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Falini B, Lazzi S, Pileri S. A comparison of the International Consensus and 5th WHO classifications of T-cell lymphomas and histiocytic/dendritic cell tumours. Br J Haematol 2023; 203:369-383. [PMID: 37387351 DOI: 10.1111/bjh.18940] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Revised: 05/17/2023] [Accepted: 06/05/2023] [Indexed: 07/01/2023]
Abstract
Since the publication in 2017 of the revised 4th Edition of the World Health Organization (WHO) classification of haematolymphoid tumours, here referred to as WHO-HAEM4, significant clinicopathological, immunophenotypic and molecular advances have been made in the field of lymphomas, contributing to refining the diagnostic criteria of several diseases, upgrading entities previously defined as provisional and identifying new entities. This process has resulted in two recent classification proposals of lymphoid neoplasms: the International Consensus Classification (ICC) and the 5th edition of the WHO classification (WHO-HAEM5). In this paper, we review and compare the two classifications in terms of diagnostic criteria and entity definition, focusing on T-cell lymphomas and histiocytic/dendritic cell tumours. Moreover, we update the genetic data of the various pathological entities. The main goal is to provide a tool to facilitate the work of the pathologists, haematologists and researchers involved in the diagnosis and treatment of these haematological malignancies.
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Affiliation(s)
- Brunangelo Falini
- Institute of Haematology and CREO, University and Santa Maria della Misericordia Hospital of Perugia, Perugia, Italy
| | - Stefano Lazzi
- Department of Medical Biotechnology, Institute of Pathology, University of Siena, Siena, Italy
| | - Stefano Pileri
- European Institute of Oncology IRCCS, Milan, Italy
- Diatech Pharmacogenetics, Jesi, Italy
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2
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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: 0] [Impact Index Per Article: 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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3
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Fernandez-Flores A, Cassarino D. CD30 in Cutaneous Pathology. Am J Dermatopathol 2023; 45:593-607. [PMID: 37625801 DOI: 10.1097/dad.0000000000002422] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/27/2023]
Abstract
ABSTRACT The discovery of CD30 as a diagnostic marker was essential in the identification of not only some lymphomas but also many other solid tumors and benign reactive conditions. Many CD30+ cutaneous disorders and tumors have been categorized since the identification of the marker. With the design of targeted therapies against CD30+ tumoral cells, the interest in CD30 determination was not only diagnostic but also mainly therapeutic. In this article, we explore the historical aspects of the discovery of CD30 and examine the main CD30-related cutaneous pathology, susceptible of anti-CD30 modern treatments.
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Affiliation(s)
- Angel Fernandez-Flores
- Dermatopathologist, Department of Histopathology, University Hospital El Bierzo, Ponferrada, Spain
- Department of Cellular Pathology, Hospital de la Reina, Ponferrada, Spain
- Research Department, Institute for Biomedical Research of a Coruña (INIBIC), University of a Coruña (UDC), A Coruña, Spain; and
| | - David Cassarino
- Pathologist, Los Angeles Medical Center (LAMC), Southern California Kaiser Permanente, Departments of Pathology and Dermatology, Los Angeles, CA
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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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Lozano-Jaramillo DA, Millan-Arreola E, Esquer-Cota OO, Lozano-Garcia JM, Valenzuela-Espinoza MA. Soft-Tissue Anaplastic Lymphoma Kinase-Positive Anaplastic Large Cell Lymphoma in a Child Unmasked by COVID-19. J Hematol 2023; 12:37-41. [PMID: 36895288 PMCID: PMC9990711 DOI: 10.14740/jh1081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Accepted: 01/26/2023] [Indexed: 03/11/2023] Open
Abstract
Anaplastic large cell lymphoma (ALCL) is children's most common mature T-cell neoplasm. The majority is positive for anaplastic lymphoma kinase (ALK). Initial presentation as a soft-tissue pelvic mass without nodal involvement is rare and can be easily misdiagnosed. We report a case of a 12-year-old male presenting with pain and movement restriction in the right extremity. Computed tomography (CT) scan revealed a solitary pelvic mass. Initial biopsy examination concluded rhabdomyosarcoma. After developing pediatric multisystemic inflammatory syndrome due to coronavirus disease 2019 (COVID-19), central and peripheral lymph node enlargement appeared. New cervical adenopathy and pelvic mass biopsies were performed. Immunohistochemistry concluded an ALK-positive ALCL with a small-cell pattern. The patient was treated with brentuximab-based chemotherapy and eventually improved. Differential diagnosis of pelvic masses in children and adolescents must include ALCL. An inflammatory trigger may promote the appearance of a typical nodal disease, previously absent. Attention is warranted during histopathological examination to avoid diagnostic errors.
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Affiliation(s)
- Diego Alberto Lozano-Jaramillo
- Centro de Investigacion Valle Bibb Fundacion, Tijuana, Baja California, Mexico.,Centro Oncologico Pediatrico de Baja California, Tijuana, Baja California, Mexico
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6
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Zhang Y, Chen M, Yu Y, Liu X, Liu W, Jiang L, Zhang W. Primary cutaneous anaplastic large-cell lymphoma with DUSP22-IRF4 rearrangement following insect bites. J Cutan Pathol 2021; 49:187-190. [PMID: 34622970 PMCID: PMC9297975 DOI: 10.1111/cup.14147] [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: 04/10/2021] [Revised: 07/31/2021] [Accepted: 09/30/2021] [Indexed: 02/05/2023]
Abstract
Primary cutaneous anaplastic large‐cell lymphoma (pC‐ALCL) is distinguished from systemic anaplastic large‐cell lymphoma (S‐ALCL) with cutaneous involvement. Although pC‐ALCL is a unique entity with different genetics, clinical characteristics, and prognosis, its causes are unknown. Herein, we report the case of a Chinese woman with a 4‐month history of a gradually enlarged ulcerative mass in her right forearm following an unidentified insect bite. Biopsy revealed an extensive infiltrate with patches of large anaplastic lymphoid cells. These cells were immunohistochemically positive for CD45, CD30, and TIA‐1 and negative for CD2, CD3, CD4, CD5, CD20, CD7, CD8, and ALK‐1. DUSP22‐IRF4 rearrangement was detected; on the other hand, TP63 rearrangement was not observed by fluorescence in situ hybridization (FISH). No Epstein‐Barr virus‐encoded small RNAs (EBERs) were detected by ISH. Rearrangement of monoclonal TCR gene was found using BIOMED‐2 polymerase chain reaction. No abnormality was found on the subsequent positron emission tomography‐computed tomography (PET‐CT) scan. After five cycles of cyclophosphamide + doxorubicin + vincristine + prednisolone (CHOP) chemotherapy, the patient achieved complete remission. This is the first report of a unique pC‐ALCL with DUSP22‐IRF4 rearrangement following an insect bite other than S‐ALCL involving the skin.
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Affiliation(s)
- Yaping Zhang
- Department of Pathology, West China Hospital, Sichuan University, Chengdu, China
| | - Min Chen
- Department of Pathology, West China Hospital, Sichuan University, Chengdu, China
| | - Yu Yu
- Department of Pathology, West China Hospital, Sichuan University, Chengdu, China
| | - Xiaoyu Liu
- Department of Pathology, West China Hospital, Sichuan University, Chengdu, China
| | - Weiping Liu
- Department of Pathology, West China Hospital, Sichuan University, Chengdu, China
| | - Lijun Jiang
- Department of Oncology, The Second People's Hospital of Neijiang, Neijiang, China
| | - Wenyan Zhang
- Department of Pathology, West China Hospital, Sichuan University, Chengdu, China
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Wurster KD, Costanza M, Kreher S, Glaser S, Lamprecht B, Schleussner N, Anagnostopoulos I, Hummel M, Jöhrens K, Stein H, Molina A, Diepstra A, Gillissen B, Köchert K, Siebert R, Merkel O, Kenner L, Janz M, Mathas S. Aberrant Expression of and Cell Death Induction by Engagement of the MHC-II Chaperone CD74 in Anaplastic Large Cell Lymphoma (ALCL). Cancers (Basel) 2021; 13:cancers13195012. [PMID: 34638496 PMCID: PMC8507667 DOI: 10.3390/cancers13195012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Accepted: 09/23/2021] [Indexed: 12/04/2022] Open
Abstract
Simple Summary Anaplastic large cell lymphoma (ALCL) is a lymphoid malignancy considered to be derived from T cells. Currently, two types of systemic ALCL are distinguished: anaplastic lymphoma kinase (ALK)-positive and ALK-negative ALCL. Although ALK+ and ALK− ALCL differ at the genomic and molecular levels, various key biological and molecular features are highly similar between both entities. We have developed the concept that both ALCL entities share a common principle of pathogenesis. In support of this concept, we here describe a common deregulation of CD74, which is usually not expressed in T cells, in ALCL. Ligation of CD74 induces cell death of ALCL cells in various conditions, and an anti-CD74-directed antibody-drug conjugate efficiently kills ALCL cell lines. Furthermore, we reveal expression of the proto-oncogene and known CD74 interaction partner MET in a fraction of ALCL cases. These data give insights into ALCL pathogenesis and might help to develop new treatment strategies for ALCL. Abstract In 50–60% of cases, systemic anaplastic large cell lymphoma (ALCL) is characterized by the t(2;5)(p23;q35) or one of its variants, considered to be causative for anaplastic lymphoma kinase (ALK)-positive (ALK+) ALCL. Key pathogenic events in ALK-negative (ALK−) ALCL are less well defined. We have previously shown that deregulation of oncogenic genes surrounding the chromosomal breakpoints on 2p and 5q is a unifying feature of both ALK+ and ALK− ALCL and predisposes for occurrence of t(2;5). Here, we report that the invariant chain of the MHC-II complex CD74 or li, which is encoded on 5q32, can act as signaling molecule, and whose expression in lymphoid cells is usually restricted to B cells, is aberrantly expressed in T cell-derived ALCL. Accordingly, ALCL shows an altered DNA methylation pattern of the CD74 locus compared to benign T cells. Functionally, CD74 ligation induces cell death of ALCL cells. Furthermore, CD74 engagement enhances the cytotoxic effects of conventional chemotherapeutics in ALCL cell lines, as well as the action of the ALK-inhibitor crizotinib in ALK+ ALCL or of CD95 death-receptor signaling in ALK− ALCL. Additionally, a subset of ALCL cases expresses the proto-oncogene MET, which can form signaling complexes together with CD74. Finally, we demonstrate that the CD74-targeting antibody-drug conjugate STRO-001 efficiently and specifically kills CD74-positive ALCL cell lines in vitro. Taken together, these findings enabled us to demonstrate aberrant CD74-expression in ALCL cells, which might serve as tool for the development of new treatment strategies for this lymphoma entity.
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Affiliation(s)
- Kathrin D. Wurster
- Max-Delbrück-Center (MDC) for Molecular Medicine, 13125 Berlin, Germany; (M.C.); (N.S.); (M.J.)
- Department of Hematology, Oncology and Cancer Immunology, Charité–Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, 12200 Berlin, Germany
- Experimental and Clinical Research Center, a joint cooperation between the Charité and the MDC, 13125 Berlin, Germany
| | - Mariantonia Costanza
- Max-Delbrück-Center (MDC) for Molecular Medicine, 13125 Berlin, Germany; (M.C.); (N.S.); (M.J.)
- Department of Hematology, Oncology and Cancer Immunology, Charité–Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, 12200 Berlin, Germany
- Experimental and Clinical Research Center, a joint cooperation between the Charité and the MDC, 13125 Berlin, Germany
| | - Stephan Kreher
- Max-Delbrück-Center (MDC) for Molecular Medicine, 13125 Berlin, Germany; (M.C.); (N.S.); (M.J.)
- Department of Hematology, Oncology and Cancer Immunology, Charité–Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, 12200 Berlin, Germany
- Experimental and Clinical Research Center, a joint cooperation between the Charité and the MDC, 13125 Berlin, Germany
| | - Selina Glaser
- Institute of Human Genetics, Ulm University, Ulm University Medical Center, 89081 Ulm, Germany; (S.G.); (R.S.)
| | - Björn Lamprecht
- Max-Delbrück-Center (MDC) for Molecular Medicine, 13125 Berlin, Germany; (M.C.); (N.S.); (M.J.)
