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Su T, Wang W, Xiong X, Zhang M, Lu Y, Su Z. Clinicopathological Characteristics and Outcome of Cytophagic Histiocytic Panniculitis: A Single-Center, Retrospective Study. Clin Cosmet Investig Dermatol 2024; 17:1267-1274. [PMID: 38831784 PMCID: PMC11146609 DOI: 10.2147/ccid.s460784] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2024] [Accepted: 05/10/2024] [Indexed: 06/05/2024]
Abstract
Background Cytophagic histiocytic panniculitis (CHP) is a rare panniculitis associated with systemic features characterized by the infiltration of subcutaneous adipose tissue by benign-appearing T lymphocytes and phagocytic histiocytes, mimicking hemophagocytic lymphohistiocytosis (HLH) and subcutaneous panniculitis-like T-cell lymphoma (SPTCL). Purpose To establish the clinicopathological features and response to treatment of CHP and evaluate the prognosis of patients and guide therapy based on the current state of knowledge. Material and Methods Clinical, laboratory, histopathological, and outcome data of 12 patients with CHP were retrospectively collected between 2009 and 2022. Results All the patients presented with plaques or nodules, mostly located in the lower extremities (11/12). Fewer cases involved systemic symptoms (9/12) and laboratory abnormalities (6/12), and none were positive for serum Epstein-Barr virus (EBV)-DNA. Histopathological examination revealed mixed septal and lobular inflammatory infiltration of histiocytes and lymphocytes. Large or atypical lymphocytes were rarely present (2/12). In some patients, varying proportions of plasma cells, neutrophils, and eosinophils were observed. The extent of histocytophagy was mild (9/12), moderate (2/12), and severe (1/12). HLH was not observed in any of our cases, none of which were fatal. Conclusion The uniqueness of our study lies in the presence of neutrophil-rich dermal and subcutaneous infiltrates, associated with connective tissue disorders (CTD) and streptococcal infections. Our study reveals that EBV-negative CHP tends to a better prognosis than previously research, filling the gap in the much-needed details of CHP in the Chinese population. Moreover, CHP may present as a reactive process in combined primary diseases; further studies are required to validate these findings.
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Affiliation(s)
- Ting Su
- Department of Dermatology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, People’s Republic of China
| | - Wentong Wang
- Department of Dermatology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, People’s Republic of China
| | - Xixi Xiong
- Department of Dermatology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, People’s Republic of China
| | - Meihua Zhang
- Department of Dermatology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, People’s Republic of China
| | - Yan Lu
- Department of Dermatology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, People’s Republic of China
| | - Zhonglan Su
- Department of Dermatology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, People’s Republic of China
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Shavit E, Marzano AV, Alavi A. Ulcerative versus non-ulcerative panniculitis: is it time for a novel clinical approach to panniculitis? Int J Dermatol 2020; 60:407-417. [PMID: 33040341 DOI: 10.1111/ijd.15224] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2020] [Revised: 07/15/2020] [Accepted: 09/04/2020] [Indexed: 01/10/2023]
Abstract
Panniculitis, or inflammation of the fatty tissue, is an ongoing diagnostic challenge to both dermatologists and pathologists. The basis of the current panniculitis classification is histology, whether the inflammation is mainly located in the fibrovascular septa or in the adipose lobules thereafter with or without vasculitis. However, overall, the difficulty rises due to various terminologies and lack of clinical relevance with this classification. In addition to that, the majority of panniculitides have mixed infiltration of both lobular and septal and not a clear-cut distinction. The aim of this article is to provide a novel clinical algorithm to the diagnosis of panniculitis and thus to provide guidelines for all clinicians who may encounter this challenging condition in their clinical practice.
