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Kulumani Mahadevan LS, Ozdemirli M. Subcutaneous panniculitis-like T cell lymphoma arising in association with chronic lymphocytic leukaemia. BMJ Case Rep 2021; 14:e243490. [PMID: 34580127 PMCID: PMC8477245 DOI: 10.1136/bcr-2021-243490] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/02/2021] [Indexed: 11/04/2022] Open
Abstract
Subcutaneous panniculitis-like T cell lymphoma (SPTCL) is a rare cutaneous T cell malignancy of cytotoxic T cell origin. It is frequently associated with autoimmune diseases. It is known to preferentially involve subcutaneous adipose tissue and histologically resembles lupus panniculitis. The aetiology and risk factors of SPTCL are unclear and there are limited studies available since this entity was initially described in 2001. There are even fewer case reports describing the association between SPTCL and chronic lymphocytic leukemia (CLL). In this article, we present a case of SPTCL arising during treatment for CLL. We conducted an extensive review of literature to delve into the possible risk factors for SPTCL development in association with CLL, including pre-existing haematological malignancies, autoimmune conditions, immunomodulation and immunosuppressive chemotherapy.
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Affiliation(s)
| | - Metin Ozdemirli
- Department of Anatomic and Clinical Pathology, Georgetown University Medical Center, Washington, DC, USA
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2
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Chang TW, Weaver AL, Shanafelt TD, Habermann TM, Wriston CC, Cerhan JR, Call TG, Brewer JD. Risk of cutaneous T-cell lymphoma in patients with chronic lymphocytic leukemia and other subtypes of non-Hodgkin lymphoma. Int J Dermatol 2017; 56:1125-1129. [PMID: 28685851 DOI: 10.1111/ijd.13653] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2016] [Revised: 03/28/2017] [Accepted: 04/17/2017] [Indexed: 11/29/2022]
Abstract
BACKGROUND Second hematologic cancers in patients with chronic lymphocytic leukemia/small lymphocytic lymphoma (CLL) are well documented and include Hodgkin lymphoma, therapy-related acute myeloid leukemia/myelodysplastic syndromes, and transformation to diffuse large B-cell lymphoma. Although cutaneous T-cell lymphoma (CTCL) has been reported in patients with CLL, the incidence and comparison to expected rates are unknown. We evaluated the incidence of CTCL among patients with CLL or other non-Hodgkin lymphoma (NHL) subtypes using data from the Surveillance, Epidemiology, and End Results (SEER) Program. METHODS We searched the SEER 13 registries for patients with a diagnosis of CLL and NHL between 1992 and 2008. Among patients identified, we evaluated the incidence of CTCL. RESULTS Among 31,286 patients with CLL, the incidence of CTCL was not significantly higher in men than women: 104.2 (95% CI, 50.0-191.8) and 28.1 (95% CI, 3.4-101.3) per 1,000,000 person-years, respectively (P = 0.06). Among 97,691 patients with NHL, the incidence of CTCL was similar in men and women (97.9 [95% CI, 62.0-146.9] and 92.0 [95% CI, 56.2-142.1] per 1,000,000 person-years, respectively; P = 0.84). The incidence of CTCL among males with CLL (standardized incidence ratio [SIR], 3.0 [95% CI, 1.4-5.5]), males with NHL (SIR, 3.7 [95% CI, 2.3-5.5]), and females with NHL (SIR, 5.9 [95% CI, 3.6-9.1]) was significantly higher than expected in the general population (all P < 0.001). CONCLUSION The risk of CTCL is greater in men with CLL than in the general population. In patients with NHL, both men and women are at greater risk for CTCL than in the general population.
