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Russo D, Cretella P, Varricchio S, Mosella F, D’Andrea F, Severino A, Mascolo M. Primary cutaneous B cell lymphoma, leg type presenting as a diabetic ulcer: a challenging diagnosis. Pathol Res Pract 2022; 235:153940. [DOI: 10.1016/j.prp.2022.153940] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2022] [Revised: 05/06/2022] [Accepted: 05/07/2022] [Indexed: 11/26/2022]
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Cretella P, Peluso AL, Picariello C, Cozzolino I, Triggiani M, Puzziello A, Giudice V, Sabbatino F, Ieni A, Zeppa P, Caputo A. Immunohistochemical algorithms and gene expression profiling in primary cutaneous B-cell lymphoma. Pathol Res Pract 2022; 231:153804. [PMID: 35183824 DOI: 10.1016/j.prp.2022.153804] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2021] [Revised: 01/25/2022] [Accepted: 02/09/2022] [Indexed: 01/08/2023]
Abstract
OBJECTIVE to assess whether immunohistochemical (IHC) algorithms used to classify the cell of origin (COO) of nodal Diffuse Large B-cell lymphoma (nDLBCL) in Germinal Center type (GCB) and non-GCB subtypes may be applied to Primary Cutaneous B-cell lymphoma (PCBCL) too, and which of these algorithms performs better on PCBCL. DESIGN Retrospective case control study. SETTING Pathology Department of the University Hospital "San Giovanni di Dio e Ruggi d'Aragona" Salerno, Italy. PARTICIPANTS Fourteen PCBCL, including Primary Cutaneous follicle centre lymphoma (PCFCL) and primary cutaneous diffuse large B-cell lymphoma, Leg type (PCDLBCL-LT) and 14 nDLBCL were evaluated for 7-year period (January 2011 to December 2017). Primary cutaneous marginal zone cell lymphoma (PCMZL) cases were not included in the present study. INTERVENTION Evaluation of immunohistochemical CD10, BCL6, MUM1/IRF4, BCL2, MYC and Ki-67 expression and classification according to three different algorithms. Gene expression profiling (GEP) was performed on the same series using Lymph2Cx assay (Nanostring). The data obtained were compared and analysed. RESULTS All the IHC algorithms showed 13 GCB and 15 non-GCB. GEP showed 12 GCB, 12 activated B cell-type and 4 unclassified. CONCLUSIONS The PCBCL were classifiable as GCB and non-GCB like the nDLBCL as IHC algorithms were concordant to GEP and produced the same results.
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Affiliation(s)
- Pasquale Cretella
- University of Salerno, Department of Medicine and Surgery, "Scuola Medica Salernitana", Salerno, Italy
| | - Anna Lucia Peluso
- University of Salerno, Department of Medicine and Surgery, "Scuola Medica Salernitana", Salerno, Italy; University of Rome "G. Marconi", Department of Energy and Environment (DEA), Rome, Italy
| | - Caterina Picariello
- University of Salerno, Department of Medicine and Surgery, "Scuola Medica Salernitana", Salerno, Italy
| | - Immacolata Cozzolino
- University of Campania "L Vanvitelli", Department of Mental and Physical Health and preventive medicine, Naples, Italy
| | - Massimo Triggiani
- University of Salerno, Department of Medicine and Surgery, "Scuola Medica Salernitana", Salerno, Italy
| | - Alessandro Puzziello
- University of Salerno, Department of Medicine and Surgery, "Scuola Medica Salernitana", Salerno, Italy
| | - Valentina Giudice
- University of Salerno, Department of Medicine and Surgery, "Scuola Medica Salernitana", Salerno, Italy
| | - Francesco Sabbatino
- University of Salerno, Department of Medicine and Surgery, "Scuola Medica Salernitana", Salerno, Italy
| | - Antonio Ieni
- University of Messina, Department of Human Pathology "G. Barresi", Messina, Italy
| | - Pio Zeppa
- University of Salerno, Department of Medicine and Surgery, "Scuola Medica Salernitana", Salerno, Italy.
