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Approach to the patient with suspected hypereosinophilic syndrome. HEMATOLOGY. AMERICAN SOCIETY OF HEMATOLOGY. EDUCATION PROGRAM 2022; 2022:47-54. [PMID: 36485140 PMCID: PMC9821533 DOI: 10.1182/hematology.2022000367] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Hypereosinophilic syndromes (HES) are a heterogenous group of rare disorders with clinical manifestations ranging from fatigue to life-threatening endomyocardial fibrosis and thromboembolic events. Given the broad differential diagnosis of HES, a comprehensive approach is needed to identify potential secondary (treatable) causes and define end-organ manifestations. Classification by clinical HES subtype is also useful in terms of assessing prognosis and guiding therapy. Corticosteroids remain the mainstay of initial therapy in the setting of acute, life-threatening PDGFR mutation-negative HES. Whereas the recent availability of eosinophil-targeted therapies with extraordinary efficacy and little apparent toxicity is changing the treatment paradigm, especially for idiopathic HES and overlap syndromes, questions remain unanswered regarding the choice of agent, impact of combination therapies, and long-term effects of eosinophil depletion. This review provides a case-based discussion of the differential diagnosis of HES, including the classification by clinical HES subtype. Treatment options are reviewed, including novel eosinophil-targeted agents recently approved for the treatment of HES and/or other eosinophil-associated disorders. Primary (myeloid) disorders associated with hypereosinophilia are not be addressed in depth in this review.
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2
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Shi Y, Wang C. What we have learned about lymphocytic variant hypereosinophilic syndrome: A systematic literature review. Clin Immunol 2022; 237:108982. [DOI: 10.1016/j.clim.2022.108982] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2021] [Revised: 03/11/2022] [Accepted: 03/14/2022] [Indexed: 01/19/2023]
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Helbig G, Klion AD. Hypereosinophilic syndromes - An enigmatic group of disorders with an intriguing clinical spectrum and challenging treatment. Blood Rev 2021; 49:100809. [PMID: 33714638 DOI: 10.1016/j.blre.2021.100809] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Revised: 11/29/2020] [Accepted: 02/19/2021] [Indexed: 01/16/2023]
Abstract
Hypereosinophilic syndromes (HES) comprises a group of rare disorders characterized by blood hypereosinophilia (>1.5 × 109/l) accompanied by eosinophil-associated organ damage. The 2016 World Health Organization classification recognizes a category of myeloid/lymphoid neoplasms with prominent eosinophilia (M/Leo) and well-characterized gene rearrangements of PDGFRA/B, FGFR1 or JAK2. PDGFRA/B-rearranged patients usually manifest as imatinib-sensitive myeloproliferative neoplasms (MPNs). FGFR1- and JAK2- rearranged cases may manifest as MPNs or aggressive lymphomas/leukemias and historically have had a dismal prognosis, although clinical trials with targeted treatment are promising. A negative screen for M/Leo in a patient with myeloid features should prompt consideration of a diagnosis of chronic eosinophilic leukemia-not otherwise specified. If these are excluded and a secondary cause is not identified, a diagnosis of idiopathic HES and/or other rare variants of HES should be considered. This review, through an illustrative case, summarizes current knowledge on HES pointing at new directions in diagnosis and treatment.
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Affiliation(s)
- Grzegorz Helbig
- Department of Hematology and Bone Marrow Transplantation, Medical School of Silesia, Silesian Medical University, Katowice, Poland.
| | - Amy D Klion
- Laboratory of Parasitic Diseases, National Institutes of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD, USA
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King RL, Tan B, Craig FE, George TI, Horny HP, Kelemen K, Orazi A, Reichard KK, Rimsza LM, Wang SA, Zamo A, Quintanilla-Martinez L. Reactive Eosinophil Proliferations in Tissue and the Lymphocytic Variant of Hypereosinophilic Syndrome. Am J Clin Pathol 2021; 155:211-238. [PMID: 33367482 DOI: 10.1093/ajcp/aqaa227] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
OBJECTIVES The 2019 Society for Hematopathology and European Association for Haematopathology Workshop reviewed the spectrum of neoplastic, nonneoplastic, and borderline entities associated with reactive eosinophilia in tissue. METHODS The workshop panel reviewed 46 cases covered in 2 workshop sessions. RESULTS The 46 cases were presented with their consensus diagnoses during the workshop. Reactive eosinophilia in lymph nodes and other tissues may be accompanied by or be distinct from peripheral blood eosinophilia. Reactive etiologies included inflammatory disorders such as Kimura disease and IgG4-related disease, which may show overlapping pathologic features and reactions to infectious agents and hypersensitivity (covered in a separate review). Hodgkin, T-cell, and B-cell lymphomas and histiocytic neoplasms can result in reactive eosinophilia. The spectrum of these diseases is discussed and illustrated through representative cases. CONCLUSIONS Reactive eosinophilia in lymph nodes and tissues may be related to both nonneoplastic and neoplastic lymphoid proliferations and histiocytic and nonhematolymphoid processes. Understanding the differential diagnosis of reactive eosinophilia and the potential for overlapping clinical and pathologic findings is critical in reaching the correct diagnosis so that patients can be treated appropriately.