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Affiliation(s)
| | - Amy L Weaver
- Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, MN, USA
| | | | | | - Cooper C Wriston
- Department of Dermatology, Mayo Clinic Health System, Owatonna, MN, USA
| | - James R Cerhan
- Department of Health Sciences Research, Mayo Clinic, Rochester, MN, USA
| | | | - Jerry D Brewer
- Department of Dermatology, Mayo Clinic, Rochester, MN, USA
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3
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Vonderheid EC, Kadin ME, Telang GH. Papular mycosis fungoides: Six new cases and association with chronic lymphocytic leukemia. World J Dermatol 2016; 5:136-143. [DOI: 10.5314/wjd.v5.i4.136] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2016] [Revised: 08/05/2016] [Accepted: 10/09/2016] [Indexed: 02/06/2023] Open
Abstract
Papular mycosis fungoides (MF) is a rare presentation of MF. Six illustrative cases of papular MF were retrospectively reviewed. Five of the cases studied by immunohistochemistry had variable numbers (range: 1%-20%) of CD30+ cells in the dermal infiltrate, a finding that is characteristic of lymphomatoid papulosis but may occasionally occur in typical early MF. Although none of our papular MF patients had progressive disease, lesions with relatively high numbers of CD30+ cells in 3 patients did not respond well to skin-directed treatments used for MF. Interestingly, these patients had evidence of co-existing clonal B cell populations in the blood (one with clonal B cell lymphocytosis and two with B-cell chronic lymphocytic leukemia). We conclude that: (1) papular MF may contain CD30+ cells, thereby causing confusion with lymphomatoid papulosis; and (2) papular MF, like more typical MF, may be associated with clonal B-cell proliferations including chronic lymphocytic leukemia.
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4
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Chang MB, Weaver AL, Brewer JD. Cutaneous T-cell lymphoma in patients with chronic lymphocytic leukemia: clinical characteristics, temporal relationships, and survival data in a series of 14 patients at Mayo Clinic. Int J Dermatol 2013; 53:966-70. [PMID: 24134412 DOI: 10.1111/ijd.12063] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND We examined the course of cutaneous T-cell lymphoma (CTCL), which has been associated with chronic lymphocytic leukemia (CLL) in patients with CLL. MATERIALS AND METHODS A search was conducted of the master diagnosis index at our institution to identify patients with both CLL and CTCL from 1980 to 2010. A retrospective chart review was then conducted. RESULTS Of the 14 patients with CTCL and CLL, eight had mycosis fungoides (MF; two with patch stage, two with plaque stage, two with tumor stage, and two with erythrodermic stage), four had Sézary syndrome, one had natural killer cell lymphoma involving the skin, and one had peripheral T-cell lymphoma involving the skin. Eight had concurrent diagnoses, five received a CLL diagnosis first, and one received a CTCL diagnosis first. Ten patients were deceased at the time of data abstraction due to unknown causes (n = 4), lymphoma (n = 2), pneumonia (n = 2), MF (n = 1), or respiratory failure (n = 1). Of the nine patients with concurrent or prior CTCL, seven were deceased, with a median time to death of 10.2 months (range, 6-89 months). Of the five patients with CLL prior to CTCL, three were deceased at 18, 27, and 47 months, respectively, after the CTCL diagnosis. The median survival for the two groups was 12 and 47 months, respectively. CONCLUSIONS Patients with CTCL concurrent with or prior to CLL have a worse overall survival than patients with CLL in whom CTCL later develops. Larger studies are needed.