| | - Alessandro Caputo
- University of Salerno, Department of Medicine and Surgery, "Scuola Medica Salernitana", Salerno, Italy
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Walter HS, Trethewey CS, Ahearne MJ, Jackson R, Jayne S, Wagner SD, Saldanha G, Dyer MJ. Successful Treatment of Primary Cutaneous Diffuse Large B-Cell Lymphoma Leg Type With Single-Agent Venetoclax. JCO Precis Oncol 2019; 3:1-5. [DOI: 10.1200/po.19.00002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Harriet S. Walter
- University of Leicester, Leicester, United Kingdom
- University Hospitals of Leicester NHS Trust, Leicester, United Kingdom
| | | | - Matthew J. Ahearne
- University of Leicester, Leicester, United Kingdom
- University Hospitals of Leicester NHS Trust, Leicester, United Kingdom
| | - Ross Jackson
- University of Leicester, Leicester, United Kingdom
| | | | - Simon D. Wagner
- University of Leicester, Leicester, United Kingdom
- University Hospitals of Leicester NHS Trust, Leicester, United Kingdom
| | - Gerald Saldanha
- University of Leicester, Leicester, United Kingdom
- University Hospitals of Leicester NHS Trust, Leicester, United Kingdom
| | - Martin J.S. Dyer
- University of Leicester, Leicester, United Kingdom
- University Hospitals of Leicester NHS Trust, Leicester, United Kingdom
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Cutaneous lymphomas: an update. Part 2: B-cell lymphomas and related conditions. Am J Dermatopathol 2014; 36:197-208; quiz 209-10. [PMID: 24658377 DOI: 10.1097/dad.0b013e318289b20e] [Citation(s) in RCA: 57] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
: Primary cutaneous B-cell lymphomas (PCBCL) are the second most common form of primary cutaneous lymphomas and account for approximately 25%-30% of all primary cutaneous lymphomas. Both forms of low-grade malignant PCBCL, primary cutaneous follicle center lymphoma (PCFCL) and primary cutaneous marginal zone lymphoma of mucosa-associated lymphoid tissue-type (MALT lymphoma) (PCMZL) represent the vast majority of PCBCL and show an indolent slowly progressive course and an excellent prognosis despite a high recurrence rate. Genetic analysis indicates that PCMZL differ from other forms of extranodal MALT lymphomas. The more common class-switched and the non-class-switched form of PCMZL can be distinguished as two distinctive subsets that differ in the cellular composition, IgM expression, and biological behavior with extracutaneous involvement found in the non-class-switched form. Recently, unusual clinical and histological forms of PCMZL and PCFCL manifesting with miliary or agminated lesions have been described that are diagnostically challenging. In contrast to PCMZL and PCFCL, primary cutaneous diffuse large B-cell lymphoma, leg type, and other rare forms of large B-cell lymphomas such as intravascular large B-cell lymphoma have an unfavorable prognosis. There is an emerging group of Epstein-Barr virus (EBV)-driven B-cell lymphoproliferations including posttransplant lymphoproliferative disorders and mucocutaneous ulcer occurring in immunocompromised patients and EBV-associated diffuse large B-cell lymphoma of the elderly arising in the setting of senescence-linked immunodeficiency. This review reports on recent findings expanding the spectrum of clinicopathological features, differential diagnostic aspects, and the pathogenesis of PCBCL and discusses the group of EBV-associated B-cell lymphoproliferations involving the skin.
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Abstract
B-cell lymphomas occurring in the skin often tend to be of systemic origin with secondary cutaneous involvement. Primary cutaneous B-cell lymphomas tend to be indolent disorders, with the exception of primary cutaneous diffuse large B-cell lymphoma-leg type (PCDLBCL-LT). In indolent conditions, the distinction between cutaneous lymphoma and cutaneous lymphoid hyperplasia can be difficult. Integration of all available information, including the clinical setting, is crucial to arriving at the appropriate diagnosis. In this review, we cover the diagnostic approaches to primary cutaneous marginal zone lymphoma, primary cutaneous follicle center lymphoma, and PCDLBCL-LT, and discuss their differential diagnosis.
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Affiliation(s)
- Uma Sundram
- Department of Pathology, Stanford Hospital and Clinics, 300 Pasteur Drive Room H2117, Stanford, CA 94305, USA; Department of Dermatology, Stanford Hospital and Clinics, 450 Broadway, Pavilion B 4th Floor, Redwood City, CA 94063, USA.
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Mondal SK, Mandal PK, Roy S, Biswas PK. Primary cutaneous large B-cell lymphoma, leg type: Report of two cases and review of literature. Indian J Med Paediatr Oncol 2012; 33:54-7. [PMID: 22754211 PMCID: PMC3385281 DOI: 10.4103/0971-5851.96973] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Primary cutaneous large B-cell lymphoma, leg type (PCLBCL-LT), is very rare neoplasm presenting on and confined to leg(s). PCLBCL-LT is distinguished from other type of primary cutaneous B-cell lymphoma (PCBCL) by its frequent relapses and poorer prognosis. We report, two cases of PCLBCL-LT, occurring in two younger patients compared to published cases in literature. Both the patients were treated with chemotherapy and local radiotherapy. During the 1-year follow-up period one patient presented with extracutaneous dissemination and succumbed. The other patient is symptom free and follow-up period was uneventful.