- Department of Hematology, Oncology and Cancer Immunology, Charité–Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, 12200 Berlin, Germany
- Experimental and Clinical Research Center, a joint cooperation between the Charité and the MDC, 13125 Berlin, Germany
- German Cancer Consortium (DKTK), German Cancer Research Center (DKFZ), 69120 Heidelberg, Germany;
| | - Nikolai Schleussner
- Max-Delbrück-Center (MDC) for Molecular Medicine, 13125 Berlin, Germany; (M.C.); (N.S.); (M.J.)
- Department of Hematology, Oncology and Cancer Immunology, Charité–Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, 12200 Berlin, Germany
- Experimental and Clinical Research Center, a joint cooperation between the Charité and the MDC, 13125 Berlin, Germany
| | - Ioannis Anagnostopoulos
- Institute of Pathology, Charité–Universitätsmedizin Berlin, 10117 Berlin, Germany; (I.A.); (K.J.)
| | - Michael Hummel
- German Cancer Consortium (DKTK), German Cancer Research Center (DKFZ), 69120 Heidelberg, Germany;
- Institute of Pathology, Charité–Universitätsmedizin Berlin, 10117 Berlin, Germany; (I.A.); (K.J.)
| | - Korinna Jöhrens
- Institute of Pathology, Charité–Universitätsmedizin Berlin, 10117 Berlin, Germany; (I.A.); (K.J.)
| | | | - Arturo Molina
- Sutro Biopharma, South San Francisco, CA 94080, USA;
| | - Arjan Diepstra
- Department of Pathology and Medical Biology, University of Groningen, University Medical Centre Groningen, 9700 RB Groningen, The Netherlands;
| | - Bernd Gillissen
- Department of Hematology, Oncology, and Tumor Immunology, Charité–Universitätsmedizin Berlin, 13125 Berlin, Germany;
| | - Karl Köchert
- Max-Delbrück-Center (MDC) for Molecular Medicine, 13125 Berlin, Germany; (M.C.); (N.S.); (M.J.)
- Department of Hematology, Oncology and Cancer Immunology, Charité–Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, 12200 Berlin, Germany
- Experimental and Clinical Research Center, a joint cooperation between the Charité and the MDC, 13125 Berlin, Germany
| | - Reiner Siebert
- Institute of Human Genetics, Ulm University, Ulm University Medical Center, 89081 Ulm, Germany; (S.G.); (R.S.)
| | - Olaf Merkel
- Unit of Experimental and Laboratory Animal Pathology, Department of Pathology, Medical University of Vienna, 1090 Vienna, Austria; (O.M.); (L.K.)
- European Research Initiative on ALK-related malignancies (ERIA), 1090 Vienna, Austria
| | - Lukas Kenner
- Unit of Experimental and Laboratory Animal Pathology, Department of Pathology, Medical University of Vienna, 1090 Vienna, Austria; (O.M.); (L.K.)
- European Research Initiative on ALK-related malignancies (ERIA), 1090 Vienna, Austria
| | - Martin Janz
- Max-Delbrück-Center (MDC) for Molecular Medicine, 13125 Berlin, Germany; (M.C.); (N.S.); (M.J.)
- Department of Hematology, Oncology and Cancer Immunology, Charité–Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, 12200 Berlin, Germany
- Experimental and Clinical Research Center, a joint cooperation between the Charité and the MDC, 13125 Berlin, Germany
| | - Stephan Mathas
- Max-Delbrück-Center (MDC) for Molecular Medicine, 13125 Berlin, Germany; (M.C.); (N.S.); (M.J.)
- Department of Hematology, Oncology and Cancer Immunology, Charité–Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, 12200 Berlin, Germany
- Experimental and Clinical Research Center, a joint cooperation between the Charité and the MDC, 13125 Berlin, Germany
- German Cancer Consortium (DKTK), German Cancer Research Center (DKFZ), 69120 Heidelberg, Germany;
- European Research Initiative on ALK-related malignancies (ERIA), 1090 Vienna, Austria
- Correspondence: ; Tel.: +49-30-94062863; Fax: +49-30-94063124
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Abstract
OBJECTIVES This review describes our approach to the diagnosis of all 4 anaplastic large cell lymphoma (ALCL) entities. METHODS ALCLs are a group of CD30-positive mature T-cell lymphomas with similar morphologic and phenotypic characteristics but variable clinical and genetic features. They include systemic ALK-positive ALCL, systemic ALK-negative ALCL, primary cutaneous ALCL, and the recently described provisional entity breast implant-associated ALCL. RESULTS In cases with classic features, the diagnosis of ALCL is often straightforward. However, variant histology, the importance of clinical history, and multiple antigenic aberrancies all present challenges to accurate diagnosis and subclassification. CONCLUSIONS A systematic approach to the diagnosis of ALCL and awareness of potential mimics are critical to avoid misdiagnosis. It is also crucial to correctly identify localized forms of ALCL to avoid classification as systemic ALCL and subsequent overtreatment.
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Affiliation(s)
- Catalina Amador
- Department of Pathology and Microbiology, University of Nebraska, Omaha, NE, USA
| | - Andrew L Feldman
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA
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9
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Clinical, Histologic, and Molecular Characteristics of Anaplastic Lymphoma Kinase-positive Primary Cutaneous Anaplastic Large Cell Lymphoma. Am J Surg Pathol 2020; 44:776-781. [PMID: 32412717 DOI: 10.1097/pas.0000000000001449] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Unlike systemic anaplastic large cell lymphoma, the vast majority of primary cutaneous anaplastic large cell lymphomas (C-ALCL) do not carry translocations involving the ALK gene and do not express ALK. Expression of ALK protein therefore strongly suggests secondary cutaneous involvement of a systemic anaplastic large cell lymphoma. Recent studies described a small subgroup of ALK-positive C-ALCL, but information on frequency, prognosis, and translocation partners is virtually lacking. A total of 6/309 (2%) C-ALCL patients included in the Dutch registry for cutaneous lymphomas between 1993 and 2019 showed immunohistochemical ALK expression. Clinical and histopathologic characteristics, immunophenotype and disease course were evaluated. Underlying ALK translocations were analyzed with anchored multiplex polymerase chain reaction-based targeted next-generation sequencing. Median age at diagnosis was 39 years (range: 16 to 53 y). All patients presented with a solitary lesion. Treatment with radiotherapy (n=5) or anthracycline-based chemotherapy (n=1) resulted in complete responses in all 6 patients. Three patients developed a relapse, of whom 2 extracutaneous. After a median follow-up of 41 months, 5 patients were alive without disease and 1 patient died of lymphoma. Immunohistochemically, 3 cases (50%) showed combined nuclear and cytoplasmic ALK expression with underlying NPM1-ALK fusions, while 3 cases (50%) showed solely cytoplasmic ALK expression with variant ALK fusion partners (TRAF1, ATIC, TPM3). ALK-positive C-ALCL is extremely uncommon, has a comparable favorable prognosis to ALK-negative C-ALCL, and should be treated in the same way with radiotherapy as first-line treatment.
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10
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Gru AA, McHargue C, Salavaggione AL. A Systematic Approach to the Cutaneous Lymphoid Infiltrates: A Clinical, Morphologic, and Immunophenotypic Evaluation. Arch Pathol Lab Med 2020; 143:958-979. [PMID: 31339758 DOI: 10.5858/arpa.2018-0294-ra] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
CONTEXT.— The evaluation of cutaneous lymphoid infiltrates, both neoplastic and inflammatory, occurs very frequently in routine dermatopathologic examination and consultation practices. The "tough" cutaneous lymphoid infiltrate is feared by many pathologists; skin biopsies are relatively small, whereas diagnostic possibilities are relatively broad. It is true that cutaneous lymphomas can be difficult to diagnose and that in many circumstances multiple biopsies are required to establish a correct diagnostic interpretation. As a reminder, one should understand that low-grade cutaneous lymphomas are indolent disorders that usually linger for decades and that therapy does not result in disease cure. It is also important to remember that in most circumstances, those patients will die from another process that is completely unrelated to a diagnosis of skin lymphoma (even in the absence of specific therapy). OBJECTIVE.— To use a clinicopathologic, immunophenotypic, and molecular approach in the evaluation of common lymphocytic infiltrates. DATA SOURCES.— An in-depth analysis of updated literature in the field of cutaneous lymphomas was done, with particular emphasis on updated terminology from the most recent World Health Organization classification of skin and hematologic tumors. CONCLUSIONS.— A diagnosis of cutaneous lymphoid infiltrates can be adequately approached using a systematic scheme following the proposed ABCDE system. Overall, cutaneous T- and B-cell lymphomas are rare and "reactive" infiltrates are more common. Evaluation of lymphoid proliferations should start with a good sense of knowledge of the clinical presentation of the lesions, the clinical differential considerations, and a conscientious and appropriate use of immunohistochemistry and molecular tools.
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Affiliation(s)
- Alejandro A Gru
- From the Departments of Pathology (Drs Gru and Salavaggione) and Dermatology (Dr Gru), University of Virginia, Charlottesville; and the Department of Dermatology (Dr McHargue), Henry Ford Health System, Detroit, Michigan
| | - Chauncey McHargue
- From the Departments of Pathology (Drs Gru and Salavaggione) and Dermatology (Dr Gru), University of Virginia, Charlottesville; and the Department of Dermatology (Dr McHargue), Henry Ford Health System, Detroit, Michigan
| | - Andrea L Salavaggione
- From the Departments of Pathology (Drs Gru and Salavaggione) and Dermatology (Dr Gru), University of Virginia, Charlottesville; and the Department of Dermatology (Dr McHargue), Henry Ford Health System, Detroit, Michigan
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11
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Fitzal F, Turner SD, Kenner L. Is breast implant-associated anaplastic large cell lymphoma a hazard of breast implant surgery? Open Biol 2020; 9:190006. [PMID: 30939983 PMCID: PMC6501645 DOI: 10.1098/rsob.190006] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Breast implant-associated anaplastic large cell lymphoma (BIA-ALCL) may occur after reconstructive or aesthetic breast surgery. Worldwide, approximately 1.7 million breast implant surgeries are performed each year. To date, over 500 cases of BIA-ALCL have been reported around the world, with 16 women having died. This review highlights the most important facts surrounding BIA-ALCL. There is no consensus regarding the true incidence rate of BIA-ALCL as it varies between countries, is probably significantly under-reported and is difficult to estimate due to the true number of breast prostheses used largely being unknown. BIA-ALCL develops in the breast mostly as a seroma surrounding the implant, but contained within the fibrous capsule, or more rarely as a solid mass that can become invasive infiltrating the chest wall and muscle, in some instances spreading to adjacent lymph nodes, in these cases having a far worse prognosis. The causation of BIA-ALCL remains to be established, but it has been proposed that chronic infection and/or implant toxins may be involved. What is clear is that complete capsulectomy is required for treatment of BIA-ALCL, which for early-stage disease leads to cure, whereas chemotherapy is needed for advanced-stage disease, whereby improved results have been reported with the use of brentuximab. A worldwide database for BIA-ALCL and implants should be supported by local governments.