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5
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KIKUCHI A, ANZAI H, KOSUGE H, NAKA W, NISHIKAWA T. Aggressive B-cell lymphoma induced by Epstein-Barr virus infection in erythrodermic cutaneous T-cell lymphoma. Br J Dermatol 2008. [DOI: 10.1046/j.1365-2133.1997.d01-1158.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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6
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Karsai S, Hou JS, Telang G, Kantor GR, Nowell PC, Vonderheid EC. Sézary Syndrome Coexisting with B-Cell Chronic Lymphocytic Leukemia: Case Report and Review of the Literature. Dermatology 2007; 216:68-75. [DOI: 10.1159/000109362] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2007] [Accepted: 05/30/2007] [Indexed: 01/16/2023] Open
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7
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Nava VE, Cohen P, Bishop M, Fowler D, Jaffe ES, Ozdemirli M. Enteropathy-type T-cell Lymphoma After Intestinal Diffuse Large B-cell Lymphoma. Am J Surg Pathol 2007; 31:476-80. [PMID: 17325491 DOI: 10.1097/01.pas.0000213391.49698.57] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
A rare case of enteropathy-type T-cell lymphoma (ETL) developed in a 47-year-old Chinese male 6 years after the diagnosis of diffuse large B-cell lymphoma (DLBCL) in the small intestine. The patient initially presented with vague gastrointestinal complaints. Work-up demonstrated an ulcerated mass in the small intestine. Partial resection and histologic examination of the intestine showed a DLBCL, positive for CD20 and Bcl-2, involving the jejunum transmurally. Further staging work-up demonstrated mesenteric and retroperitoneal lymphadenopathy, splenomegaly, and ascites. The patient was treated aggressively with radiotherapy, chemotherapy, and autologous bone marrow transplant, and complete remission was obtained. Six years later, the patient presented with diarrhea and dehydration. Clinical work-up revealed thickening of the small intestinal wall, and biopsies demonstrated ETL based on morphology, immunohistochemistry, and polymerase chain reaction analysis. Celiac disease was diagnosed concurrently. The patient responded to chemotherapy, received allogeneic peripheral blood stem cell transplantation from an HLA-matched sibling donor, and remains in remission. To our best knowledge, this is the first reported case of metachronous ETL and DLBCL. Possible associations between the 2 types of lymphoma are discussed.
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MESH Headings
- Adult
- Biomarkers, Tumor/analysis
- Celiac Disease/complications
- Celiac Disease/diagnosis
- Chemotherapy, Adjuvant
- Humans
- Immunohistochemistry
- Intestinal Neoplasms/chemistry
- Intestinal Neoplasms/pathology
- Intestinal Neoplasms/surgery
- Lymphoma, B-Cell/chemistry
- Lymphoma, B-Cell/pathology
- Lymphoma, B-Cell/surgery
- Lymphoma, Large B-Cell, Diffuse/chemistry
- Lymphoma, Large B-Cell, Diffuse/pathology
- Lymphoma, Large B-Cell, Diffuse/surgery
- Lymphoma, T-Cell/chemistry
- Lymphoma, T-Cell/pathology
- Lymphoma, T-Cell/therapy
- Male
- Neoplasm Staging
- Neoplasms, Second Primary/pathology
- Peripheral Blood Stem Cell Transplantation
- Treatment Outcome
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Affiliation(s)
- Victor E Nava
- Department of Pathology, Lombardi Comprehensive Cancer Center, Georgetown University Hospital, Washington, DC 20007, USA
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8
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Barzilai A, Trau H, David M, Feinmesser M, Bergman R, Shpiro D, Schiby G, Rosenblatt K, Or R, Hodak E. Mycosis fungoides associated with B-cell malignancies. Br J Dermatol 2006; 155:379-86. [PMID: 16882178 DOI: 10.1111/j.1365-2133.2006.07346.x] [Citation(s) in RCA: 56] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND The coexistence of mycosis fungoides, a peripheral T-cell lymphoma, and B-cell malignancies or Hodgkin's lymphoma in the same patient is unusual. Most descriptions are isolated case reports and case series are strikingly sparse. OBJECTIVES To detect cases of mycosis fungoides associated with B-cell malignancies or Hodgkin's lymphoma and to analyse the characteristics of and the interplay between the lymphoproliferative neoplasms. METHODS Patients with mycosis fungoides who had B-cell malignancies or Hodgkin's lymphoma were selected from among 398 patients either treated or followed up in two tertiary medical centres during a 7-year period. RESULTS Eleven patients with mycosis fungoides and B-cell malignancy were detected (seven of non-Hodgkin's lymphoma, three of chronic