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Affiliation(s)
| | - Brent Tan
- Division of Hematopathology, Stanford University, Stanford, CA
| | - Fiona E Craig
- Division of Hematopathology, Mayo Clinic, Phoenix, AZ
| | - Tracy I George
- Department of Pathology, University of Utah School of Medicine, Salt Lake City
| | - Hans-Peter Horny
- Institute of Pathology, University of Munich (LMU), Munich, Germany
| | | | - Attilio Orazi
- Department of Pathology, TexasTech University Health Sciences Center, P.L. Foster School of Medicine, El Paso
| | | | - Lisa M Rimsza
- Division of Hematopathology, Mayo Clinic, Phoenix, AZ
| | - Sa A Wang
- Department of Hematopathology, MD Anderson Cancer Center, Houston, TX
| | - Alberto Zamo
- Institute of Pathology, University of Würzburg, Würzburg, Germany
| | - Leticia Quintanilla-Martinez
- Institute of Pathology and Neuropathology, Eberhard Karls University of Tübingen and Comprehensive Cancer Center, Tübingen University Hospital, Tübingen, Germany
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Boggs NA, Rao VK. The Role of Bone Marrow Evaluation in Clinical Allergy and Immunology Practice: When and Why. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY. IN PRACTICE 2020; 8:3356-3362. [PMID: 32531483 PMCID: PMC10996386 DOI: 10.1016/j.jaip.2020.05.049] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/03/2020] [Revised: 05/24/2020] [Accepted: 05/27/2020] [Indexed: 11/21/2022]
Abstract
Allergists and immunologists rely on other specialists for higher risk procedures such as biopsies of the lung or gastrointestinal tract. However, we perform and interpret a handful of procedures ourselves. Training programs have historically required competency for prescribing immunoglobulin infusions, patch testing, rhino laryngoscopy, lung function testing, and provocation testing for airway hyperreactivity even though other specialists often perform them. Bone marrow aspirations and biopsies are not included in fellowship training assessments despite a significant number of marrow evaluations being requested by allergists and immunologists. For example, nearly 1 marrow assessment per month has been requested over 2 years for patients in the Allergy Immunology Clinic at Walter Reed National Military Medical Center. Marrow assessments are often required for diagnosis, monitoring, and treatment-related toxicities. Interpretive and procedural competency would benefit the field given the range of diseases in clinical immunology practice that require marrow assessment. We have generated a comprehensive list of the major conditions that might require bone marrow assessments in any Allergy and Immunology practice. We then summarize the specific tests that must be ordered and show how to determine sample quality. Finally, some providers may desire procedural competency and for those individuals we discuss tips for the procedure.
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Affiliation(s)
- Nathan A Boggs
- Uniformed Services University of the Health Sciences, Bethesda, Md.