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Felcht M, Heck M, Weiss C, Becker JC, Dippel E, Müller CSL, Nashan D, Sachse MM, Nicolay JP, Booken N, Goerdt S, Klemke CD. Expression of the T-cell regulatory marker FOXP3 in primary cutaneous large B-cell lymphoma tumour cells. Br J Dermatol 2012; 167:348-58. [PMID: 22512270 DOI: 10.1111/j.1365-2133.2012.10987.x] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
BACKGROUND Primary cutaneous B-cell lymphomas (PCBCL) are subdivided into the aggressive form, primary cutaneous diffuse large B-cell lymphoma, leg type (PCLBCL, LT) and two subtypes of indolent behaviour (primary cutaneous follicle centre lymphoma and primary cutaneous marginal zone B-cell lymphoma). The difference in clinical behaviour can be explained by the tumour cell itself, or the lymphoma microenvironment including the antitumour immune response. OBJECTIVES To investigate the presence of regulatory T cells (Treg), CD4+CD25+FOXP3+, in the microenvironment of PCBCL in correlation with clinical outcome. METHODS Tumour specimens of 55 consecutive cases of PCBCL were blinded and analysed for FOXP3, CD4 and CD25 expression by immunohistochemistry. Confocal images were taken with a Leica SP5. Statistical analyses were performed to determine significance. The test was considered significant when P<0.05. RESULTS The CD4 and FOXP3 expression as well as the CD4/FOXP3 ratio were significantly increased in PCBCL of indolent behaviour in contrast to PCLBCL, LT (P=0.0002 for CD4, P<0.0001 for FOXP3 and P=0.0345 for FOXP3/CD4 ratio). CD25 expression did not differ in the three groups (P=0.9414). Within the group of patients with PCLBCL, LT we identified a subgroup with FOXP3+ tumour cells as demonstrated by CD20/FOXP3 double stainings. Patients with FOXP3+ PCLBCL, LT tumour cells showed a better prognosis on Kaplan-Meier analysis. CONCLUSION High numbers of Treg in the lymphoma microenvironment correlate with a better prognosis in PCBCL. In PCLBCL, LT the presence of FOXP3+ tumour cells is beneficial for prognosis suggesting that FOXP3 expression of PCLBCL, LT tumour cells might serve as a tumour suppressor.
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Affiliation(s)
- M Felcht
- Working Group of Cutaneous Lymphomas of the Arbeitsgemeinschaft für Dermatologische Forschung (ADF), Germany
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Krupp M, Maass T, Marquardt JU, Staib F, Bauer T, König R, Biesterfeld S, Galle PR, Tresch A, Teufel A. The functional cancer map: a systems-level synopsis of genetic deregulation in cancer. BMC Med Genomics 2011; 4:53. [PMID: 21718500 PMCID: PMC3148554 DOI: 10.1186/1755-8794-4-53] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2010] [Accepted: 06/30/2011] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND Cancer cells are characterized by massive dysegulation of physiological cell functions with considerable disruption of transcriptional regulation. Genome-wide transcriptome profiling can be utilized for early detection and molecular classification of cancers. Accurate discrimination of functionally different tumor types may help to guide selection of targeted therapy in translational research. Concise grouping of tumor types in cancer maps according to their molecular profile may further be helpful for the development of new therapeutic modalities or open new avenues for already established therapies. METHODS Complete available human tumor data of the Stanford Microarray Database was downloaded and filtered for relevance, adequacy and reliability. A total of 649 tumor samples from more than 1400 experiments and 58 different tissues were analyzed. Next, a method to score deregulation of KEGG pathway maps in different tumor entities was established, which was then used to convert hundreds of gene expression profiles into corresponding tumor-specific pathway activity profiles. Based on the latter, we defined a measure for functional similarity between tumor entities, which yielded to phylogeny of tumors. RESULTS We provide a comprehensive, easy-to-interpret functional cancer map that characterizes tumor types with respect to their biological and functional behavior. Consistently, multiple pathways commonly associated with tumor progression were revealed as common features in the majority of the tumors. However, several pathways previously not linked to carcinogenesis were identified in multiple cancers suggesting an essential role of these pathways in cancer biology. Among these pathways were 'ECM-receptor interaction', 'Complement and Coagulation cascades', and 'PPAR signaling pathway'. CONCLUSION The functional cancer map provides a systematic view on molecular similarities across different cancers by comparing tumors on the level of pathway activity. This work resulted in identification of novel superimposed functional pathways potentially linked to cancer biology. Therefore, our work may serve as a starting point for rationalizing combination of tumor therapeutics as well as for expanding the application of well-established targeted tumor therapies.