lymphocytic leukaemia, one of multiple myeloma). No case of Hodgkin's lymphoma was found. In seven patients the mycosis fungoides preceded the B-cell malignancy whereas in four it was the B-cell malignancy which occurred first. The time elapsed between onset of the two malignancies ranged from 4 to 22 years (average: 12 years). Patients who had mycosis fungoides as the first neoplasm presented with earlier stages of mycosis fungoides (four of seven: IA, three of seven: IB) than those who had mycosis fungoides as their second neoplasm (of four, one: IB, one: folliculotropic, two: IIB). Among the four patients in whom the appearance of mycosis fungoides followed the B-cell malignancy, three had been treated with multiagent chemotherapy. Two patients who presented with early-stage mycosis fungoides (IA) as the first lymphoma developed mycosis fungoides tumours after becoming immunosuppressed. In two patients infiltrates composed of both malignant T- and B-cell populations were found in a single biopsy. One showed two distinct populations of the malignant cells in the skin tumour, thus constituting a classical composite lymphoma of mycosis fungoides and chronic lymphocytic leukaemia, while in the other patient the two malignant populations of marginal B-cell lymphoma and mycosis fungoides (as evidenced by both phenotypic and genotypic findings) were intermingled. CONCLUSIONS This case series indicates that while the coexistence of Hodgkin's lymphoma and mycosis fungoides is extremely rare, the association of mycosis fungoides and B-cell malignancies is not as rare as reflected in the literature, with non-Hodgkin's lymphoma constituting the most common associated B-cell malignancy. In this series as well as in the cases reported in the literature mycosis fungoides usually preceded the development of B-cell malignancies, which may be in accordance with previous reports of an increased risk of developing a second haematological neoplasm. The importance of a competent immune system for patients with mycosis fungoides is well demonstrated in these cases. It is suggested that for greater precision the criteria for diagnosis of composite lymphoma of the skin should include both phenotypic and genotypic features.
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Affiliation(s)
- A Barzilai
- Dermatology, Sheba Medical Center, Tel-Hashomer, Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
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9
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Inokuchi T, Shincho M, Moriwaki Y, Ka T, Takahashi S, Tsutsumi Z, Lin Y, Hirota S, Yamamoto T. Coexistent B-cell lymphoma and cutaneous T-cell lymphoma. Intern Med 2006; 45:641-7. [PMID: 16755097 DOI: 10.2169/internalmedicine.45.1564] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
A 78-year-old man with a history of mycosis fungoides was referred for evaluation of a right adrenal mass. A physical examination showed the left cervical lymph node to be palpable, which was later shown to be caused by a diffuse large B-cell lymphoma. The patient was diagnosed with concurrent mycosis fungoides and a diffuse large B-cell lymphoma. Three courses of chemotherapy were performed, however, the patient died of advanced disease. Autopsy findings showed that the right adrenal and soft tissue masses had an identical B-cell origin. Although the exact mechanism remains unclear, the pathogenesis of this rare association is discussed.
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Affiliation(s)
- Taku Inokuchi
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Hyogo College of Medicine, Nishinomiya
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10
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Ohmatsu H, Saeki H, Fujita H, Toyoma K, Sugaya M, Asahina A, Masuda S, Hirai H, Watanabe T, Nagawa H, Tamaki K. Mycosis fungoides associated with intestinal mucosa-associated lymphoid tissue lymphoma. Int J Dermatol 2005; 44:878-80. [PMID: 16207197 DOI: 10.1111/j.1365-4632.2005.02247.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
Coexistence of cutaneous T-cell lymphoma (CTCL) and a B-cell malignancy is rare. We report a case of mycosis fungoides (MF) associated with intestinal mucosa-associated lymphoid tissue (MALT) lymphoma, which is a low-grade B-cell lymphoma of marginal cell origin. To the best of our knowledge, there have been only two cases of coexistent CTCL and MALT lymphoma, and this is the first case with typical MF and intestinal MALT lymphoma. The coexistence in our case might be coincidental, but genetic predisposition and the immunoregulatory capacity of neoplastic T lymphocytes may be factors contributing to this association.
