| | - Marco Paulli
- Anatomo-Pathology Unit, University of Pavia, Pavia, Italy
| | - Serena Rupoli
- Clinic of Hematology, Ospedali Riuniti Ancona, Ancona, Italy
| | - Giovanni Barosi
- Center for the Study of Myelofibrosis, Laboratory of Biochemistry, Biotechnology and Advanced Diagnostics, IRCCS Policlinico S. Matteo Foundation, Pavia, Italy
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Yamashita T, Abbade LPF, Marques MEA, Marques SA. Mycosis fungoides and Sézary syndrome: clinical, histopathological and immunohistochemical review and update. An Bras Dermatol 2012; 87:817-28; quiz 829-30. [PMID: 23197199 PMCID: PMC3699909 DOI: 10.1590/s0365-05962012000600001] [Citation(s) in RCA: 50] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2011] [Accepted: 07/19/2011] [Indexed: 12/22/2022] Open
Abstract
This paper reviews the diagnostic and classificatory concepts of mycosis fungoides and Sézary syndrome in light of the latest normative publications. It describes the great variability of the clinical expression of mycosis fungoides in its early stages as well as the histopathological and immunohistochemical aspects that help with diagnosis. The diagnostic criteria required for characterizing Sézary syndrome and the staging system used for both mycosis fungoides and Sézary syndrome are described.
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Affiliation(s)
- Thamy Yamashita
- M.Sc.,PhD in Pathology, Department of Pathology, Botucatu School of
Medicine- Universidade Estadual Paulista "Julio de Mesquita Filho" (São
Paulo State University) (FMB-UNESP) - São Paulo (SP), Brazil
| | - Luciana Patricia Fernandes Abbade
- PhD - Assistant Professor, Department of Dermatology and Radiotherapy,
Botucatu School of Medicine - Universidade Estadual Paulista "Julio de Mesquita
Filho" (São Paulo State University) (FMB-UNESP) - São Paulo (SP),
Brazil
| | - Mariangela Esther Alencar Marques
- Professor, Department of Pathology, Botucatu School of Medicine -
Universidade Estadual Paulista "Julio de Mesquita Filho" (São Paulo
State University) (FMB-UNESP) - São Paulo (SP), Brazil
| | - Silvio Alencar Marques
- Professor - Department of Dermatology and Radiotherapy, Botucatu School
of Medicine - Universidade Estadual Paulista "Julio de Mesquita Filho"
(São Paulo State University) (FMB-UNESP) - São Paulo (SP), Brazil
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5
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Beylot-Barry M, Dereure O, Vergier B, Barete S, Laroche L, Machet L, Delfau-Larue MH, D’Incan M, Grange F, Ortonne N, Merlio JP, Bagot M. Prise en charge des lymphomes T cutanés : recommandations du Groupe français d’étude des lymphomes cutanés. Ann Dermatol Venereol 2010; 137:611-21. [DOI: 10.1016/j.annder.2010.06.021] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2010] [Revised: 04/19/2010] [Accepted: 06/22/2010] [Indexed: 10/19/2022]
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8
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Modern techniques for the diagnostic evaluation of the trephine bone marrow biopsy: Methodological aspects and applications. ACTA ACUST UNITED AC 2008; 42:203-52. [DOI: 10.1016/j.proghi.2007.10.002] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2007] [Accepted: 10/08/2007] [Indexed: 12/19/2022]
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Olsen E, Vonderheid E, Pimpinelli N, Willemze R, Kim Y, Knobler R, Zackheim H, Duvic M, Estrach T, Lamberg S, Wood G, Dummer R, Ranki A, Burg G, Heald P, Pittelkow M, Bernengo MG, Sterry W, Laroche L, Trautinger F, Whittaker S. Revisions to the staging and classification of mycosis fungoides and Sezary syndrome: a proposal of the International Society for Cutaneous Lymphomas (ISCL) and the cutaneous lymphoma task force of the European Organization of Research and Treatment of Cancer (EORTC). Blood 2007; 110:1713-22. [PMID: 17540844 DOI: 10.1182/blood-2007-03-055749] [Citation(s) in RCA: 933] [Impact Index Per Article: 54.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
The ISCL/EORTC recommends revisions to the Mycosis Fungoides Cooperative Group classification and staging system for cutaneous T-cell lymphoma (CTCL). These revisions are made to incorporate advances related to tumor cell biology and diagnostic techniques as pertains to mycosis fungoides (MF) and Sézary syndrome (SS) since the 1979 publication of the original guidelines, to clarify certain variables that currently impede effective interinstitution and interinvestigator communication and/or the development of standardized clinical trials in MF and SS, and to provide a platform for tracking other variables of potential prognostic significance. Moreover, given the difference in prognosis and clinical characteristics of the non-MF/non-SS subtypes of cutaneous lymphoma, this revision pertains specifically to MF and SS. The evidence supporting the revisions is discussed as well as recommendations for evaluation and staging procedures based on these revisions.