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Affiliation(s)
- Florian Fitzal
- 1 Department of Surgery and Comprehensive Cancer Center, Medical University Vienna , Vienna , Austria
| | - Suzanne D Turner
- 2 Division of Cellular and Molecular Pathology, Department of Pathology, University of Cambridge , Cambridge CB20QQ , UK.,6 Department for Experimental and Laboratory Animal Pathology, Clinical Institute of Pathology, Medical University of Vienna , 1090 Vienna , Austria
| | - Lukas Kenner
- 3 Ludwig Boltzmann Institute for Cancer Research , 1090 Vienna , Austria.,4 Unit of Laboratory Animal Pathology, University of Veterinary Medicine Vienna , 1210 Vienna , Austria.,5 Division of Experimental Pathology, Medical University of Vienna , 1090 Vienna , Austria.,6 Department for Experimental and Laboratory Animal Pathology, Clinical Institute of Pathology, Medical University of Vienna , 1090 Vienna , Austria.,7 The European Research Initiative for ALK-related Malignancies (ERIA) , Cambridge , UK
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12
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Turner SD. Commentary on: Anaplastic Large Cell Lymphoma of the Breast Arising in a Burn Cicatrix. Aesthet Surg J 2020; 40:NP164-NP166. [PMID: 31886484 DOI: 10.1093/asj/sjz285] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Affiliation(s)
- Suzanne D Turner
- Cellular and Molecular Tumour Biology, Division of Cellular and Molecular Pathology, Department of Pathology, University of Cambridge, Cambridge, UK
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13
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Lymphomas arising in immune-privileged sites: insights into biology, diagnosis, and pathogenesis. Virchows Arch 2019; 476:647-665. [PMID: 31863183 DOI: 10.1007/s00428-019-02698-3] [Citation(s) in RCA: 50] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2019] [Revised: 09/24/2019] [Accepted: 10/16/2019] [Indexed: 02/07/2023]
Abstract
Session 2 of the 2018 European Association of Hematopathology/Society for Hematopathology Workshop focused on lymphomas arising in immune-privileged sites: both lymphomas arising in the traditionally described "immune sanctuary" sites of the central nervous system (CNS) and testes, as well as those arising at sites of local immune privilege. Primary CNS large B cell lymphoma and primary testicular large B cell lymphoma were discussed, and the biology of these unique tumors was highlighted by several cases showing the classic mutation profile including MYD88 L265P and CD79B. The tendency of these tumors to involve both the CNS and testis was also reinforced by several cases. Four cases of low-grade B cell lymphomas (LGBCL) of the CNS were discussed. Two were classic Bing-Neel syndrome associated with LPL, and two were LGBCL with plasmacytic differentiation and amyloid deposition without systemic disease. Rare examples of systemic T and NK cell lymphomas involving the CNS were also discussed. Several cases of breast implant-associated anaplastic large cell lymphoma (BI-ALCL) were submitted showing the typical clinicopathologic features. These cases were discussed along with a case with analogous features arising in a patient with a gastric band implant, as well as large B cell lymphomas arising alongside foreign materials. Finally, large B cell lymphomas arising in effusions or localized sites of chronic inflammation (fibrin-associated diffuse large B cell lymphoma [DLBCL] and DLBCL associated with chronic inflammation) were described. The pathogenesis of all of these lymphomas is believed to be related to decreased immune surveillance, either innate to the physiology of the organ or acquired at a local site.
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14
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Cocks M, Porcu P, Wick MR, Gru AA. Recent Advances in Cutaneous T-cell Lymphoma: Diagnostic and Prognostic Considerations. Surg Pathol Clin 2019; 12:783-803. [PMID: 31352988 DOI: 10.1016/j.path.2019.03.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
This review describes the latest advances in the diagnosis of cutaneous T-cell lymphoma focusing on the most clinically useful features introduced since the publication of the World Health Organization revision in 2017. Clinical entities described include mycosis fungoides, Sézary syndrome, lymphomatoid papulosis, primary cutaneous anaplastic large cell lymphoma, primary cutaneous gamma delta T-cell lymphoma, primary cutaneous acral CD8+ T-cell lymphoma, primary cutaneous CD4+ small/medium T-cell lymphoproliferative disorder, and hydroa-vacciniforme-like lymphoproliferative disorder. Distinguishing histologic clues to diagnosis are discussed, and important molecular advances are described. Key prognostic indicators that may assist clinicians with timely and appropriate management options are presented.
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Affiliation(s)
- Margaret Cocks
- Department of Pathology, University of Virginia, PO Box 800214, 1215 Lee Street, Hospital Expansion Building Room 2015, Charlottesville, VA 22908, USA
| | - Pierluigi Porcu
- Division of Medical Oncology and Hematopoietic Stem Cell Transplantation, Jefferson University, Suite 420A, 925 Chestnut Street, Philadelphia, PA 19107, USA
| | - Mark R Wick
- Department of Pathology, University of Virginia, PO Box 800214, 1215 Lee Street, Hospital Expansion Building Room 3020, Charlottesville, VA 22908, USA
| | - Alejandro A Gru
- Department of Pathology, University of Virginia, PO Box 800214, 1215 Lee Street, Hospital Expansion Building Room 3018, Charlottesville, VA 22908, USA.
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15
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Kempf W, Torricelli R, Zettl A, Zimmermann AK, Berisha A, Ghielmini M. Primary Cutaneous Anaplastic Lymphoma Kinase-Positive Large B-Cell Lymphoma. Am J Dermatopathol 2019; 41:602-605. [PMID: 31335416 DOI: 10.1097/dad.0000000000001348] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Large B-cell lymphomas include several subtypes. Recently, anaplastic lymphoma kinase (ALK)-positive large B-cell lymphoma has been delineated as a distinct entity involving mostly lymph nodes and rarely affecting extranodal sites. We describe the first case of a primary cutaneous ALK-positive large B-cell lymphoma in a 48-year-old man with a solitary nodule on the back, and describe the histologic and phenotypic features. Accurate staging confirmed the absence of other lesions, and so surgical excision and postoperative local radiation therapy were initiated and resulted in complete remission. Two years later, extracutaneous spread with involvement of axillary lymph nodes occurred. Complete remission was achieved again by multiagent chemotherapy. Our case demonstrates that a primary cutaneous form of ALK-positive large B-cell lymphoma exists. The immunophenotypic analysis of cutaneous large B-cell lymphomas affecting the skin primarily or secondarily should include the assessment of ALK expression.
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MESH Headings
- Anaplastic Lymphoma Kinase/analysis
- Anaplastic Lymphoma Kinase/genetics
- Antineoplastic Combined Chemotherapy Protocols/therapeutic use
- Biomarkers, Tumor/analysis
- Biomarkers, Tumor/genetics
- Biopsy
- Dermatologic Surgical Procedures
- Humans
- Immunohistochemistry
- In Situ Hybridization, Fluorescence
- Lymphatic Metastasis
- Lymphoma, Large B-Cell, Diffuse/enzymology
- Lymphoma, Large B-Cell, Diffuse/genetics
- Lymphoma, Large B-Cell, Diffuse/pathology
- Lymphoma, Large B-Cell, Diffuse/therapy
- Male
- Middle Aged
- Radiotherapy, Adjuvant
- Skin Neoplasms/enzymology
- Skin Neoplasms/genetics
- Skin Neoplasms/pathology
- Skin Neoplasms/therapy
- Treatment Outcome
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Affiliation(s)
- Werner Kempf
- Kempf und Pfaltz, Histologische Diagnostik, Zurich, Switzerland
| | | | | | | | | | - Michele Ghielmini
- Oncologia Ospedale Regionale Bellinzona e Valli, Bellinzona, Switzerland
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16
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Prieto-Torres L, Rodriguez-Pinilla SM, Onaindia A, Ara M, Requena L, Piris MÁ. CD30-positive primary cutaneous lymphoproliferative disorders: molecular alterations and targeted therapies. Haematologica 2019; 104:226-235. [PMID: 30630983 PMCID: PMC6355473 DOI: 10.3324/haematol.2018.197152] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2018] [Accepted: 12/07/2018] [Indexed: 01/06/2023] Open
Abstract
Primary cutaneous CD30-positive T-cell lymphoproliferative disorders are the second most common subgroup of cutaneous T-cell lymphomas. They include two clinically different entities with some overlapping features and borderline cases: lymphomatoid papulosis and primary cutaneous anaplastic large cell lymphoma. Molecular studies of primary cutaneous anaplastic large cell lymphoma reveal an increasing level of heterogeneity that is associated with histological and immunophenotypic features of the cases and their response to specific therapies. Here, we review the most significant genetic, epigenetic and molecular alterations described to date in primary cutaneous CD30-positive T-cell lymphoproliferative disorders, and their potential as therapeutic targets.
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Affiliation(s)
| | - Socorro M Rodriguez-Pinilla
- Department of Pathology, Hospital Universitario Fundación Jiménez Díaz, Madrid.,Hospital Universitario Fundación Jiménez Díaz, Madrid, CIBERONC, Madrid
| | - Arantza Onaindia
- Pathology, Hospital Universitario Marques de Valdecilla, Santander
| | - Mariano Ara
- Dermatology Hospital Clínico Universitario Lozano Blesa, Zaragoza, Spain
| | | | - Miguel Á Piris
- Department of Pathology, Hospital Universitario Fundación Jiménez Díaz, Madrid.,Hospital Universitario Fundación Jiménez Díaz, Madrid, CIBERONC, Madrid
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17
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Kadin ME, Morgan J, Xu H, Epstein AL, Sieber D, Hubbard BA, Adams WP, Bacchi CE, Goes JCS, Clemens MW, Medeiros LJ, Miranda RN. IL-13 is produced by tumor cells in breast implant-associated anaplastic large cell lymphoma: implications for pathogenesis. Hum Pathol 2018; 78:54-62. [PMID: 29689246 DOI: 10.1016/j.humpath.2018.04.007] [Citation(s) in RCA: 42] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2017] [Revised: 04/10/2018] [Accepted: 04/11/2018] [Indexed: 02/07/2023]
Abstract
More than 500 women worldwide have developed a CD30+ T-cell lymphoma around breast implants, strongly suggesting a cause-and-effect relationship, and designated as breast implant-associated anaplastic large cell lymphoma (BIA-ALCL). The mechanism of lymphomagenesis is unknown. Recently, a bacterial biofilm containing gram-negative bacilli was discovered on the surface of breast implants associated with ALCL. We and others have described overexpression of the proto-oncogene JUNB and mutations of JAK1/2, TP53 and STAT3 in BIA-ALCL. Here we report that BIA-ALCL cell lines and anaplastic lymphoma cells in clinical specimens produce IL-13, the signature cytokine of allergic inflammation. Supporting the link of BIA-ALCL to allergic inflammation, lymphoma cells were often surrounded by eosinophils and mast cells, features typically absent in systemic ALCL. Because of the link of IL-13 to allergy, we looked for IgE and found it decorating the surface of mast cells and antigen-presenting follicular dendritic cells in capsules and lymph nodes infiltrated by anaplastic lymphoma cells, but not uninvolved capsules. Plasma cells within capsules and regional lymph nodes were identified as a possible source of IgE. Together, these findings suggest the hypothesis that an amplified immune response with features of a chronic allergic reaction in a susceptible patient underlies the pathogenesis of BIA-ALCL.
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Affiliation(s)
| | - John Morgan
- Roger Williams Medical Center, Providence, RI 02908
| | - Haiying Xu
- Roger Williams Medical Center, Providence, RI 02908
| | | | | | | | | | | | - Joao C S Goes
- Inst Bras Controle Câncer, San Paolo, Brazil 04536-010
| | - Mark W Clemens
- Plastic Surgery Division, MD Anderson Cancer Center, Houston, TX 77030
| | | | - Roberto N Miranda
- Hematopathology Division, MD Anderson Cancer Center, Houston, TX 77030
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18
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A Case of ALK+ Anaplastic Large-Cell Lymphoma With Aberrant Myeloperoxidase Expression and Initial Cutaneous Presentation. Am J Dermatopathol 2018; 40:519-522. [DOI: 10.1097/dad.0000000000001061] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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19
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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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20
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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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21
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An Exploration into the Origins and Pathogenesis of Anaplastic Large Cell Lymphoma, Anaplastic Lymphoma Kinase (ALK)-Positive. Cancers (Basel) 2017. [PMCID: PMC5664080 DOI: 10.3390/cancers9100141] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
T-cell non-Hodgkin lymphoma is a heterogeneous disease ranging from malignancies arising from thymic T cells halted in development, through to mature, circulating peripheral T cells. The latter cases are diagnostically problematic with many entering the category of peripheral T-cell lymphoma, not otherwise specified (PTCL, NOS). Anaplastic large cell lymphoma (ALCL) is one of the exceptions to this whereby aberrant expression of anaplastic lymphoma kinase (ALK) and the distinctive presence of cell surface CD30 places this entity in its own class. Besides the expression of a well-studied oncogenic translocation, ALCL, ALK+ may also have a unique pathogenesis with a thymic origin like T lymphoblastic lymphoma but a peripheral presentation akin to PTCL. This perspective discusses evidence towards the potential origin of ALCL, ALK+, and mechanisms that may give rise to its unique phenotype.