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MESH Headings
- Antigens, CD20/analysis
- CD3 Complex/analysis
- CD4 Antigens/analysis
- CD8 Antigens/analysis
- Chromosomes, Human, Pair 11/genetics
- Chromosomes, Human, Pair 18/genetics
- Gene Rearrangement
- Humans
- Immunoglobulin Heavy Chains/genetics
- Immunohistochemistry
- Intestinal Neoplasms/complications
- Intestinal Neoplasms/genetics
- Intestinal Neoplasms/metabolism
- Leukocyte Common Antigens/analysis
- Lymphoma, B-Cell, Marginal Zone/complications
- Lymphoma, B-Cell, Marginal Zone/genetics
- Lymphoma, B-Cell, Marginal Zone/metabolism
- Male
- Middle Aged
- Mycosis Fungoides/complications
- Mycosis Fungoides/genetics
- Mycosis Fungoides/metabolism
- Receptors, Antigen, T-Cell, alpha-beta/genetics
- Skin Neoplasms/complications
- Skin Neoplasms/genetics
- Skin Neoplasms/metabolism
- Translocation, Genetic
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Affiliation(s)
- Hanako Ohmatsu
- Department of Dermatology, Faculty of Medicine, University of Tokyo, Tokyo, Japan.
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11
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Martinez A, Pittaluga S, Villamor N, Colomer D, Rozman M, Raffeld M, Montserrat E, Campo E, Jaffe ES. Clonal T-cell Populations and Increased Risk for Cytotoxic T-cell Lymphomas in B-CLL Patients. Am J Surg Pathol 2004; 28:849-58. [PMID: 15223953 DOI: 10.1097/00000478-200407000-00002] [Citation(s) in RCA: 58] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Chronic lymphocytic leukemia (CLL) is associated with increased risk of malignancy, but the occurrence of other lymphomas, in particular T-cell lymphomas, is rare. We identified 7 cases of peripheral T-cell malignancy associated with B-cell-derived CLL from the files of two institutions over a 20-year period. The presence of both B and T lymphoproliferative disorders was confirmed in all cases by immunophenotype and in 6 cases by gene rearrangements. Six patients developed peripheral T-cell lymphoma (PTCL), unspecified, during the course of CLL (10-168 months). In all 5 evaluable cases, the cells had a cytotoxic T-cell phenotype; the sixth case was CD56+, but TIA-1 and Granzyme B could not be studied. A seventh patient with CLL developed mycosis fungoides, and an aggressive NK cell leukemia. To investigate possible risk factors for the development of PTCL, we screened 100 unselected peripheral blood samples from newly diagnosed CLL patients by PCR for the presence of clonal T cell populations. We found evidence of clonal T-cell expansion in 8 patients and increased lymphocytes with large granular lymphocyte morphology in 7 of 8 cases. The immunophenotype was assessed by multicolor flow cytometry and in 4 cases the T-cell expansion was composed of either CD3+/CD8+ or CD3+/CD4-/CD8- cells. The cytotoxic nature of the clonal T-cell expansions in the peripheral blood correlates with the cytotoxic nature of the PTCLs, but their role in the subsequent development of T-cell lymphomas is still unclear. PTCL following CLL should be distinguished from typical Richter syndrome, which it can mimic clinically.