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Affiliation(s)
- Elise Olsen
- Department of Medicine, Divisions of Dermatology and Oncology, Duke University Medical Center, Durham, NC 27516, USA.
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Kremer M, Quintanilla-Martínez L, Nährig J, von Schilling C, Fend F. Immunohistochemistry in bone marrow pathology: a useful adjunct for morphologic diagnosis. Virchows Arch 2005; 447:920-37. [PMID: 16231177 DOI: 10.1007/s00428-005-0070-8] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2005] [Accepted: 08/23/2005] [Indexed: 12/11/2022]
Abstract
Pathomorphological examination of trephine biopsies of the bone marrow (BM) represents a standard method for the diagnosis and staging of hematologic neoplasms and other disorders involving the BM. The increasing knowledge about the genetic basis and biology of hematologic neoplasms, as well as the recently proposed WHO classification system, provide the framework for an accurate diagnosis. Although conventional morphology remains the gold standard for paraffin-embedded BM trephines, immunohistochemical stainings have become an integral part of the diagnostic workup. Antibodies suitable for paraffin sections are generally applicable to BM trephines, but modifications of staining protocols may be necessary due to the alternative fixatives and decalcification procedures used for BM biopsies. The indications for immunostainings range from confirmation and classification of lymphoma involvement, subclassification of acute leukemias, and estimating blast counts in myelodysplastic and myeloproliferative syndromes to characterization of BM involvement in nonhematologic neoplasms. Although subtyping of NHL in the BM is more difficult from the point of morphology, classification of the entities that frequently involve the BM, especially the small B-cell lymphomas, can easily be achieved with the help of immunohistochemistry. In this review, we try to summarize the current state of the art in BM immunohistochemistry for the diagnosis of hematologic disorders. Moreover, diagnostic algorithms and useful antibody panels are proposed for a rational and cost-effective approach.
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Affiliation(s)
- Marcus Kremer
- Institute of Pathology, Technical University Munich, Ismaningerstrasse 22, 81675 Munich, Germany
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Beylot-Barry M, Parrens M, Delaunay M, Thiebault R, Vergier B, DeMascarel A, Dubus P, Beylot C, Merlio JP. Is bone marrow biopsy necessary in patients with mycosis fungoides and Sezary syndrome? A histological and molecular study at diagnosis and during follow-up. Br J Dermatol 2005; 152:1378-9. [PMID: 15949023 DOI: 10.1111/j.1365-2133.2005.06621.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Abstract
Peripheral T-cell lymphomas (PTCL) account for 10-15% of all lymphoproliferative disorders in the western hemisphere. In PTCL, bone marrow biopsy is performed to establish the diagnosis, rule out other pathology, assess the extent of disease and monitor treatment response. The frequency and histology of bone marrow involvement varies greatly between different clinicopathological entities recognized by the World Health Organisation (WHO) classification, reflecting the differences in the underlying biology. Some lymphomas, such as angioimmunoblastic T-cell lymphoma, show nodular and/or interstitial pattern of infiltration with accompanying reactive changes. Others, including hepatosplenic T-cell lymphoma and large granular lymphocyte leukaemia, are characterized by intrasinusoidal infiltration. In many instances the pathological features are subtle and immunohistochemical and molecular studies are required for the diagnosis. Histological appearances may overlap with a variety of reactive T-cell proliferations and other malignancies. Furthermore PTCL frequently induce secondary changes in the marrow that may obscure the neoplastic infiltrate. The diagnosis often requires critical integration of the information obtained from clinical features, peripheral blood, bone marrow aspirate and biopsy findings. In this article we review the histopathology of bone marrow biopsy in PTCL within the context of the new WHO classification.
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Affiliation(s)
- Ahmet Dogan
- Department of Histopathology, University College London, London, UK.
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