| | - V Koneti Rao
- National Institutes of Health, National Institute of Allergy and Infectious Diseases, Bethesda, Md
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Carpentier C, Verbanck S, Schandené L, Heimann P, Trépant AL, Cogan E, Roufosse F. Eosinophilia Associated With CD3 -CD4 + T Cells: Characterization and Outcome of a Single-Center Cohort of 26 Patients. Front Immunol 2020; 11:1765. [PMID: 32849632 PMCID: PMC7432433 DOI: 10.3389/fimmu.2020.01765] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Accepted: 07/01/2020] [Indexed: 12/21/2022] Open
Abstract
Background: Lymphocytic variant hypereosinophilic syndrome is characterized by marked over-production of eosinophilopoietic factor(s) by dysregulated T cells leading to eosinophil expansion. In most cases, these T cells are clonal and express a CD3-CD4+ phenotype. As this is a rare disorder, presenting manifestations, disease course, treatment responses, and outcome are not well-characterized. Materials and Methods: In this retrospective single-center observational study, we reviewed medical files of all patients with persistent hypereosinophilia seen between 1994 and 2019 in whom CD3-CD4+ T cells were detected. Data collection included clinical and biological findings at presentation, treatment responses, disease course, and serial CD3-CD4+ T cell counts. Results: Our cohort comprises 26 patients, including 2 with hypereosinophilia of undetermined significance. All 24 symptomatic patients had cutaneous lesions and/or angioedema, and fasciitis was present in several cases. The aberrant T cell subset represented 2% or less total lymphocytes in 11 subjects. TCR gene rearrangement patterns on whole blood were polyclonal in these cases, while they all had serum CCL17/TARC levels above 1,500 pg/ml. Disease manifestations were mild and did not require maintenance therapy in roughly one third of the cohort, while two thirds required long-term oral corticosteroids and/or second-line agents. Among these, interferon-alpha was the most effective treatment option with a response observed in 8/8 patients, one of whom was cured of disease. Treatment had to be interrupted in most cases however due to poor tolerance and/or development of secondary resistance. Anti-interleukin-5 antibodies reduced blood eosinophilia in 5/5 patients, but clinical responses were disappointing. A sub-group of 5 patients had severe treatment-refractory disease, and experienced significant disease- and treatment-related morbidity and mortality, including progression to T cell lymphoma in three. Conclusions: This retrospective longitudinal analysis of the largest monocentric cohort of CD3-CD4+ T cell associated lymphocytic variant hypereosinophilic syndrome published so far provides clinicians confronted with this rare disorder with relevant new data on patient presentation and outcome that should help tailor therapy and follow-up to different levels of disease severity. It highlights the need for novel therapeutic options, especially for the subset of patients with severe treatment-refractory disease. Future research efforts should be made toward understanding CD3-CD4+ T cell biology in order to develop new treatments that target primary pathogenic mechanisms.
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Affiliation(s)
- Caroline Carpentier
- Department of Internal Medicine, Hôpital Erasme, Université Libre de Bruxelles, Brussels, Belgium
| | - Sylvain Verbanck
- Department of Internal Medicine, Hôpital Erasme, Université Libre de Bruxelles, Brussels, Belgium
| | - Liliane Schandené
- Laboratory of Immunobiology, Hôpital Erasme, Université Libre de Bruxelles, Brussels, Belgium
| | - Pierre Heimann
- Department of Medical Genetics, Hôpital Erasme, Université Libre de Bruxelles, Brussels, Belgium
| | - Anne-Laure Trépant
- Department of Pathology, Hôpital Erasme, Université Libre de Bruxelles, Brussels, Belgium
| | - Elie Cogan
- Department of Internal Medicine, Hôpital Erasme, Université Libre de Bruxelles, Brussels, Belgium
| | - Florence Roufosse
- Department of Internal Medicine, Hôpital Erasme, Université Libre de Bruxelles, Brussels, Belgium
- Institute for Medical Immunology, Université Libre de Bruxelles, Brussels, Belgium
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Shin W, Mun S, Choi S, Han K. Application of NanoString technologies in angioimmunoblastic T cell lymphoma. Genes Genomics 2020; 42:485-494. [PMID: 32146712 DOI: 10.1007/s13258-020-00919-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2020] [Accepted: 02/13/2020] [Indexed: 01/09/2023]
Abstract
BACKGROUND Angioimmunoblastic T-cell lymphoma (AITL) is an aggressive disease. Most cancer diagnoses are determined by anatomical histology. Therefore, many samples are stored in FFPE blocks for H&E staining. However, RNAs extracted from the FFPE block have a high level of fragmentation, making it difficult to perform accurate DEG analysis using RNA sequencing. OBJECTIVE To overcome fragmented RNA's drawback in NGS application, we applied the NanoString nCounter® technique of hybridization method that can be used for DEG analysis without PCR amplification. METHODS We characterized the gene expression profiling of AITLs though transcriptome analysis based on the nCounter® PanCancer IO 360™ Panel and NanoString platform. To perform the analysis of differential expression gene (DEG) profiles in AITLs, we compared the NanoString data from eight AITL patients with a healthy control donor. RESULTS Ninety-one genes were up-regulated and six genes were down-regulated in AITLs compared to control. The Gene Ontology (GO) analysis of 97-DEGs revealed that they were closely related to cytokine, MAPK cascade, leukocyte differentiation, and immune response, suggesting that this affect the immune system. In addition, KEGG analysis revealed that AITL DEGs were found to be highly involved in cytokine-cytokine receptor interaction and PI3K-Akt signaling pathway. CONCLUSION We believe that comprehensive multiplex studies, along with NanoString analysis, may be helpful to understand the molecular mechanisms of AITL, including mutations, gene expression, and protein expression studies.