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Affiliation(s)
- Markus Krupp
- Department of Medicine I, Johannes Gutenberg University, Mainz, Germany.
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Wobser M, Kneitz H, Bröcker EB, Becker JC. Primary cutaneous diffuse large B-cell lymphoma, leg-type, treated with a modified R-CHOP immunochemotherapy - diagnostic and therapeutic challenges. J Dtsch Dermatol Ges 2010; 9:204-11. [PMID: 21122066 DOI: 10.1111/j.1610-0387.2010.07578.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND Primary cutaneous diffuse large B-cell lymphoma (PCLBCL) represents a rare subtype among primary cutaneous B-cell lymphoma exhibiting a characteristic genetic background, an aggressive clinical course and a high relapse rate under different therapeutic regimen. Therefore, PCLBCL has a rather restricted prognosis. PATIENTS AND METHODS Four patients with PCLBCL were treated at our institution with age- and toxicity-adapted first-line immunochemotherapy with rituximab and modified CHOP (cyclophosphamid, vincristin, liposomal doxorubicin, prednisolon). On relapse, the same regimen with R-CHOP or different antineoplastic strategies (radiation, polychemotherapy, immunotherapy, stem cell transplantation) were applied. Toxicity, clinical response and overall survival was documented. RESULTS Under this regimen, clinical response to modified R-CHOP was achieved in all patients with tolerable toxicity - however, being characterized by a rapid disease progression with inconsistent response towards the subsequent therapeutic armentarium and unsecure impact on overall survival. CONCLUSIONS So far, it is still unknown, if an extensive multimodal therapy for PBLBCL improves overall survival. Immunochemotherapy with R-CHOP currently represents the most effective treatment.
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Affiliation(s)
- Marion Wobser
- Department of Dermatology, University Clinic of Würzburg, Germany.
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Pham-Ledard A, Prochazkova-Carlotti M, Vergier B, Petrella T, Grange F, Beylot-Barry M, Merlio JP. IRF4 Expression without IRF4 Rearrangement Is a General Feature of Primary Cutaneous Diffuse Large B-Cell Lymphoma, Leg Type. J Invest Dermatol 2010; 130:1470-2. [DOI: 10.1038/jid.2009.418] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Patrizi A, Raone B, Sabattini E, Gurioli C, Pileri A, D'Acunto C. Primary Cutaneous Large B-Cell Lymphoma, Leg Type, Localized on the Dorsum. Case Rep Dermatol 2009; 1:87-92. [PMID: 20652122 PMCID: PMC2895218 DOI: 10.1159/000253874] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Primary cutaneous large B-cell lymphoma, leg-type (PCLBCL-LT), is a large B-cell lymphoma primarily involving the skin. It is distinguished from the other 3 subsets of this lymphoproliferative disorder by its immunohistopathological features, configuring confluent sheets of medium-sized to large B lymphocytes with round nuclei provided with evident nucleoli, resembling centroblasts or immunoblasts, which express Bcl-6, Bcl-2. Prevalently appearing on the lower limbs, as a single or multicentric and frequently ulcerated skin nodule or plaque, PCLBCL-LT has a worse prognosis than the other large B-cell lymphomas. Moreover, the age of onset is delayed (7th decade) compared to those of the other 3 subtypes (6th decade); it presents a slight female predominance (2:1), and a higher percentage of positivity to Bcl-2. We present a 52-year-old man who showed a 2-year standing, non-ulcerated, round, 4 cm in diameter, red plaque, medially located on the dorsum. After biopsy the diagnosis of PCLBCL-LT was made on histopathological and immunohistochemical studies, the latter showing positivity to CD20, Bcl-2, and Bcl-6. After treatment with radiotherapy the patient has shown a 4.4-year follow-up free of disease.
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Affiliation(s)
- A Patrizi
- Dermatology, Department of Internal Medicine, Geriatrics and Nephrologic Diseases, University of Bologna, Bologna, Italy
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van Krieken JHJM. New developments in the pathology of malignant lymphoma: a review of the literature published from January to April 2008. J Hematop 2009; 1:37-45. [PMID: 19669203 PMCID: PMC2712329 DOI: 10.1007/s12308-008-0010-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Affiliation(s)
- J Han J M van Krieken
- Department of Pathology, Nijmegen Medical Centre, Radboud University, P.O. Box 9101, 6500, HB Nijmegen, The Netherlands,
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New developments in the pathology of malignant lymphoma: a review of the literature published from May to July 2008. J Hematop 2009; 1:145-60. [PMID: 19669214 PMCID: PMC2713479 DOI: 10.1007/s12308-008-0012-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
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