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22
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Anaplastic Lymphoma Kinase in Cutaneous Malignancies. Cancers (Basel) 2017; 9:cancers9090123. [PMID: 28895885 PMCID: PMC5615338 DOI: 10.3390/cancers9090123] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2017] [Revised: 09/05/2017] [Accepted: 09/10/2017] [Indexed: 12/22/2022] Open
Abstract
Anaplastic lymphoma kinase (ALK) is a receptor tyrosine kinase that has been implicated in the pathogenesis of a variety of neoplasms. As suggested by its name, ALK was first described as part of a translocation product in cases of anaplastic large-cell lymphoma, with other genetic and cytogenetic ALK mutations subsequently coming to attention in the development of many other hematologic and solid organ malignancies. ALK has now been shown to play a role in the pathogenesis of several cutaneous malignancies, including secondary cutaneous systemic anaplastic large-cell lymphoma (ALCL) and primary cutaneous ALCL, melanoma, spitzoid tumors, epithelioid fibrous histiocytoma, Merkel cell carcinoma, and basal cell carcinoma. The characterization of ALK-positivity in these cutaneous malignancies presents exciting opportunities for utilizing ALK-targeted inhibitors in the treatment of these diseases.
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23
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Chernova NG, Zvonkov EE, Kovrigina AM, Sudarikov AB, Badmazhapova DS, Gabeeva NG, Obukhova TN, Karagyulyan SR, Savchenko VG. [Breast implant-associated anaplastic large-cell lymphoma: A case report and a review of literature]. TERAPEVT ARKH 2017; 89:93-98. [PMID: 28766547 DOI: 10.17116/terarkh201789793-98] [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: 11/18/2022]
Abstract
Breast implant-associated anaplastic large-cell lymphoma will be identified as a separate nosological entity in the 2017 adapted WHO classification due to differences in its clinical presentations, pathogenesis, and prognosis with those of nodal and cutaneous anaplastic large-cell lymphomas. The paper gives a review of the literature and describes the authors' own clinical case of common breast implant-associated anaplastic large-cell lymphoma involving breast tissue, axillary lymph nodes, anterior chest muscles, and bone marrow. The treatment policy chosen by the authors could achieve complete remission.
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Affiliation(s)
- N G Chernova
- National Research Center for Hematology, Ministry of Health of Russia, Moscow, Russia
| | - E E Zvonkov
- National Research Center for Hematology, Ministry of Health of Russia, Moscow, Russia
| | - A M Kovrigina
- National Research Center for Hematology, Ministry of Health of Russia, Moscow, Russia
| | - A B Sudarikov
- National Research Center for Hematology, Ministry of Health of Russia, Moscow, Russia
| | - D S Badmazhapova
- National Research Center for Hematology, Ministry of Health of Russia, Moscow, Russia
| | - N G Gabeeva
- National Research Center for Hematology, Ministry of Health of Russia, Moscow, Russia
| | - T N Obukhova
- National Research Center for Hematology, Ministry of Health of Russia, Moscow, Russia
| | - S R Karagyulyan
- National Research Center for Hematology, Ministry of Health of Russia, Moscow, Russia
| | - V G Savchenko
- National Research Center for Hematology, Ministry of Health of Russia, Moscow, Russia
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24
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Azarpira N, Safaie A, Monabati A, Hosseinzadeh M, Noori S, Moini M, Rahimi A, Heidari T, Rahsaz M. PAX-5 positive anaplastic large cell lymphoma presenting by dysphagia; a case report. GASTROENTEROLOGY AND HEPATOLOGY FROM BED TO BENCH 2017; 10:332-336. [PMID: 29379600 PMCID: PMC5758743] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
Anaplastic large cell lymphoma (ALCL) is a distinct pathologic entity with characteristic morphologic, im¬munophenotypic and cytogenetic features. Obstructive symptoms are rare presentation of ALCL. We report a 16-year-old boy who initially presented with dysphagia. Upper gastrointestinal endoscopy revealed severe stenosis with an infiltrative process starting from 24 cm of incisors in lower esophagus Esophageal mucosal biopsy demonstrated lymphomatous involvement that ancillary tests confirmed the diagnosis of ALCL, ALK (kinase-positive), and PAX5 positive. The patient responded to CHOP-based chemotherapy. This case illustrated an unusual presentation of primary Non Hodgkin lymphoma of esophagus.
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Affiliation(s)
- Negar Azarpira
- Transplant Research Center, Shiraz University of Medical Science, Shiraz, Iran
| | - Akbar Safaie
- Pathology Department, Shiraz University of Medical Science, Shiraz, Iran
| | - Ahmad Monabati
- Pathology Department, Shiraz University of Medical Science, Shiraz, Iran
| | | | - Sadat Noori
- Pathology Department, Shiraz University of Medical Science, Shiraz, Iran
| | - Maryam Moini
- Gastroenterology Research Center, Department of Internal Medicine, Shiraz University of Medical Science, Shiraz, Iran
| | - Alireza Rahimi
- Gastroenterology Research Center, Department of Internal Medicine, Shiraz University of Medical Science, Shiraz, Iran
| | - Tahereh Heidari
- Transplant Research Center, Shiraz University of Medical Science, Shiraz, Iran
| | - Marjan Rahsaz
- Transplant Research Center, Shiraz University of Medical Science, Shiraz, Iran
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25
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Tsuyama N, Sakamoto K, Sakata S, Dobashi A, Takeuchi K. Anaplastic large cell lymphoma: pathology, genetics, and clinical aspects. J Clin Exp Hematop 2017; 57:120-142. [PMID: 29279550 PMCID: PMC6144189 DOI: 10.3960/jslrt.17023] [Citation(s) in RCA: 59] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2017] [Revised: 11/19/2017] [Accepted: 11/21/2017] [Indexed: 12/20/2022] Open
Abstract
Anaplastic large cell lymphoma (ALCL) was first described in 1985 as a large-cell neoplasm with anaplastic morphology immunostained by the Ki-1 antibody, which recognizes CD30. In 1994, the nucleophosmin (NPM)-anaplastic lymphoma kinase (ALK) fusion receptor tyrosine kinase was identified in a subset of patients, leading to subdivision of this disease into ALK-positive and -negative ALCL in the present World Health Organization classification. Due to variations in morphology and immunophenotype, which may sometimes be atypical for lymphoma, many differential diagnoses should be considered, including solid cancers, lymphomas, and reactive processes. CD30 and ALK are key molecules involved in the pathogenesis, diagnosis, and treatment of ALCL. In addition, signal transducer and activator of transcription 3 (STAT3)-mediated mechanisms are relevant in both types of ALCL, and fusion/mutated receptor tyrosine kinases other than ALK have been reported in ALK-negative ALCL. ALK-positive ALCL has a better prognosis than ALK-negative ALCL or other peripheral T-cell lymphomas. Patients with ALK-positive ALCL are usually treated with anthracycline-based regimens, such as combination cyclophosphamide, doxorubicin, vincristine, and prednisolone (CHOP) or CHOEP (CHOP plus etoposide), which provide a favorable prognosis, except in patients with multiple International Prognostic Index factors. For targeted therapies, an anti-CD30 monoclonal antibody linked to a synthetic antimitotic agent (brentuximab vedotin) and ALK inhibitors (crizotinib, alectinib, and ceritinib) are being used in clinical settings.
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26
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Abstract
Cutaneous CD30+ T-cell lymphoproliferative disorders (CD30+ T-LPD) represent a spectrum encompassing lymphomatoid papulosis (LyP), primary cutaneous anaplastic large-cell lymphoma (pcALCL) and borderline lesions. They share the expression of CD30 as a common phenotypic marker. They differ however in their clinical presentation, the histological features and clinical course. Moreover, LyP and PcALCL show numerous clinical, histological and phenotypic variants. Overlapping features of LyP and pcALCL with themselves and with other cutaneous and systemic lymphomas emphasize the importance of careful clinicopathologic correlation and staging in the diagnosis of CD30+ T-LPD. Furthermore, an increasing number of inflammatory and infectious skin disorders harboring medium-sized to large CD30+ cells have to be considered in the differential diagnosis. Whereas the expression of CD30 in cutaneous CD30+ T-LPD stands for a favourable prognosis, its expression in other cutaneous and systemic lymphomas has a divergent impact. The assessment of CD30 expression does not only provide prognostic information, but is of potential therapeutic relevance as CD30 can serve as a therapeutic target. This review focuses on the clinicopathological and phenotypic spectrum of CD30+ T-LPD, its differential diagnoses and the role of CD30 as a diagnostic, prognostic and therapeutic marker.
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Affiliation(s)
- Werner Kempf
- Kempf und Pfaltz, Histologische Diagnostik, Zürich, Switzerland; Department of Dermatology, University Hospital Zurich, CH-8091, Zurich, Switzerland.
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27
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Malcolm TIM, Hodson DJ, Macintyre EA, Turner SD. Challenging perspectives on the cellular origins of lymphoma. Open Biol 2016; 6:rsob.160232. [PMID: 27683157 PMCID: PMC5043587 DOI: 10.1098/rsob.160232] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2016] [Accepted: 09/02/2016] [Indexed: 12/18/2022] Open
Abstract
Both B and T lymphocytes have signature traits that set them apart from other cell types. They actively and repeatedly rearrange their DNA in order to produce a unique and functional antigen receptor, they have potential for massive clonal expansion upon encountering antigen via this receptor or its precursor, and they have the capacity to be extremely long lived as ‘memory’ cells. All three of these traits are fundamental to their ability to function as the adaptive immune response to infectious agents, but concurrently render these cells vulnerable to transformation. Thus, it is classically considered that lymphomas arise at a relatively late stage in a lymphocyte's development during the process of modifying diversity within antigen receptors, and when the cell is capable of responding to stimulus via its receptor. Attempts to understand the aetiology of lymphoma have reinforced this notion, as the most notable advances to date have shown chronic stimulation of the antigen receptor by infectious agents or self-antigens to be key drivers of these diseases. Despite this, there is still uncertainty about the cell of origin in some lymphomas, and increasing evidence that a subset arises in a more immature cell. Specifically, a recent study indicates that T-cell lymphoma, in particular nucleophosmin-anaplastic lymphoma kinase-driven anaplastic large cell lymphoma, may originate in T-cell progenitors in the thymus.
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Affiliation(s)
- Tim I M Malcolm
- Division of Molecular Histopathology, Department of Pathology, University of Cambridge, Lab Block Level 3, Box 231, Addenbrooke's Hospital, Cambridge CB2 0QQ, UK
| | - Daniel J Hodson
- Department of Haematology, University of Cambridge, Cambridge, UK
| | - Elizabeth A Macintyre
- Hematology and INSERM1151, Institut Necker-Enfants Malades, Université Sorbonne Paris Cité at Descartes and Assistance Publique-Hôpitaux de Paris, Paris 75743 Cedex 15, France
| | - Suzanne D Turner
- Division of Molecular Histopathology, Department of Pathology, University of Cambridge, Lab Block Level 3, Box 231, Addenbrooke's Hospital, Cambridge CB2 0QQ, UK
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28
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Bogdanic M, Ostojic Kolonic S, Kaic G, Kardum Paro MM, Lasan Trcic R, Kardum-Skelin I. Fine-needle aspiration cytology yield as a basis for morphological, molecular, and cytogenetic diagnosis in alk-positive anaplastic large cell lymphoma with atypical clinical presentation. Diagn Cytopathol 2016; 45:51-54. [PMID: 27468968 DOI: 10.1002/dc.23542] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2015] [Accepted: 07/06/2016] [Indexed: 11/07/2022]
Abstract
ALK positive anaplastic large cell lymphoma is a T-cell lymphoma usually occurring in children and young adults. It frequently involves lymph nodes and extranodal sites and is associated with favorable prognosis. A 20-year old man was admitted for painful mass in the left axilla with overlying skin redness. Clinical presentation and US findings were highly suspicious for sarcoma. Definitive diagnosis was established cytolologically and using ancillary technologies from cytological samples. Fine needle aspiration cytology of tumor mass (lymph node conglomerate and surrounding tissue) show predominance of large, pleomorphic, atypical cells with large nuclei and vacuolised cytoplasm. Atypical cells immunocytochemically were positive for LCA, CD30, CD3, EMA, and ALK; negative for CD15 and CD56. NPM-ALK transcript was detected by reverse transcriptase-polymerase chain reaction (RT-PCT). Molecular analysis of TCRß and TCRγ genes demonstrated clonal TCR genes rearrangement. Complex karyotype with multiple numerical and structural changes was found on conventional cytogenetics. These findings excluded sarcoma and corroborated the diagnosis of ALK positive ALCL. Cutaneous involvement in ALCL can clinically mimic sarcoma, especially in cases with localized disease without B symptoms. In those cases, immunostaining, PCR, and conventional cytogenetics are helpful to exclude sarcoma. Diagn. Cytopathol. 2017;45:51-54. © 2016 Wiley Periodicals, Inc.