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Affiliation(s)
- Wonseok Shin
- Department of Nanobiomedical Science and BK21 PLUS NBM Global Research Center for Regenerative Medicine, Dankook University, Cheonan, 31116, Republic of Korea
| | - Seyoung Mun
- Department of Nanobiomedical Science and BK21 PLUS NBM Global Research Center for Regenerative Medicine, Dankook University, Cheonan, 31116, Republic of Korea.,Center for Bio-Medical Engineering Core Facility, Dankook University, Cheonan, 31116, Republic of Korea
| | - Seungkyu Choi
- Department of Pathology, Dankook University College of Medicine, Cheonan, 31116, Republic of Korea.
| | - Kyudong Han
- Department of Nanobiomedical Science and BK21 PLUS NBM Global Research Center for Regenerative Medicine, Dankook University, Cheonan, 31116, Republic of Korea. .,Center for Bio-Medical Engineering Core Facility, Dankook University, Cheonan, 31116, Republic of Korea.
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Khoury P, Makiya M, Klion AD. Clinical and Biological Markers in Hypereosinophilic Syndromes. Front Med (Lausanne) 2017; 4:240. [PMID: 29312946 PMCID: PMC5743906 DOI: 10.3389/fmed.2017.00240] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2017] [Accepted: 12/13/2017] [Indexed: 12/15/2022] Open
Abstract
Hypereosinophilic syndromes (HES) are rare, heterogeneous syndromes characterized by markedly elevated eosinophil counts in the blood and/or tissue and evidence of eosinophil-associated pathology. Although parasitic infections, drug hypersensitivity, and other disorders of defined etiology can present as HES (associated HES), treatment is directed at the underlying cause rather than the eosinophilia itself. A number of additional subtypes of HES have been described, based on clinical and laboratory features. These include (1) myeloid HES—a primary disorder of the myeloid lineage, (2) lymphocytic variant HES—eosinophilia driven by aberrant or clonal lymphocytes secreting eosinophil-promoting cytokines, (3) overlap HES—eosinophilia restricted to a single organ or organ system, (4) familial eosinophilia—a rare inherited form of HES, and (5) idiopathic HES. Since clinical manifestations, response to therapy, and prognosis all differ between HES subtypes, this review will focus on clinical and biological markers that serve as markers of disease activity in HES (excluding associated HES), including those that are likely to be useful only in specific clinical subtypes.
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Affiliation(s)
- Paneez Khoury
- Human Eosinophil Section, Laboratory of Parasitic Diseases, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD, United States
| | - Michelle Makiya
- Human Eosinophil Section, Laboratory of Parasitic Diseases, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD, United States
| | - Amy D Klion
- Human Eosinophil Section, Laboratory of Parasitic Diseases, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD, United States
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9
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Kahn JE, Groh M, Lefèvre G. (A Critical Appraisal of) Classification of Hypereosinophilic Disorders. Front Med (Lausanne) 2017; 4:216. [PMID: 29259972 PMCID: PMC5723313 DOI: 10.3389/fmed.2017.00216] [Citation(s) in RCA: 49] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2017] [Accepted: 11/16/2017] [Indexed: 12/17/2022] Open
Abstract
Hypereosinophilia (HE) is a heterogeneous condition that can be reported in various (namely inflammatory, allergic, infectious, or neoplastic) diseases with distinct pathophysiological pathways. In 1975, Chusid et al. published the first diagnostic criteria of hypereosinophilic syndromes (HES). Over the years, as both basic and clinical knowledge improved, several updates have been suggested, with a focus on better distinguishing isolated or asymptomatic eosinophilia from diseases with specific eosinophil-related organ damage. Moreover, underlying molecular and cellular mechanisms of eosinophilia gradually became the cornerstone of successive attempts to classify HE-related diseases. In 2011, the International Cooperative Working Group on Eosinophil Disorders criteria emerged from a multidisciplinary Working Conference on Eosinophil Disorders and Syndromes, and provided substantial contribution to the clarification of general concepts and definitions in the field of HE. Yet, owing to the low prevalence of HE/HES, to the numerous diseases encompassed in the spectrum of HE-related disorders (with sometimes overlapping phenotypes), many questions are left unanswered (e.g., the need to better standardize the use of modern molecular tools, or the clinical relevance of distinguishing different subtypes of idiopathic HES). Here, we review the current state of knowledge in the fields of classification and diagnosis criteria of HE-related diseases, with emphasis on the analysis of both strengths and weaknesses of present concepts and their usefulness in daily practice.
