Analysis of cutaneous lymphomas in a medical center in Bahia, Brazil

OBJECTIVES

To evaluate the frequency of the different types of cutaneous lymphoma (CL) in 1 university hospital in Brazil and compare this frequency with those observed in other countries.

METHODS

After review, 72 (84.7%) cases of primary cutaneous T-cell lymphoma (CTCL) and 13 (15.3%) cases of primary cutaneous B-cell lymphoma (CBCL) were included.

RESULTS

Of the CTCLs, 40.3% were mycosis fungoides (MF); 26.4% were adult T-cell leukemias/lymphomas (ATLs); 23.6% were peripheral T-cell lymphomas, unspecified; and 8.3% were anaplastic large cell lymphomas. Of the MF cases, 17.2% progressed to transformed MF. Five-year survival for primary human T-cell lymphotropic virus type 1-negative CTCL, ATL, and CBCL was 64.0%, 42.1%, and 62.5%, respectively. MF and ATL were the most frequent primary CTCLs.

CONCLUSIONS

The frequencies observed here are close to those observed in Peru but different from those of European countries. Unfortunately, the World Health Organization/European Organization of Research and Treatment of Cancer classification does not include primary cutaneous ATL.

Primary Cutaneous Folliculotropic and Lymphohistiocytic Anaplastic Large Cell Lymphoma

Background:

Primary cutaneous anaplastic large cell lymphoma (PC-ALCL) is a T-cell lymphoma that presents in the skin and consists of CD30+ anaplastic large lymphocytes with abundant cytoplasm and pleomorphic nuclei. In addition to the classic variant, several other histologic patterns of ALCL have been identified, among them the lymphohistiocytic variant.

Objective and Methods:

We describe a case of the lymphohistiocytic variant of PC-ALCL with a marked follicular involvement. The lesion appeared as a single nodule in the face that completely regressed following biopsy. A diffuse infiltration of lymphocytes and macrophages was seen in the dermis associated with hypertrophied hair follicles, follicular mucinosis, and marked folliculotropism, leading to follicular disruption. Cohesive groups of CD30+ large, atypical lymphocytes with a high proliferative index were seen focally. The patient was followed up for 41 months, during which time no relapses occurred.

Conclusions:

This case shows that PC-ALCL may present with different histologic features, including a follicular variant, that may mimic both benign and malignant conditions.

Anaplastic large cell lymphoma: twenty-five years of discovery

CONTEXT

The year 2010 commemorates the 25th year since the seminal publication by Karl Lennert and Harald Stein and others in Kiel, West Germany, describing an unusual large cell lymphoma now known as anaplastic large cell lymphoma (ALCL). Investigators at many universities and hospitals worldwide have contributed to our current in-depth understanding of this unique peripheral T-cell lymphoma, which in its systemic form, principally occurs in children and young adults.

OBJECTIVE

To summarize our current knowledge of the clinical and pathologic features of systemic and primary cutaneous ALCL. Particular emphasis is given to the biology and pathogenesis of ALCL.

DATA SOURCES

Search of the medical literature (Ovid MEDLINE In-Process & Other Non-Indexed Citations and Ovid MEDLINE: 1950 to Present [National Library of Medicine]) and more than 20 years of diagnostic experience were used as the source of data for review.

CONCLUSIONS

Based on immunostaining for activation antigen CD30 and the presence of dysregulation of the anaplastic lymphoma kinase gene (2p23), the diagnosis of ALCL has become relatively straightforward for most patients. Major strides have been made during the last decade in our understanding of the complex pathogenesis of ALCL. Constitutive NPM-ALK signaling has been shown to drive oncogenesis via an intricate network of redundant and interacting pathways that regulate cell proliferation, cell fate, and cytoskeletal modeling. Nevertheless, pathomechanistic, therapeutic, and diagnostic challenges remain that should be resolved as we embark on the next generation of discovery.

Primary cutaneous anaplastic large cell lymphoma

Anaplastic large cell lymphoma (ALCL) is characterized by proliferation of anaplastic large CD 30+ T-cell lymphoid cells with abundant cytoplasm. Primary cutaneous ALCL is a rare form of ALCL, usually seen in elderly patients. In this report, the authors present an unusual case of 15-year-old boy with a solitary left ear lobe mass, previously reported as keratoacanthoma which was later histopathologically and immunohistochemically diagnosed as T-cell phenotype, anaplastic lymphoma kinase (ALK)-negative primary cutaneous anaplastic large cell lymphoma. The patient's response to chemotherapy was good and he is receiving the continuation phases of his chemotherapy.