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Affiliation(s)
- Eran Shavit
- Division of Dermatology, Department of Medicine, Women's College Hospital, University of Toronto, Toronto, ON, Canada.,Dermatology Unit, Barzilai University Medical Center, Ashkelon, Israel.,The Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheba, Israel
| | - Angelo Valerio Marzano
- Dermatology Unit, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Milan, Italy.,Department of Physiopathology and Transplantation, Università degli Studi di Milano, Milan, Italy
| | - Afsaneh Alavi
- Division of Dermatology, Department of Medicine, Women's College Hospital, University of Toronto, Toronto, ON, Canada
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Cytophagic Histiocytic Panniculitis (CHP) in a Patient with SLE Found after Autopsy: When a Rash Is "Complicated!". Case Rep Dermatol Med 2019; 2019:6830862. [PMID: 31355015 PMCID: PMC6636589 DOI: 10.1155/2019/6830862] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2019] [Accepted: 05/16/2019] [Indexed: 11/25/2022] Open
Abstract
Introduction Cytophagic histolytic panniculitis (CHP) is a clinical disorder characterized by nodular panniculitis of the subcutaneous adipose tissue. It was first described in 1980 by Winkelmann. Histologically it is described as an infiltration of the adipose tissue by T- lymphocytes and phagocytic macrophages (also known as “bean bag cells”). Most of the cases are reported under the age of 50 and is a rare cause of panniculitis. We report a case of CHP in a young patient who presented to our emergency room (ER). Case Summary A 39-year-old African American woman who presented to our hospital with lethargy, progressive confusion, and generalized rash involving both lower extremities of 1 week duration. She had a history of pancytopenia and focal proliferative and membranous lupus nephritis classes 3 and 5. Her physical examination was remarkable for bilateral lower extremity pitting edema and a desquamating rash on both of her legs. The Nicolsky sign was positive. She was noted to be hypotensive and was started on intravenous fluids and broad spectrum antibiotics. Routine laboratory tests revealed severe pancytopenia, with a hemoglobin of 3.9 g/dl, white blood cell count 600/ul, and platelet count of 11000/ul. Within an hour of arrival to the ER she developed acute respiratory failure. She was intubated and placed on mechanical ventilation. She developed shock requiring vasopressors. No imaging could be done due to her unstable condition. Four hours after her initial presentation she developed asystole and expired. Postmortem histopathology of the adipose tissue revealed CHP. Conclusion CHP can be rapidly fatal. The treatment involves high dose of intravenous steroids and immunosuppressants such as cyclosporine.
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Rezania D, Sokol L, Cualing HD. Classification and Treatment of Rare and Aggressive Types of Peripheral T-Cell/Natural Killer-Cell Lymphomas of the Skin. Cancer Control 2017; 14:112-23. [PMID: 17387296 DOI: 10.1177/107327480701400204] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Background The classification of cutaneous lymphomas has been contentious. Two major competing classifications were the World Health Organization (WHO) and the European Organization for Research and Treatment of Cancer (EORTC). The principal authors met for a consensus meeting resulted in a combined classification called WHO-EORTC Classification of Cutaneous Lymphoma. Methods We review the classification of “mature” or peripheral T-cell lymphoma (PTCL) with high predilection to the skin as published by the WHO-EORTC. We also highlight new information and changes from the previous classifications of cutaneous PTCL according to the WHO classification or the EORTC classification. Finally, the salient findings are compared with similar-looking nodal PTCLs with a high frequency of skin involvement. Results This review focuses on a rare group of cutaneous PTCLs other than mycosis fungoides or its variants. Changes from the previous classifications are discussed, and the rare group of nodal PTCLs with high predilection to the skin are presented. The salient findings, diagnostic features, and treatments are included, along with summary tables and clinical-histopathologic images. Conclusions This review may serve as a guide for hematologists, oncologists and dermatologists in the diagnosis and management of these rare, aggressive, and often difficult to diagnose lymphomas. Although cutaneous lymphomas are morphologically identical to systemic lymphomas, the former behave differently, require divergent management, and should be recognized as separate entities. The consensus WHO-EORTC classification presents unified terminology and definitions to promote conformity in diagnosing and treating these cases, to foster a multidisciplinary approach to these often-obscure diseases, and to lead to more advances in identifying molecular targets specific to these entities.
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Affiliation(s)
- Dorna Rezania
- Hematopathology and Laboratory Medicine Program, H. Lee Moffitt Cancer Center & Research Institute, 12902 Magnolia Drive, Tampa, FL 33612, USA
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Liao W, Xiao S, Yong J, Fan S, Fang W, Zheng Y, Liu J. Bilateral ptosis as first presentation of cytophagic histiocytic panniculitis: a case report. BMC Ophthalmol 2017; 17:112. [PMID: 28666424 PMCID: PMC5493882 DOI: 10.1186/s12886-017-0511-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2016] [Accepted: 06/23/2017] [Indexed: 11/22/2022] Open
Abstract
Background Cytophagic histiocytic panniculitis (CHP) is a rare form of nodular panniculitis that may progress to panniculitis-like T-cell lymphoma. We report a case of CHP that first manifested as bilateral ptosis, which is the first reported case of this presentation. Case presentation A 25-year-old woman without medical history was referred to the neurology department of our hospital for evaluation of bilateral ptosis. Three months previously, she suddenly complained of bilateral ptosis without apparent cause. Simultaneously, non-painful tender subcutaneous nodules and eschar-like skin lesions were observed on her extremities and trunk. A diagnosis of CHP was made based on skin biopsy from the left thigh showing lobular panniculitis, vasculitis, and adiponecrosis, with infiltration of inflammatory cells, including lymphocytes, histiocytes, and phagocytic histiocytes. Her condition continued to worsen with corticosteroid and immunosuppressive agent (thalidomide) treatment. Significant improvement was noticed after three cycles of chemotherapy of THP-COP (pirarubicin, cyclophosphamide, vincristine, and prednisolone). Conclusions CHP is a rare condition whose clinical presentation may include bilateral ptosis and biopsy is required for diagnosis of CHP.