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Affiliation(s)
- Jean Emmanuel Kahn
- Service de Médecine Interne, Centre de Référence des Syndromes Hyperéosinophiliques-CEREO, Hôpital Foch, Université Versailles-Saint Quentin en Yvelines, Suresnes, France
| | - Matthieu Groh
- Service de Médecine Interne, Hôpital Saint Louis, Université Paris-Diderot, Paris, France
| | - Guillaume Lefèvre
- Université de Lille, INSERM, CHU Lille, U995 - LIRIC - Lille Inflammation Research International Center, Institut d'Immunologie, Centre de Référence des Syndromes Hyperéosinophiliques-CEREO, Unité d'Immunologie Clinique, Lille, France
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10
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Abstract
Evaluation of peripheral blood and bone marrow for an indication of persistent eosinophilia can be a challenging task because there are many causes of eosinophilia and the morphologic differences between reactive and neoplastic causes are often subtle or lack specificity. The purpose of this review is to provide an overview of the differential diagnosis for eosinophilia, to recommend specific steps for the pathologist evaluating blood and bone marrow, and to emphasize 2 important causes of eosinophilia that require specific ancillary tests for diagnosis: myeloproliferative neoplasm with PDGFRA rearrangement and lymphocyte-variant hypereosinophilic syndrome.
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Affiliation(s)
- Daniel F Boyer
- From the Department of Pathology, University of Michigan, Ann Arbor
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11
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Loghavi S, Wang SA, Medeiros LJ, Jorgensen JL, Li X, Xu-Monette ZY, Miranda RN, Young KH. Immunophenotypic and diagnostic characterization of angioimmunoblastic T-cell lymphoma by advanced flow cytometric technology. Leuk Lymphoma 2016; 57:2804-2812. [PMID: 27105079 DOI: 10.3109/10428194.2016.1170827] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Angioimmunoblastic T-cell lymphoma (AITL) often shows systemic symptoms related to immune dysregulation and cytokine production. Biopsy usually harbors few malignant cells in an abundant reactive background, which can be diagnostically challenging in cases with small biopsies. This study was performed to assess the value of flow cytometry (FC) and to determine the immunophenotypic alterations in 155 samples from 38 patients with AITL. FC detected an aberrant T-cell population in 97 of 155 samples that represented 0.5-90% of lymphocytes. Blood was involved in 11 of 16 patients. The most frequent immunophenotypic aberrancies included loss of CD3; altered T-cell receptor expression and aberrant CD10 expression. Altered CD3 expression was more frequently seen in peripheral blood (PB) and bone marrow (BM), whereas aberrant CD10 expression was more common in lymph node (LN). AITL cells often exhibit abnormal CD4+ immunophenotype with diminished or absent CD3 and variable CD10 expression. Multiparameter FC is an effective tool for supporting the diagnosis of AITL in any fluid and various tissue specimens types.