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Affiliation(s)
- Maja Bogdanic
- Department of Cytology and Cytogenetic, University Hospital Merkur, Zagreb, Croatia
| | - Slobodanka Ostojic Kolonic
- School of Medicine, University of Zagreb, Croatia.,Department of Medicine, School of Medicine, University of Zagreb, Zagreb, Croatia
| | - Gordana Kaic
- Department of Cytology and Cytogenetic, University Hospital Merkur, Zagreb, Croatia
| | | | - Ruzica Lasan Trcic
- Department of Pediatrics, University Hospital Center Zagreb, Zagreb, Croatia
| | - Ika Kardum-Skelin
- Department of Cytology and Cytogenetic, University Hospital Merkur, Zagreb, Croatia.,School of Medicine, University of Zagreb, Croatia
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Kadin ME, Deva A, Xu H, Morgan J, Khare P, MacLeod RAF, Van Natta BW, Adams WP, Brody GS, Epstein AL. Biomarkers Provide Clues to Early Events in the Pathogenesis of Breast Implant-Associated Anaplastic Large Cell Lymphoma. Aesthet Surg J 2016; 36:773-81. [PMID: 26979456 DOI: 10.1093/asj/sjw023] [Citation(s) in RCA: 114] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/27/2016] [Indexed: 12/17/2022] Open
Abstract
Almost 200 women worldwide have been diagnosed with breast implant-associated anaplastic large cell lymphoma (BIA-ALCL). The unique location and specific lymphoma type strongly suggest an etio-pathologic link between breast implants and BIA-ALCL. It is postulated that chronic inflammation via bacterial infection may be an etiological factor. BIA-ALCL resembles primary cutaneous ALCL (pcALCL) in morphology, activated T-cell phenotype, and indolent clinical course. Gene expression array analysis, flow cytometry, and immunohistochemistry were used to study pcALCL and BIA-ALCL cell lines. Clinical samples were also studied to characterize transcription factor and cytokine profiles of tumor cells and surrounding lymphocytes. BIA-ALCL and pcALCL were found to have common expression of transcription factors SOCS3, JunB, SATB1, and a cytokine profile suggestive of a Th1 phenotype. Similar patterns were observed in a CD30+ cutaneous lymphoproliferative disorder (LPD). The patterns of cytokine and transcription factor expression suggest that BIA-ALCL is likely to arise from chronic bacterial antigen stimulation of T-cells. Further analysis of cytokine and transcription factor profiles may allow early detection and treatment of BIA-ALCL leading to better prognosis and survival. LEVEL OF EVIDENCE 5: Risk.
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Affiliation(s)
- Marshall E Kadin
- Dr Kadin is a Professor of Dermatology, Boston University School of Medicine, Boston, MA; and a Staff Physician, Roger Williams Medical Center, Providence, RI. Dr Deva is an Associate Professor of Cosmetic, Plastic, and Reconstructive Surgery, Macquarie University, NSW, Australia. Ms Xu is a Research Assistant, Dr Morgan is Director of the Research Core Facility, and Dr Khare is Director of the Cancer Immunotherapy and Gene Therapy Facility, Roger Williams Medical Center, Providence, RI. Dr MacLeod is Director of Cytogenetics at the Leibniz Institute, DSMZ - German Collection of Microorganisms and Cell Cultures, Braunschweig, Germany. Dr Van Natta is an Associate Clinical Professor, Department of Surgery, Indiana University School of Medicine, Indianapolis, IN. Dr Adams is an Associate Clinical Professor, Department of Plastic Surgery, University of Texas Southwestern Medical Center, Dallas, TX. Dr Brody is Professor Emeritus in the Division of Plastic Surgery, and Dr Epstein is a Professor of Pathology, University of Southern California Keck School of Medicine, Los Angeles, CA
| | - Anand Deva
- Dr Kadin is a Professor of Dermatology, Boston University School of Medicine, Boston, MA; and a Staff Physician, Roger Williams Medical Center, Providence, RI. Dr Deva is an Associate Professor of Cosmetic, Plastic, and Reconstructive Surgery, Macquarie University, NSW, Australia. Ms Xu is a Research Assistant, Dr Morgan is Director of the Research Core Facility, and Dr Khare is Director of the Cancer Immunotherapy and Gene Therapy Facility, Roger Williams Medical Center, Providence, RI. Dr MacLeod is Director of Cytogenetics at the Leibniz Institute, DSMZ - German Collection of Microorganisms and Cell Cultures, Braunschweig, Germany. Dr Van Natta is an Associate Clinical Professor, Department of Surgery, Indiana University School of Medicine, Indianapolis, IN. Dr Adams is an Associate Clinical Professor, Department of Plastic Surgery, University of Texas Southwestern Medical Center, Dallas, TX. Dr Brody is Professor Emeritus in the Division of Plastic Surgery, and Dr Epstein is a Professor of Pathology, University of Southern California Keck School of Medicine, Los Angeles, CA
| | - Haiying Xu
- Dr Kadin is a Professor of Dermatology, Boston University School of Medicine, Boston, MA; and a Staff Physician, Roger Williams Medical Center, Providence, RI. Dr Deva is an Associate Professor of Cosmetic, Plastic, and Reconstructive Surgery, Macquarie University, NSW, Australia. Ms Xu is a Research Assistant, Dr Morgan is Director of the Research Core Facility, and Dr Khare is Director of the Cancer Immunotherapy and Gene Therapy Facility, Roger Williams Medical Center, Providence, RI. Dr MacLeod is Director of Cytogenetics at the Leibniz Institute, DSMZ - German Collection of Microorganisms and Cell Cultures, Braunschweig, Germany. Dr Van Natta is an Associate Clinical Professor, Department of Surgery, Indiana University School of Medicine, Indianapolis, IN. Dr Adams is an Associate Clinical Professor, Department of Plastic Surgery, University of Texas Southwestern Medical Center, Dallas, TX. Dr Brody is Professor Emeritus in the Division of Plastic Surgery, and Dr Epstein is a Professor of Pathology, University of Southern California Keck School of Medicine, Los Angeles, CA
| | - John Morgan
- Dr Kadin is a Professor of Dermatology, Boston University School of Medicine, Boston, MA; and a Staff Physician, Roger Williams Medical Center, Providence, RI. Dr Deva is an Associate Professor of Cosmetic, Plastic, and Reconstructive Surgery, Macquarie University, NSW, Australia. Ms Xu is a Research Assistant, Dr Morgan is Director of the Research Core Facility, and Dr Khare is Director of the Cancer Immunotherapy and Gene Therapy Facility, Roger Williams Medical Center, Providence, RI. Dr MacLeod is Director of Cytogenetics at the Leibniz Institute, DSMZ - German Collection of Microorganisms and Cell Cultures, Braunschweig, Germany. Dr Van Natta is an Associate Clinical Professor, Department of Surgery, Indiana University School of Medicine, Indianapolis, IN. Dr Adams is an Associate Clinical Professor, Department of Plastic Surgery, University of Texas Southwestern Medical Center, Dallas, TX. Dr Brody is Professor Emeritus in the Division of Plastic Surgery, and Dr Epstein is a Professor of Pathology, University of Southern California Keck School of Medicine, Los Angeles, CA
| | - Pranay Khare
- Dr Kadin is a Professor of Dermatology, Boston University School of Medicine, Boston, MA; and a Staff Physician, Roger Williams Medical Center, Providence, RI. Dr Deva is an Associate Professor of Cosmetic, Plastic, and Reconstructive Surgery, Macquarie University, NSW, Australia. Ms Xu is a Research Assistant, Dr Morgan is Director of the Research Core Facility, and Dr Khare is Director of the Cancer Immunotherapy and Gene Therapy Facility, Roger Williams Medical Center, Providence, RI. Dr MacLeod is Director of Cytogenetics at the Leibniz Institute, DSMZ - German Collection of Microorganisms and Cell Cultures, Braunschweig, Germany. Dr Van Natta is an Associate Clinical Professor, Department of Surgery, Indiana University School of Medicine, Indianapolis, IN. Dr Adams is an Associate Clinical Professor, Department of Plastic Surgery, University of Texas Southwestern Medical Center, Dallas, TX. Dr Brody is Professor Emeritus in the Division of Plastic Surgery, and Dr Epstein is a Professor of Pathology, University of Southern California Keck School of Medicine, Los Angeles, CA
| | - Roderick A F MacLeod
- Dr Kadin is a Professor of Dermatology, Boston University School of Medicine, Boston, MA; and a Staff Physician, Roger Williams Medical Center, Providence, RI. Dr Deva is an Associate Professor of Cosmetic, Plastic, and Reconstructive Surgery, Macquarie University, NSW, Australia. Ms Xu is a Research Assistant, Dr Morgan is Director of the Research Core Facility, and Dr Khare is Director of the Cancer Immunotherapy and Gene Therapy Facility, Roger Williams Medical Center, Providence, RI. Dr MacLeod is Director of Cytogenetics at the Leibniz Institute, DSMZ - German Collection of Microorganisms and Cell Cultures, Braunschweig, Germany. Dr Van Natta is an Associate Clinical Professor, Department of Surgery, Indiana University School of Medicine, Indianapolis, IN. Dr Adams is an Associate Clinical Professor, Department of Plastic Surgery, University of Texas Southwestern Medical Center, Dallas, TX. Dr Brody is Professor Emeritus in the Division of Plastic Surgery, and Dr Epstein is a Professor of Pathology, University of Southern California Keck School of Medicine, Los Angeles, CA
| | - Bruce W Van Natta
- Dr Kadin is a Professor of Dermatology, Boston University School of Medicine, Boston, MA; and a Staff Physician, Roger Williams Medical Center, Providence, RI. Dr Deva is an Associate Professor of Cosmetic, Plastic, and Reconstructive Surgery, Macquarie University, NSW, Australia. Ms Xu is a Research Assistant, Dr Morgan is Director of the Research Core Facility, and Dr Khare is Director of the Cancer Immunotherapy and Gene Therapy Facility, Roger Williams Medical Center, Providence, RI. Dr MacLeod is Director of Cytogenetics at the Leibniz Institute, DSMZ - German Collection of Microorganisms and Cell Cultures, Braunschweig, Germany. Dr Van Natta is an Associate Clinical Professor, Department of Surgery, Indiana University School of Medicine, Indianapolis, IN. Dr Adams is an Associate Clinical Professor, Department of Plastic Surgery, University of Texas Southwestern Medical Center, Dallas, TX. Dr Brody is Professor Emeritus in the Division of Plastic Surgery, and Dr Epstein is a Professor of Pathology, University of Southern California Keck School of Medicine, Los Angeles, CA