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Affiliation(s)
- Antonio Martinez
- Laboratory of Pathology, National Cancer Institute, National Institutes of Health, Bethesda, MD 20892, USA
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12
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Ohmatsu H, Saeki H, Fujita H, Toyoma K, Sugaya M, Asahina A, Masuda S, Hirai H, Watanabe T, Nagawa H, Tamaki K. Mycosis fungoides associated with intestinal mucosa-associated lymphoid tissue lymphoma. Int J Dermatol 2004. [DOI: 10.1111/j.1365-4632.2004.02247.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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13
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Scarisbrick JJ, Child F, Spittle M, Calonje E, Russell-Jones R. Systemic Hodgkin's lymphoma in a patient with Sézary syndrome. Br J Dermatol 2000; 142:771-5. [PMID: 10792230 DOI: 10.1046/j.1365-2133.2000.03424.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
We report a case of a 71-year-old male with Sézary syndrome diagnosed in 1996 who subsequently developed systemic Hodgkin's lymphoma. His only past treatment was bath psoralen plus ultraviolet A. He has since been treated with multiagent chemotherapy (ChlVPP/PABLOE) which induced a remission in his Hodgkin's disease. Eighteen months later he remains in remission from Hodgkin's disease but the Sézary syndrome remains active. He has also developed a squamous cell carcinoma on the upper lip. Sézary syndrome is a primary cutaneous T-cell lymphoma characterized by a malignant proliferation of CD4-positive cells in the skin and peripheral circulation. The CD4 count may be markedly elevated but this results from expansion of a neoplastic T-cell clone and there is a relative lymphopenia of normal T cells leading to a degree of immunoparesis. Immunosuppression is known to be associated with an increased rate of malignancies and this may account for the occurrence of Hodgkin's disease and squamous cell carcinoma in this patient with Sézary syndrome.
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Affiliation(s)
- J J Scarisbrick
- Skin Tumour Unit, St John's Institute of Dermatology, St Thomas' Hospital, Lambeth Palace Rd, Westminster, London SE1 7EH, UK
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14
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15
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KIKUCHI A, ANZAI H, KOSUGE H, NAKA W, NISHIKAWA T. Aggressive B-cell lymphoma induced by Epstein-Barr virus infection in erythrodermic cutaneous T-cell lymphoma. Br J Dermatol 1997. [DOI: 10.1111/j.1365-2133.1997.tb08762.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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16
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Metzman MS, Stevens SR, Griffiths CE, Ross CW, Barnett JM, Cooper KD. A clinical and histologic mycosis fungoides simulant occurring as a T-cell infiltrate coexisting with B-cell leukemia cutis. J Am Acad Dermatol 1995; 33:341-5. [PMID: 7615882 DOI: 10.1016/0190-9622(95)91430-7] [Citation(s) in RCA: 22] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
One year after the onset of chronic lymphocytic leukemia, an elderly man had scaly cutaneous plaques on the thighs that clinically and histologically resembled the mycosis fungoides type of cutaneous T-cell lymphoma. Two years later the patient had indurated, red dermal nodules on the face that clinically and histologically were characteristic of cutaneous chronic lymphocytic leukemia. Immunophenotyping results from a facial nodule confirmed the presence of a B-cell infiltrate (CD20+). Immunophenotyping of a lesion on the right thigh showed that half the cells were composed of a CD2+, CD45RO+ (UCHL-1+) upper dermal and focally epidermotropic population of T cells consistent with mycosis fungoides; however, these T cells coexisted with an equal number of CD20+ B cells arranged in distinct clusters. DNA from the thigh lesion exhibited a B-cell immunoglobulin gene rearrangement, but the T-cell receptor gene rearrangements were germline. In this case, the evidence favors a mycosis fungoides simulant occurring as a reactive T-cell infiltrate to an underlying B-cell chronic lymphocytic leukemia.