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Affiliation(s)
- Sanam Loghavi
- a Department of Hematopathology , The University of Texas, MD Anderson Cancer Center , Houston , TX , USA
| | - Sa A Wang
- a Department of Hematopathology , The University of Texas, MD Anderson Cancer Center , Houston , TX , USA
| | - L Jeffrey Medeiros
- a Department of Hematopathology , The University of Texas, MD Anderson Cancer Center , Houston , TX , USA
| | - Jeffrey L Jorgensen
- a Department of Hematopathology , The University of Texas, MD Anderson Cancer Center , Houston , TX , USA
| | - Xin Li
- a Department of Hematopathology , The University of Texas, MD Anderson Cancer Center , Houston , TX , USA
| | - Zijun Y Xu-Monette
- a Department of Hematopathology , The University of Texas, MD Anderson Cancer Center , Houston , TX , USA
| | - Roberto N Miranda
- a Department of Hematopathology , The University of Texas, MD Anderson Cancer Center , Houston , TX , USA
| | - Ken H Young
- a Department of Hematopathology , The University of Texas, MD Anderson Cancer Center , Houston , TX , USA
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Lefèvre G, Copin MC, Roumier C, Aubert H, Avenel-Audran M, Grardel N, Poulain S, Staumont-Sallé D, Seneschal J, Salles G, Ghomari K, Terriou L, Leclech C, Morati-Hafsaoui C, Morschhauser F, Lambotte O, Ackerman F, Trauet J, Geffroy S, Dumezy F, Capron M, Roche-Lestienne C, Taieb A, Hatron PY, Dubucquoi S, Hachulla E, Prin L, Labalette M, Launay D, Preudhomme C, Kahn JE. CD3-CD4+ lymphoid variant of hypereosinophilic syndrome: nodal and extranodal histopathological and immunophenotypic features of a peripheral indolent clonal T-cell lymphoproliferative disorder. Haematologica 2015; 100:1086-95. [PMID: 25682606 PMCID: PMC5004425 DOI: 10.3324/haematol.2014.118042] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2014] [Accepted: 02/10/2015] [Indexed: 11/09/2022] Open
Abstract
The CD3(-)CD4(+) lymphoid variant of hypereosinophilic syndrome is characterized by hypereosinophilia and clonal circulating CD3(-)CD4(+) T cells. Peripheral T-cell lymphoma has been described during this disease course, and we observed in our cohort of 23 patients 2 cases of angio-immunoblastic T-cell lymphoma. We focus here on histopathological (n=12 patients) and immunophenotypic (n=15) characteristics of CD3(-)CD4(+) lymphoid variant of hypereosinophilic syndrome. Atypical CD4(+) T cells lymphoid infiltrates were found in 10 of 12 CD3(-)CD4(+) L-HES patients, in lymph nodes (n=4 of 4 patients), in skin (n=9 of 9) and other extra-nodal tissues (gut, lacrymal gland, synovium). Lymph nodes displayed infiltrates limited to the interfollicular areas or even an effacement of nodal architecture, associated with proliferation of arborizing high endothelial venules and increased follicular dendritic cell meshwork. Analysis of 2 fresh skin samples confirmed the presence of CD3(-)CD4(+) T cells. Clonal T cells were detected in at least one tissue in 8 patients, including lymph nodes (n=4 of 4): the same clonal T cells were detected in blood and in at least one biopsy, with a maximum delay of 23 years between samples. In the majority of cases, circulating CD3(-)CD4(+) T cells were CD2(hi) (n=9 of 14), CD5(hi) (n=12 of 14), and CD7(-)(n=4 of 14) or CD7(low) (n=10 of 14). Angio-immunoblastic T-cell lymphoma can also present with CD3(-)CD4(+) T cells; despite other common histopathological and immunophenotypic features, CD10 expression and follicular helper T-cell markers were not detected in lymphoid variant of hypereosinophilic syndrome patients, except in both patients who developed angio-immunoblastic T-cell lymphoma, and only at T-cell lymphoma diagnosis. Taken together, persistence of tissular clonal T cells and histopathological features define CD3(-)CD4(+) lymphoid variant of hypereosinophilic syndrome as a peripheral indolent clonal T-cell lymphoproliferative disorder, which should not be confused with angio-immunoblastic T-cell lymphoma.