| | - William P Adams
- Dr Kadin is a Professor of Dermatology, Boston University School of Medicine, Boston, MA; and a Staff Physician, Roger Williams Medical Center, Providence, RI. Dr Deva is an Associate Professor of Cosmetic, Plastic, and Reconstructive Surgery, Macquarie University, NSW, Australia. Ms Xu is a Research Assistant, Dr Morgan is Director of the Research Core Facility, and Dr Khare is Director of the Cancer Immunotherapy and Gene Therapy Facility, Roger Williams Medical Center, Providence, RI. Dr MacLeod is Director of Cytogenetics at the Leibniz Institute, DSMZ - German Collection of Microorganisms and Cell Cultures, Braunschweig, Germany. Dr Van Natta is an Associate Clinical Professor, Department of Surgery, Indiana University School of Medicine, Indianapolis, IN. Dr Adams is an Associate Clinical Professor, Department of Plastic Surgery, University of Texas Southwestern Medical Center, Dallas, TX. Dr Brody is Professor Emeritus in the Division of Plastic Surgery, and Dr Epstein is a Professor of Pathology, University of Southern California Keck School of Medicine, Los Angeles, CA
| | - Garry S Brody
- Dr Kadin is a Professor of Dermatology, Boston University School of Medicine, Boston, MA; and a Staff Physician, Roger Williams Medical Center, Providence, RI. Dr Deva is an Associate Professor of Cosmetic, Plastic, and Reconstructive Surgery, Macquarie University, NSW, Australia. Ms Xu is a Research Assistant, Dr Morgan is Director of the Research Core Facility, and Dr Khare is Director of the Cancer Immunotherapy and Gene Therapy Facility, Roger Williams Medical Center, Providence, RI. Dr MacLeod is Director of Cytogenetics at the Leibniz Institute, DSMZ - German Collection of Microorganisms and Cell Cultures, Braunschweig, Germany. Dr Van Natta is an Associate Clinical Professor, Department of Surgery, Indiana University School of Medicine, Indianapolis, IN. Dr Adams is an Associate Clinical Professor, Department of Plastic Surgery, University of Texas Southwestern Medical Center, Dallas, TX. Dr Brody is Professor Emeritus in the Division of Plastic Surgery, and Dr Epstein is a Professor of Pathology, University of Southern California Keck School of Medicine, Los Angeles, CA
| | - Alan L Epstein
- Dr Kadin is a Professor of Dermatology, Boston University School of Medicine, Boston, MA; and a Staff Physician, Roger Williams Medical Center, Providence, RI. Dr Deva is an Associate Professor of Cosmetic, Plastic, and Reconstructive Surgery, Macquarie University, NSW, Australia. Ms Xu is a Research Assistant, Dr Morgan is Director of the Research Core Facility, and Dr Khare is Director of the Cancer Immunotherapy and Gene Therapy Facility, Roger Williams Medical Center, Providence, RI. Dr MacLeod is Director of Cytogenetics at the Leibniz Institute, DSMZ - German Collection of Microorganisms and Cell Cultures, Braunschweig, Germany. Dr Van Natta is an Associate Clinical Professor, Department of Surgery, Indiana University School of Medicine, Indianapolis, IN. Dr Adams is an Associate Clinical Professor, Department of Plastic Surgery, University of Texas Southwestern Medical Center, Dallas, TX. Dr Brody is Professor Emeritus in the Division of Plastic Surgery, and Dr Epstein is a Professor of Pathology, University of Southern California Keck School of Medicine, Los Angeles, CA
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Turner SD, Lamant L, Kenner L, Brugières L. Anaplastic large cell lymphoma in paediatric and young adult patients. Br J Haematol 2016; 173:560-72. [PMID: 26913827 DOI: 10.1111/bjh.13958] [Citation(s) in RCA: 63] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Anaplastic large cell lymphoma (ALCL) is a heterogeneous disease of debateable origin that, in children, is largely anaplastic lymphoma kinase (ALK) positive with aberrant ALK activity induced following the formation of chromosomal translocations. Whilst the survival rates for this disease are relatively high, a significant proportion (20-40%) of patients suffer disease relapse, in some cases on multiple occasions and therefore suffer the toxic side-effects of combination chemotherapy. Traditionally, patients are treated with a combination of agents although recent data from relapse patients have suggested that low risk patients might benefit from single agent vinblastine and, going forward, the addition of ALK inhibitors to the therapeutic regimen may have beneficial consequences. There are also a plethora of other drugs that might be advantageous to patients with ALCL and many of these have been identified through laboratory research although the decision as to which drugs to implement in trials will not be trivial.
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Affiliation(s)
- Suzanne D Turner
- Department of Pathology, Division of Molecular Histopathology, University of Cambridge, Cambridge, UK.,European Research Initiative for ALK related Malignancies, Toulouse, France
| | - Laurence Lamant
- European Research Initiative for ALK related Malignancies, Toulouse, France.,Institut Universitaire de Cancérologie Oncopole, Toulouse, France
| | - Lukas Kenner
- European Research Initiative for ALK related Malignancies, Toulouse, France.,Clinical Institute of Pathology, Medical University of Vienna, Vienna, Austria.,Ludwig Boltzmann Institute for Cancer Research (LBI-CR), Vienna, Austria.,Department of Laboratory Animal Pathology, University of Veterinary Medicine Vienna, Vienna, Austria
| | - Laurence Brugières
- European Research Initiative for ALK related Malignancies, Toulouse, France.,Département de Cancérologie de l'Enfant et l'Adolescent, Gustave Roussy, Villejuif, France
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31
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Anaplastic large cell lymphoma arises in thymocytes and requires transient TCR expression for thymic egress. Nat Commun 2016; 7:10087. [PMID: 26753883 PMCID: PMC4729925 DOI: 10.1038/ncomms10087] [Citation(s) in RCA: 57] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2015] [Accepted: 11/02/2015] [Indexed: 01/16/2023] Open
Abstract
Anaplastic large cell lymphoma (ALCL) is a peripheral T-cell lymphoma presenting mostly in children and young adults. The natural progression of this disease is largely unknown as is the identity of its true cell of origin. Here we present a model of peripheral ALCL pathogenesis where the malignancy is initiated in early thymocytes, before T-cell receptor (TCR) β-rearrangement, which is bypassed in CD4/NPM–ALK transgenic mice following Notch1 expression. However, we find that a TCR is required for thymic egress and development of peripheral murine tumours, yet this TCR must be downregulated for T-cell lymphomagenesis. In keeping with this, clonal TCR rearrangements in human ALCL are predominantly in-frame, but often aberrant, with clonal TCRα but no comparable clonal TCRβ rearrangement, yielding events that would not normally be permissive for survival during thymic development. Children affected by ALCL may thus harbour thymic lymphoma-initiating cells capable of seeding relapse after chemotherapy. Anaplastic large cell lymphoma is characterized by an NPM–ALK fusion but the cell of origin for this cancer is unclear. Here, the authors show that, in an NPM–ALK mouse model, the tumours likely arise from early thmyocytes and require an initial burst of TCR signalling for initiation.
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32
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Laurent C, Delas A, Gaulard P, Haioun C, Moreau A, Xerri L, Traverse-Glehen A, Rousset T, Quintin-Roue I, Petrella T, Emile JF, Amara N, Rochaix P, Chenard-Neu MP, Tasei AM, Menet E, Chomarat H, Costes V, Andrac-Meyer L, Michiels JF, Chassagne-Clement C, de Leval L, Brousset P, Delsol G, Lamant L. Breast implant-associated anaplastic large cell lymphoma: two distinct clinicopathological variants with different outcomes. Ann Oncol 2015; 27:306-14. [PMID: 26598546 DOI: 10.1093/annonc/mdv575] [Citation(s) in RCA: 155] [Impact Index Per Article: 17.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2015] [Accepted: 11/11/2015] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND ALK-negative anaplastic large cell lymphoma associated with breast implant (i-ALCL) has been recently recognized as a distinct entity. Among 43 830 lymphomas registered in the French Lymphopath network since 2010, 300 breast lymphomas comprising 25 peripheral T-cell lymphomas (PTCL) were reviewed. Among PTCL, ALK-negative ALCL was the most frequent and all of them were associated with breast implants. PATIENTS AND METHODS Since 2010, all i-ALCL cases were collected from different institutions through Lymphopath. Immuno-morphologic features, molecular data and clinical outcome of 19 i-ALCLs have been retrospectively analyzed. RESULTS The median age of the patients was 61 years and the median length between breast implant and i-ALCL was 9 years. Most implants were silicone-filled and textured. Implant removal was performed in 17 out of 19 patients with additional treatment based on mostly CHOP or CHOP-like chemotherapy regimens (n = 10/19) or irradiation (n = 1/19). CHOP alone or ABVD following radiation without implant removal have been given in two patients. The two clinical presentations, i.e. effusion and less frequently tumor mass correlated with distinct histopathologic features: in situ i-ALCL (anaplastic cell proliferation confined to the fibrous capsule) and infiltrative i-ALCL (pleomorphic cells massively infiltrating adjacent tissue with eosinophils and sometimes Reed-Sternberg-like cells mimicking Hodgkin lymphoma). Malignant cells were CD30-positive, showed a variable staining for EMA and were ALK negative. Most cases had a cytotoxic T-cell immunophenotype with variable T-cell antigen loss and pSTAT3 nuclear expression. T-cell receptor genes were clonally rearranged in 13 out of 13 tested cases. After 18 months of median follow-up, the 2-year overall survival for in situ and infiltrative i-ALCL was 100% and 52.5%, respectively. CONCLUSIONS In situ i-ALCLs have an indolent clinical course and generally remain free of disease after implant removal. However, infiltrative i-ALCLs could have a more aggressive clinical course that might require additional therapy to implant removal.