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MESH Headings
- Aged
- Aged, 80 and over
- Diagnosis, Differential
- Gene Rearrangement
- Humans
- Immunohistochemistry
- Immunophenotyping
- Leukemia, Lymphocytic, Chronic, B-Cell/complications
- Leukemia, Lymphocytic, Chronic, B-Cell/genetics
- Leukemia, Lymphocytic, Chronic, B-Cell/pathology
- Male
- Mycosis Fungoides/etiology
- Mycosis Fungoides/genetics
- Mycosis Fungoides/pathology
- Skin Neoplasms/etiology
- Skin Neoplasms/genetics
- Skin Neoplasms/pathology
- T-Lymphocytes
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Affiliation(s)
- M S Metzman
- Cutaneous Lymphoma Program, University of Michigan Comprehensive Cancer Center, Ann Arbor, USA
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17
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Grange F, Avril MF, Esteve E, Joly P, Bosq J, de Murets A, Thomine E, Ortoli JC, Duvillard P, Vaillant L. Coexistent cutaneous T-cell lymphoma and B-cell malignancy. French Study Group on Cutaneous Lymphomas. J Am Acad Dermatol 1994; 31:724-31. [PMID: 7929916 DOI: 10.1016/s0190-9622(94)70232-2] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
BACKGROUND The coexistence of cutaneous T-cell lymphoma (CTCL) and a B-cell malignancy (BCM) is rare. OBJECTIVE Our aim was to assess the clinical and pathologic aspects of coexistent CTCL and BCM and to examine potential explanations for this association. METHODS We report six cases of concurrent CTCL and BCM in which B- and T-cell lineages were demonstrated by immunologic studies. The literature includes 13 additional cases. All 19 CTCL-BCM cases are reviewed. RESULTS CTCL either preceded or followed the BCM, which was a low-grade malignancy in most cases (16 of 19). Possible explanations for the association include a genetic predisposition, underlying viral infection, chemotherapy-induced carcinogenesis, stimulation of a B-cell clone by malignant helper T cells, and alterations in progenitor cells before determination of B- and T-cell lineage. CONCLUSION An alteration in progenitor cells, with subsequent oncogenic activation of variable origin, might account for most cases of coexistent CTCL and BCM.
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Affiliation(s)
- F Grange
- Institut Gustave Roussy, Villejuif, France
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18
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Euvrard S, Noble CP, Kanitakis J, Ffrench M, Berger F, Delecluse HJ, D'incan M, Thivolet J, Touraine JL. Brief report: successive occurrence of T-cell and B-cell lymphomas after renal transplantation in a patient with multiple cutaneous squamous-cell carcinomas. N Engl J Med 1992; 327:1924-6. [PMID: 1454087 DOI: 10.1056/nejm199212313272706] [Citation(s) in RCA: 41] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Affiliation(s)
- S Euvrard
- Department of Dermatology, Edouard Herriot Hospital, Lyon, France
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19
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Harland CC, Whittaker SJ, Ng YL, Holden CA, Wong E, Smith NP. Coexistent cutaneous T-cell lymphoma and B-cell chronic lymphocytic leukaemia. Br J Dermatol 1992; 127:519-23. [PMID: 1467293 DOI: 10.1111/j.1365-2133.1992.tb14852.x] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Three patients with cutaneous T-cell lymphoma (CTCL) are reported who had concurrent B-cell chronic lymphocytic leukaemia (B-CLL). The separate lineage and clonal nature of the individual lymphoid malignancies were confirmed by gene-rearrangement analysis. The chronology of the illnesses did not support the hypothesis that CTCL predisposes to the development of B-cell proliferative disorders. There was no clear association with immunosuppressive therapy, and HTLV-1 studies were negative in all patients. Consequently, we speculate that a lymphoid stem cell defect, which may lead to the development of either aberrant B- or T-cell clones, may be responsible for such cases of dual lymphoid neoplasia.
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MESH Headings
- Aged
- Aged, 80 and over
- Blotting, Southern
- DNA/genetics
- Gene Rearrangement, B-Lymphocyte
- Gene Rearrangement, T-Lymphocyte
- Humans
- Immunoenzyme Techniques
- Leukemia, Lymphocytic, Chronic, B-Cell/genetics
- Leukemia, Lymphocytic, Chronic, B-Cell/pathology
- Lymphoma, T-Cell, Cutaneous/genetics
- Lymphoma, T-Cell, Cutaneous/pathology
- Male
- Neoplasms, Multiple Primary/pathology
- Skin/immunology
- Skin Neoplasms/genetics
- Skin Neoplasms/pathology
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Affiliation(s)
- C C Harland
- Department of Dermatology, St Helier Hospital, Carshalton, U.K
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Affiliation(s)
- J D Bunker
- Mycosis Fungoides Clinic, University of Colorado Health Science Center, Denver
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