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Affiliation(s)
- Guillaume Lefèvre
- Institute of Immunology, French Eosinophil Network and Research Unit EA2686, Lille University Hospital, Université Lille Nord de France, Lille Department of Internal Medicine - Clinical Immunology Unit and Research Unit EA2686, Lille University Hospital, Université Lille Nord de France, Lille
| | - Marie-Christine Copin
- Institute of Pathology and CNRS Unit Research UMR 8161, Lille University Hospital, Université Lille Nord de France, Lille
| | - Christophe Roumier
- Institute of Hematology and Inserm Unit U837, Lille University Hospital, Université Lille Nord de France, Lille
| | - Hélène Aubert
- Department of Dermatology, Nantes University Hospital, Nantes
| | | | - Nathalie Grardel
- Institute of Hematology and Inserm Unit U837, Lille University Hospital, Université Lille Nord de France, Lille
| | - Stéphanie Poulain
- Institute of Hematology and Inserm Unit U837, Lille University Hospital, Université Lille Nord de France, Lille
| | - Delphine Staumont-Sallé
- Department of Dermatology, Lille University Hospital, Université Lille Nord de France, Lille
| | - Julien Seneschal
- Department of Dermatology and Pediatric Dermatology, National Reference Center for Rare Skin Diseases and Inserm Unit Research U1035, Bordeaux University Hospital, Bordeaux
| | - Gilles Salles
- Department of Hematology, Lyon Sud University Hospital, Hospices Civils de Lyon, Lyon 1 University, Bron
| | | | - Louis Terriou
- Department of Internal Medicine - Clinical Immunology Unit and Research Unit EA2686, Lille University Hospital, Université Lille Nord de France, Lille
| | - Christian Leclech
- Department of Dermatology, Angers University Hospital and UNAM University, Angers
| | | | - Franck Morschhauser
- Department of Internal Medicine, Bicêtre University Hospital - APHP, Paris Sud XI University, Le Kremlin-Bicêtre
| | - Olivier Lambotte
- Department of Hematology, Lille University Hospital, Université Lille Nord de France, Lille
| | - Félix Ackerman
- Department of Hematology, Lille University Hospital, Université Lille Nord de France, Lille
| | - Jacques Trauet
- Institute of Immunology, French Eosinophil Network and Research Unit EA2686, Lille University Hospital, Université Lille Nord de France, Lille
| | - Sandrine Geffroy
- Institute of Hematology and Inserm Unit U837, Lille University Hospital, Université Lille Nord de France, Lille
| | - Florent Dumezy
- Institute of Hematology and Inserm Unit U837, Lille University Hospital, Université Lille Nord de France, Lille
| | - Monique Capron
- Inserm Unit Research U995, Lille University Hospital, Université Lille Nord de France, Lille
| | - Catherine Roche-Lestienne
- Institut de Génétique Médicale, Inserm Unit U837, Lille University Hospital, Université Lille Nord de France, Lille
| | - Alain Taieb
- Department of Dermatology and Pediatric Dermatology, National Reference Center for Rare Skin Diseases and Inserm Unit Research U1035, Bordeaux University Hospital, Bordeaux
| | - Pierre-Yves Hatron
- Department of Internal Medicine - Clinical Immunology Unit and Research Unit EA2686, Lille University Hospital, Université Lille Nord de France, Lille
| | - Sylvain Dubucquoi
- Institute of Immunology, French Eosinophil Network and Research Unit EA2686, Lille University Hospital, Université Lille Nord de France, Lille
| | - Eric Hachulla
- Institute of Immunology, French Eosinophil Network and Research Unit EA2686, Lille University Hospital, Université Lille Nord de France, Lille Department of Internal Medicine - Clinical Immunology Unit and Research Unit EA2686, Lille University Hospital, Université Lille Nord de France, Lille
| | - Lionel Prin
- Institute of Immunology, French Eosinophil Network and Research Unit EA2686, Lille University Hospital, Université Lille Nord de France, Lille
| | - Myriam Labalette
- Institute of Immunology, French Eosinophil Network and Research Unit EA2686, Lille University Hospital, Université Lille Nord de France, Lille
| | - David Launay
- Institute of Immunology, French Eosinophil Network and Research Unit EA2686, Lille University Hospital, Université Lille Nord de France, Lille Department of Internal Medicine - Clinical Immunology Unit and Research Unit EA2686, Lille University Hospital, Université Lille Nord de France, Lille
| | - Claude Preudhomme
- Institute of Hematology and Inserm Unit U837, Lille University Hospital, Université Lille Nord de France, Lille
| | - Jean-Emmanuel Kahn
- Institute of Immunology, French Eosinophil Network and Research Unit EA2686, Lille University Hospital, Université Lille Nord de France, Lille Department of Internal Medicine, Foch Hospital and Versailles-Saint-Quentin-en-Yvelines University, Suresnes, France
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