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Affiliation(s)
- C Laurent
- Department of Pathology, Institut Universitaire du Cancer-Oncopole, Toulouse INSERM, U.1037, Centre de recherche en cancérologie de Toulouse-Purpan, Toulouse
| | - A Delas
- Department of Pathology, Institut Universitaire du Cancer-Oncopole, Toulouse
| | - P Gaulard
- Department of Pathology, AP-HP, Groupe hospitalier Henri Mondor-Albert Chenevier, Créteil INSERM U955, Université Paris-Est, Créteil
| | - C Haioun
- INSERM U955, Université Paris-Est, Créteil Lymphoid Malignancies Unit, AP-HP, Groupe hospitalier Henri Mondor-Albert Chenevier, Créteil
| | - A Moreau
- Department of Pathology, Centre Hospitalier Hôtel Dieu, Nantes
| | - L Xerri
- Department of Pathology, Institut Paoli-Calmettes, Marseille
| | | | - T Rousset
- Department of Pathology, Hôpital Gui de Chauliac-Saint Eloi, Montpellier
| | - I Quintin-Roue
- Department of Pathology, Centre Hospitalier de Brest, Brest, France
| | - T Petrella
- Département de Pathologie, Montréal, Canada
| | - J F Emile
- Department of Pathology, Hôpital Ambroise Paré, Boulogne
| | - N Amara
- Department of Pathology, Institut Universitaire du Cancer-Oncopole, Toulouse
| | - P Rochaix
- Department of Pathology, Institut Universitaire du Cancer-Oncopole, Toulouse
| | | | - A M Tasei
- Department of Pathology, Centre Hospitalier Henri Duffaut, Avignon
| | - E Menet
- Department of Pathology, Hôpital René Huguenin, Saint Cloud
| | | | - V Costes
- Department of Pathology, Hôpital Gui de Chauliac-Saint Eloi, Montpellier
| | | | - J F Michiels
- Department of Pathology, Centre Hospitalier Pasteur L'Archet, Nice
| | | | - L de Leval
- Pathology institut of Lausanne, Centre Hospitalier Universitaire Vaudois, Suisse, Lausanne, Switzerland
| | - P Brousset
- Department of Pathology, Institut Universitaire du Cancer-Oncopole, Toulouse INSERM, U.1037, Centre de recherche en cancérologie de Toulouse-Purpan, Toulouse
| | - G Delsol
- Department of Pathology, Institut Universitaire du Cancer-Oncopole, Toulouse INSERM, U.1037, Centre de recherche en cancérologie de Toulouse-Purpan, Toulouse
| | - L Lamant
- Department of Pathology, Institut Universitaire du Cancer-Oncopole, Toulouse INSERM, U.1037, Centre de recherche en cancérologie de Toulouse-Purpan, Toulouse
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Wehkamp U, Oschlies I, Nagel I, Brasch J, Kneba M, Günther A, Klapper W, Weichenthal M. ALK-positive primary cutaneous T-cell-lymphoma (CTCL) with unusual clinical presentation and aggressive course. J Cutan Pathol 2015; 42:870-7. [DOI: 10.1111/cup.12547] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2014] [Revised: 11/17/2014] [Accepted: 01/11/2015] [Indexed: 12/21/2022]
Affiliation(s)
- Ulrike Wehkamp
- Department of Dermatology; University of Kiel; Kiel Germany
| | - Ilske Oschlies
- Department of Pathology, Section for Hematopathology; University of Kiel; Kiel Germany
| | - Inga Nagel
- Department of Human Genetics; University of Kiel; Kiel Germany
| | - Jochen Brasch
- Department of Dermatology; University of Kiel; Kiel Germany
| | - Michael Kneba
- Medical Department II; University of Kiel; Kiel Germany
| | - Andreas Günther
- Division of Stem Cell Transplantation and Immunotherapy; University of Kiel; Kiel Germany
| | - Wolfram Klapper
- Department of Pathology, Section for Hematopathology; University of Kiel; Kiel Germany
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Kang JH, Lee JH, Kim M, Cho BK, Song CH, Ock SM, Park HJ. Anaplastic lymphoma kinase-positive anaplastic large cell lymphoma arising in a patient with hypersensitivity to mosquito bites. Korean J Fam Med 2015; 36:35-41. [PMID: 25780514 PMCID: PMC4360489 DOI: 10.4082/kjfm.2015.36.1.35] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2014] [Accepted: 12/03/2014] [Indexed: 11/28/2022] Open
Abstract
Hypersensitivity to mosquito bites is defined as the appearance of intense skin reactive lesions and systemic symptoms subsequent to mosquito bites. Most cases of hypersensitivity to mosquito bites reported thus far have been associated with chronic Epstein-Barr virus infection or natural killer cell leukemia/lymphoma. In this study, we describe the case of an 18-year-old Korean boy who had hypersensitivity to mosquito bites associated with primary systemic anaplastic lymphoma kinase-positive anaplastic large cell lymphoma. After a mosquito bite, the patient developed a progressive cutaneous nodule on his left lower leg and regional lymphadenopathy in the left inguinal area. The histopathological and immunohistochemical findings suggested anaplastic lymphoma kinase-positive anaplastic large cell lymphoma. Positron emission tomography-computed tomography revealed increased fluorodeoxyglucose uptake in the left T4 vertebrae, left external iliac lymph nodes, left inguinal lymph nodes, and lateral subcutaneous region of the left lower leg. According to the clinical, histopathological, and immunohistochemical findings, as well as the imaging data, the patient was diagnosed with primary systemic anaplastic lymphoma kinase-positive anaplastic large cell lymphoma. Consequently, the patient received a total of 6 cycles of cyclophosphamide + doxorubicin + vincristine + prednisolone chemotherapy at 3-week intervals, after which the lesions regressed.
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Affiliation(s)
- Jin Hee Kang
- Department of Dermatology, The Catholic University of Korea College of Medicine, Seoul, Korea
| | - Ji Hae Lee
- Department of Dermatology, The Catholic University of Korea College of Medicine, Seoul, Korea
| | - Miri Kim
- Department of Dermatology, The Catholic University of Korea College of Medicine, Seoul, Korea
| | - Baik Kee Cho
- Department of Dermatology, The Catholic University of Korea College of Medicine, Seoul, Korea
| | - Chan Hee Song
- Department of Family Medicine, The Catholic University of Korea College of Medicine, Seoul, Korea
| | - Sun Myeong Ock
- Department of Family Medicine, The Catholic University of Korea College of Medicine, Seoul, Korea
| | - Hyun Jeong Park
- Department of Dermatology, The Catholic University of Korea College of Medicine, Seoul, Korea
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35
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Xing X, Feldman AL. Anaplastic large cell lymphomas: ALK positive, ALK negative, and primary cutaneous. Adv Anat Pathol 2015; 22:29-49. [PMID: 25461779 DOI: 10.1097/pap.0000000000000047] [Citation(s) in RCA: 84] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Anaplastic large cell lymphomas (ALCLs) comprise a group of CD30-positive non-Hodgkin lymphomas that generally are of T-cell origin and share common morphologic and phenotypic characteristics. The World Health Organization recognizes 3 entities: primary cutaneous ALCL (pcALCL), anaplastic lymphoma kinase (ALK)-positive ALCL, and, provisionally, ALK-negative ALCL. Despite overlapping pathologic features, these tumors differ in clinical behavior and genetics. pcALCL presents in the skin and, while it may involve locoregional lymph nodes, rarely disseminates. Outcomes typically are excellent. ALK-positive ALCL and ALK-negative ALCL are systemic diseases. ALK-positive ALCLs consistently have chromosomal rearrangements involving the ALK gene with varied gene partners, and generally have a favorable prognosis. ALK-negative ALCLs lack ALK rearrangements and their genetic and clinical features are more variable. A subset of ALK-negative ALCLs has rearrangements in or near the DUSP22 gene and has a favorable prognosis similar to that of ALK-positive ALCL. DUSP22 rearrangements also are seen in a subset of pcALCLs. In this review, we discuss the clinical, morphologic, phenotypic, genetic, and biological features of ALCLs.
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Anaplastic large cell lymphoma (ALCL) and breast implants: breaking down the evidence. MUTATION RESEARCH-REVIEWS IN MUTATION RESEARCH 2014; 762:123-32. [PMID: 25475421 DOI: 10.1016/j.mrrev.2014.08.002] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/01/2014] [Revised: 08/12/2014] [Accepted: 08/13/2014] [Indexed: 01/31/2023]
Abstract
Systemic anaplastic large cell lymphoma (ALCL) is a distinct disease classification provisionally sub-divided into ALCL, Anaplastic Lymphoma Kinase (ALK)(+) and ALCL, ALK(-) entities. More recently, another category of ALCL has been increasingly reported in the literature and is associated with the presence of breast implants. A comprehensive review of the 71 reported cases of breast implant associated ALCL (iALCL) is presented indicating the apparent risk factors and main characteristics of this rare cancer. The average patient is 50 years of age and most cases present in the capsule surrounding the implant as part of the periprosthetic fluid or the capsule itself on average at 10 years post-surgery suggesting that iALCL is a late complication. The absolute risk is low ranging from 1:500,000 to 1:3,000,000 patients with breast implants per year. The majority of cases are ALK-negative, yet are associated with silicone-coated implants suggestive of the mechanism of tumorigenesis which is discussed in relation to chronic inflammation, immunogenicity of the implants and sub-clinical infection. In particular, capsulotomy alone seems to be sufficient for the treatment of many cases suggesting the implants provide the biological stimulus whereas others require further treatment including chemo- and radiotherapy although reported cases remain too low to recommend a therapeutic approach. However, CD30-based therapeutics might be a future option.
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Hart AM, Lechowicz MJ, Peters KK, Holden J, Carlson GW. Breast Implant-Associated Anaplastic Large Cell Lymphoma: Report of 2 Cases and Review of the Literature. Aesthet Surg J 2014; 34:884-94. [PMID: 24938778 DOI: 10.1177/1090820x14539503] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/03/2014] [Indexed: 11/17/2022] Open
Abstract
Although primary breast lymphomas are exceedingly rare, cases of breast implant-associated anaplastic large cell lymphoma (iALCL) continue to be reported. The authors describe their experience with 2 patients and review the literature. Both patients presented with periprosthetic fluid collection. Neither had evidence of systemic disease nor received systemic therapy. Both were disease free after bilateral capsulectomies and implant removal without implant replacement, and disease did not recur. During the literature review, 63 cases of iALCL (including our 2 patients) were identified. The median time from implant placement to diagnosis was 9 years. Both saline and silicone implants were associated with iALCL. Of the 26 cases for which implant surface was reported, the surface was textured in 24. Of the 58 patients with an identifiable presentation, 39 had periprosthetic fluid collection, including 7 with an associated mass; 13 had an isolated mass at presentation, including 1 with axillary adenopathy. Forty patients had capsulectomy, 7 of whom underwent implant replacement. Of the 44 patients with known treatment, 33 received chemotherapy and 23 received radiation. Of the 49 patients with known anaplastic large cell lymphoma, 15 had disease recurrence, and 4 patient deaths were reported. Of the 18 patients presenting with a mass, 11 had disease recurrence, including all 4 patients who died. This study represents the largest review of patients with iALCL described to date. Although most cases have an indolent clinical course, the variety of presentations defined as "seroma" vs "capsular involvement" emphasizes the importance of investigating a definitive method of diagnosis, management, and treatment of this disease. LEVEL OF EVIDENCE 5.
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Affiliation(s)
- Alexandra M Hart
- Dr Hart is a resident in the Department of General Surgery at Emory University
| | - Mary Jo Lechowicz
- Dr Lechowicz is an Associate Professor in the Department of Hematology and Medical Oncology, Winship Cancer Institute
| | - Kendall K Peters
- Dr Peters is a plastic surgeon in private practice in Orlando, Florida
| | - Jeannine Holden
- Dr Holden is the Director of Hematopathology and Fly Cytometry
| | - Grant W Carlson
- Dr Carlson is the Chief of the Division of Plastic Surgery at Emory University, Atlanta, Georgia
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Barbosa L, Brito MJ, Balaco I, Noruegas MJ. Anaplastic cutaneous lymphoma mimicking an infection. J Radiol Case Rep 2014; 8:39-47. [PMID: 24967027 DOI: 10.3941/jrcr.v8i3.1934] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
We present a case of a 17-year-old boy who presented with a skin lesion with extension to the soft tissues of the left thigh. On ultrasound, a homogeneous and hypoechoic expansile formation in the subcutaneous tissue was found, measuring 6.5 × 5 × 3.5 cm, with scarce vascularization. Computed tomography showed a low attenuating neoformation with surrounding edema. An inflammatory disorder was the first diagnosis, but the absence of improvement with antibiotics led us to perform magnetic resonance imaging that showed a high signal lesion on T2-weighted imaging and low intensity signal on T1-weighted imaging and surrounding contrast uptake. Positron emission tomography and computed tomography showed uptake of 18F-fluorodeoxyglucose by the lesion. The final diagnosis was anaplastic cutaneous lymphoma.
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Affiliation(s)
- Luciana Barbosa
- Radiology Department, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
| | - Manuel João Brito
- Pediatric Oncology Department, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
| | - Inês Balaco
- Pediatric Orthopedic Department, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
| | - Maria José Noruegas
- Radiology Department, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
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Abstract
Cutaneous CD30+ lymphoproliferative disorders are the second most common types of cutaneous T-cell lymphomas. They represent a well-defined spectrum encompassing lymphomatoid papulosis (LyP), primary cutaneous anaplastic large-cell lymphoma (pcALCL), and borderline lesions. They share the expression of CD30 as a common phenotypic hallmark, but they differ in their clinical presentation, course, and histologic features. New variants have been recently identified, including CD8+ epidermotropic LyP type D, angioinvasive LyP type E, and ALK-positive pcALCL. This review describes clinical, histopathologic, and phenotypic variants; their differential diagnoses (benign and malignant); and the role of CD30 as a diagnostic, prognostic, and therapeutic marker.
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Affiliation(s)
- Werner Kempf
- Kempf und Pfaltz, Histologische Diagnostik, Seminarstrasse 1, Zürich CH-8042, Switzerland; Department of Dermatology, University Hospital, Zürich CH-8091, Switzerland.
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Diagnostic Dilemma in a Patient With Chronic Fistulating Nonhealing Ulcer. ARCHIVES OF PEDIATRIC INFECTIOUS DISEASES 2014. [DOI: 10.5812/pedinfect.16471] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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George EV, Pharm J, Houston C, Al-Quran S, Brian G, Dong H, Hai W, Reeves W, Yang LJ. Breast implant-associated ALK-negative anaplastic large cell lymphoma: a case report and discussion of possible pathogenesis. INTERNATIONAL JOURNAL OF CLINICAL AND EXPERIMENTAL PATHOLOGY 2013; 6:1631-1642. [PMID: 23923082 PMCID: PMC3726980] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Received: 05/14/2013] [Accepted: 07/01/2013] [Indexed: 06/02/2023]
Abstract
Breast implant associated anaplastic large cell lymphoma (BIA-ALCL) is a recently recognized clinical entity, with only 39 well-documented cases reported worldwide, including 3 fatalities. Because of its rarity, the clinical and pathologic features of this malignancy have yet to be fully defined. Moreover, the pathogenesis of ALCL in association with textured silicone gel breast implants is poorly understood. Here we report a case of BIA-ALCL arising in a 67-year-old woman with a mastectomy due to breast cancer followed by implantation of textured silicone gel breast prosthesis. The patient presented with breast enlargement and tenderness 8 years following reconstructive surgery. MRI revealed a fluid collection surrounding the affected breast implant. Pathologic examination confirmed the presence of malignant ALCL T cells that were CD30+, CD8+, CD15+, HLA-DR+, CD25+ ALK- and p53. A diagnosis of indolent BIA-ALCL was made since tumor cells were not found outside of the capsule. Interestingly, an extensive mixed lymphocytic infiltrate and ectopic lymphoid tissue (lymphoid neogenesis) adjacent to the fibrous implant capsule were present. The patient was treated with capsulectomy and implantation of new breast prostheses. Six months later, the patient was found to have BIA-ALCL involvement of an axillary lymph node with cytogenetic evolution of the tumor. To our knowledge, this is the sixth reported case of aggressive BIA-ALCL. Unique features of this case include the association with lymphoid neogenesis and the in vivo cytogenetic progression of the tumor. This case provides insight into the potential role of chronic inflammation and genetic instability in the pathogenesis of BIA-ALCL.
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Affiliation(s)
- Eva V George
- Departments of Pathology, Immunology, Laboratory Medicine, University of Florida College of MedicineGainesville, FL 32607
| | - John Pharm
- Department of Pathology, John D Archbold Memorial HospitalThomasville, GA 31799, USA
| | - Courtney Houston
- Department of Surgery, John D Archbold Memorial HospitalThomasville, GA 31799, USA
| | - Semar Al-Quran
- Departments of Pathology, Immunology, Laboratory Medicine, University of Florida College of MedicineGainesville, FL 32607
| | - Grey Brian
- Departments of Pathology, Immunology, Laboratory Medicine, University of Florida College of MedicineGainesville, FL 32607
| | - Huijia Dong
- Departments of Pathology, Immunology, Laboratory Medicine, University of Florida College of MedicineGainesville, FL 32607
| | - Wang Hai
- Departments of Pathology, Immunology, Laboratory Medicine, University of Florida College of MedicineGainesville, FL 32607
| | - Westley Reeves
- Department of Medicine, University of Florida College of MedicineGainesville, FL 32607
| | - Li-Jun Yang
- Departments of Pathology, Immunology, Laboratory Medicine, University of Florida College of MedicineGainesville, FL 32607
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Story SK, Schowalter MK, Geskin LJ. Breast implant-associated ALCL: a unique entity in the spectrum of CD30+ lymphoproliferative disorders. Oncologist 2013; 18:301-7. [PMID: 23429741 DOI: 10.1634/theoncologist.2012-0238] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
CD30(+) lymphoproliferative disorders represent a spectrum of diseases with distinct clinical phenotypes ranging from reactive conditions to aggressive systemic anaplastic lymphoma kinase (ALK)(-) anaplastic large cell lymphoma (ALCL). In January 2011, the U.S. Food and Drug Administration (FDA) announced a possible association between breast implants and ALCL, which was likened to systemic ALCL and treated accordingly. We analyzed existing data to see if implant-associated ALCL (iALCL) may represent a distinct entity, different from aggressive ALCL. We conducted a systematic review of publications regarding ALCL and breast implantation for 1990-2012 and contacted corresponding authors to obtain long-term follow-up where available. We identified 44 unique cases of iALCL, the majority of which were associated with seroma, had an ALK(-) phenotype (97%), and had a good prognosis, different from the expected 40% 5-year survival rate of patients with ALK(-) nodal ALCL (one case remitted spontaneously following implant removal; only two deaths have been reported to the FDA or in the scientific literature since 1990). The majority of these patients received cyclophosphamide, doxorubicin, vincristine, and prednisolone with or without radiation, but radiation alone also resulted in complete clinical responses. It appears that iALCL demonstrates a strong association with breast implants, a waxing and waning course, and an overall good prognosis, with morphology, cytokine profile, and biological behavior similar to those of primary cutaneous ALCL. Taken together, these data are suggestive that iALCL may start as a reactive process with the potential to progress and acquire an aggressive phenotype typical of its systemic counterpart. A larger analysis and prospective evaluation and follow-up of iALCL patients are necessary to definitively resolve the issue of the natural course of the disease and best therapeutic approaches for these patients.
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Affiliation(s)
- Sara K Story
- University of Pittsburgh Department of Dermatology, Pittsburgh, Pennsylvania 15213, USA
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Engberg AK, Bunick CG, Subtil A, Ko CJ, Girardi M. Development of a plaque infiltrated with large CD30+ T cells over a silicone-containing device in a patient with history of Sézary syndrome. J Clin Oncol 2012. [PMID: 23182990 DOI: 10.1200/jco.2012.42.9241] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Oschlies I, Lisfeld J, Lamant L, Nakazawa A, d'Amore ESG, Hansson U, Hebeda K, Simonitsch-Klupp I, Maldyk J, Müllauer L, Tinguely M, Stücker M, Ledeley MC, Siebert R, Reiter A, Brugières L, Klapper W, Woessmann W. ALK-positive anaplastic large cell lymphoma limited to the skin: clinical, histopathological and molecular analysis of 6 pediatric cases. A report from the ALCL99 study. Haematologica 2012; 98:50-6. [PMID: 22773605 DOI: 10.3324/haematol.2012.065664] [Citation(s) in RCA: 77] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Anaplastic large cell lymphomas are peripheral T-cell lymphomas that are characterized by a proliferation of large anaplastic blasts expressing CD30. In children, systemic anaplastic large cell lymphomas often present at advanced clinical stage and harbor translocations involving the anaplastic lymphoma kinase (ALK) gene leading to the expression of chimeric anaplastic lymphoma kinase (ALK)-fusion proteins. Primary cutaneous anaplastic large cell lymphoma is regarded as an ALK-negative variant confined to the skin and is part of the spectrum of primary cutaneous CD30-positive T-cell lymphoproliferative disorders. Thirty-three of 487 pediatric patients registered within the Anaplastic Large Cell Lymphoma-99 trial (1999 to 2006) presented with a skin limited CD30-positive lympho-proliferative disorder. In 23 of the 33 patients, material for international histopathological review was available, and the cases were studied for histopathological, immunophenotypical and clinical features as well as for breaks within the ALK gene. Five of 23 cases and one additional case (identified after closure of the trial) expressed ALK-protein. Complete staging excluded any other organ involvement in all children. Expression of ALK proteins was demonstrated by immunohistochemistry in all cases and the presence of breaks of the ALK gene was genetically confirmed in 5 evaluable cases. The histopathological and clinical picture of these skin-restricted ALK-positive lymphomas was indistinguishable from that of cutaneous anaplastic large cell lymphoma. Five children presented with a single skin lesion that was completely resected in 4 and incompletely resected in one. Three of these patients received no further therapy, 2 additional local radiotherapy, and one chemotherapy. All children remain in complete remission with a median follow up of seven years (range 1-8 years). We present 6 pediatric cases of ALK-positive primary cutaneous anaplastic large cell lymphomas. After thorough exclusion of systemic involvement, therapy confined to local measures seems to be sufficient to induce cure.
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Affiliation(s)
- Ilske Oschlies
- Department of Pathology, Hematopathology Section and Lymph Node Registry, Christian-Albrechts-University Kiel and University Hospital Schleswig-Holstein, Campus Kiel, Kiel, Germany.
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ALK+ALCLs induce cutaneous, HMGB-1-dependent IL-8/CXCL8 production by keratinocytes through NF-κB activation. Blood 2012; 119:4698-707. [PMID: 22394598 DOI: 10.1182/blood-2011-10-386011] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Anaplastic large-cell lymphomas (ALCLs) bearing the t(2;5) translocation (ALK(+)ALCLs) are frequently characterized by skin colonization and associated with a poor prognosis. Using conditional transgenic models of anaplastic lymphoma kinase-positive (ALK(+)) lymphomas and human ALK(+)ALCL cell lines, in the present study, we show that high-mobility-group box-1 (HMGB-1), a proinflammatory cytokine, is released by ALK(+) cells, and demonstrate extracellular HMGB-1-stimulated secretion of the IL-8 chemokine by HaCaT keratinocytes through the involvement of MMP-9, PAR-2, and the NF-κB pathway. Furthermore, we demonstrate that, in vitro, IL-8 is able to induce the invasiveness of ALK(+) cells, which express the IL-8 receptors CXCR1 and CXCR2. In vitro and in vivo, HMGB-1 inhibition achieved by glycyrrhizin treatment led to a drastic reduction in ALK(+) cell invasiveness. The pathophysiological relevance of our observations was confirmed by demonstrating that the HMGB-1 and IL-8 receptors are expressed in ALK(+)ALCL biopsies. We have also shown that IL-8 secretion is correlated with leukemic dissemination of ALK(+) cells in a significant number of patients. The results of the present study demonstrate for the first time a relationship among the pro-inflammatory mediators HMGB-1, MMP-9, PAR-2, and IL-8. We propose that these mediators create a premetastatic niche within the skin, thereby participating in ALK(+) lymphoma epidermotropism.
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Abstract
Peripheral T-cell lymphomas (PTCLs) represent a heterogeneous group of more than 20 neoplastic entities derived from mature T cells and natural killer (NK) cells involved in innate and adaptive immunity. With few exceptions these malignancies, which may present as disseminated, predominantly extranodal or cutaneous, or predominantly nodal diseases, are clinically aggressive and have a dismal prognosis. Their diagnosis and classification is hampered by several difficulties, including a significant morphological and immunophenotypic overlap across different entities, and the lack of characteristic genetic alterations for most of them. Although there is increasing evidence that the cell of origin is a major determinant for the delineation of several PTCL entities, however, the cellular derivation of most entities remains poorly characterized and/or may be heterogeneous. The complexity of the biology and pathophysiology of PTCLs has been only partly deciphered. In recent years, novel insights have been gained from genome-wide profiling analyses. In this review, we will summarize the current knowledge on the pathobiological features of peripheral NK/T-cell neoplasms, with a focus on selected disease entities manifesting as tissue infiltrates primarily in extranodal sites and lymph nodes.
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Barreca A, Lasorsa E, Riera L, Machiorlatti R, Piva R, Ponzoni M, Kwee I, Bertoni F, Piccaluga PP, Pileri SA, Inghirami G. Anaplastic lymphoma kinase in human cancer. J Mol Endocrinol 2011; 47:R11-23. [PMID: 21502284 DOI: 10.1530/jme-11-0004] [Citation(s) in RCA: 86] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
The receptor tyrosine kinases (RTKs) play a critical role, controlling cell proliferation, survival, and differentiation of normal cells. Their pivotal function has been firmly established in the pathogenesis of many cancers as well. The anaplastic lymphoma kinase (ALK), a transmembrane RTK, originally identified in the nucleophosmin (NPM)-ALK chimera of anaplastic large cell lymphoma, has emerged as a novel tumorigenic player in several human cancers. In this review, we describe the expression of the ALK-RTK, its related fusion proteins, and their molecular mechanisms of activation. Novel tailored strategies are briefly illustrated for the treatment of ALK-positive neoplasms.
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Affiliation(s)
- Antonella Barreca
- Department of Pathology and Center for Experimental Research and Medical Studies (CeRMS), University of Torino, Via Santena 7, Torino 10126, Italy
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