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Affiliation(s)
- Wang Liao
- Department of Neurology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, Guangdong, 510120, China
| | - Songhua Xiao
- Department of Neurology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, Guangdong, 510120, China
| | - Juanjuan Yong
- Department of Pathology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, Guangdong, 510120, China
| | - Shengnuo Fan
- Department of Neurology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, Guangdong, 510120, China
| | - Wenli Fang
- Department of Neurology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, Guangdong, 510120, China
| | - Yuqiu Zheng
- Department of Neurology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, Guangdong, 510120, China
| | - Jun Liu
- Department of Neurology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, Guangdong, 510120, China.
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Lupus erythematosus panniculitis resistant to standard treatment, complicated with macrophage activation syndrome. Postepy Dermatol Alergol 2017; 34:281-283. [PMID: 28670262 PMCID: PMC5471385 DOI: 10.5114/ada.2017.67852] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2016] [Accepted: 10/04/2016] [Indexed: 12/17/2022] Open
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Velter C, Lipsker D. [Cutaneous panniculitis]. Rev Med Interne 2016; 37:743-750. [PMID: 27321570 DOI: 10.1016/j.revmed.2016.05.008] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2015] [Revised: 02/02/2016] [Accepted: 05/10/2016] [Indexed: 01/08/2023]
Abstract
Panniculitis is an inflammation of the subcutaneous fat. Skin biopsy plays a critical role in the differential diagnosis of panniculitis. The most common approach to diagnosis relies on the differentiation between predominantly septal or lobular panniculitis, followed by the distinction between lesions with and without vasculitis. It is also very important to submit a part of the skin biopsy for microbiological analysis and for T-cell clonal expansion if T-cell lymphoma is suspected. Erythema nodosum, the most frequent septal panniculitis, has many causes and in its typical clinical presentation, does not require skin biopsy. In other panniculitis, diagnosis is based on the integration of the clinical and histological data, which renders a deep cutaneous biopsy necessary. Periarteritis nodosa, a septal panniculitis with vasculitis characterized by subcutaneous nodules and livedo racemosa, can be associated with systemic involvement. Nodular thrombophlebitis needs search for associated coagulopathy, Behçet's disease, periarteritis nodosa or Buerger's disease. Lobular panniculitis are classified according to the nature of cells present in the inflammatory infiltrate. If there is a lymphocytic infiltration, lupus panniculitis is difficult to differentiate from subcutaneous panniculitis-like T-cell lymphoma. If there are histiocytes, it can be a sarcoidosis, a cytophagic histiocytic panniculitis or, in newborn, a subcutaneous fat necrosis. Neutrophilic panniculitis needs careful clinic-pathologic correlation. Treatment of panniculitis can be challenging and is based on the histopathological findings. Frequently, the precise cause of panniculitis cannot be established from the outset, so it is important to follow-up patients and not hesitate to repeat the skin biopsy.
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Affiliation(s)
- C Velter
- Clinique dermatologique, hôpitaux universitaires de Strasbourg, faculté de médecine, université de Strasbourg, 1, place de l'Hôpital, 67091 Strasbourg, France.
| | - D Lipsker
- Clinique dermatologique, hôpitaux universitaires de Strasbourg, faculté de médecine, université de Strasbourg, 1, place de l'Hôpital, 67091 Strasbourg, France
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Usefulness of Random Skin Biopsy as a Diagnostic Tool of Intravascular Lymphoma Presenting With Fever of Unknown Origin. Am J Dermatopathol 2015; 37:686-90. [DOI: 10.1097/dad.0000000000000321] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
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9
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Callen JP, Requena L. Cutaneous vasculitis and panniculitis. Rheumatology (Oxford) 2015. [DOI: 10.1016/b978-0-323-09138-1.00162-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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10
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Miyabe Y, Murata Y, Baba Y, Ito E, Nagasaka K. Successful treatment of cyclosporine-A-resistant cytophagic histiocytic panniculitis with tacrolimus. Mod Rheumatol 2014. [DOI: 10.3109/s10165-011-0435-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- Yoshishige Miyabe
- Department of Rheumatology, Ome Municipal General Hospital,
4-16-5 Higashi-Ome, Ome, Tokyo 198-0042, Japan
| | - Yutaka Murata
- Department of Rheumatology, Ome Municipal General Hospital,
4-16-5 Higashi-Ome, Ome, Tokyo 198-0042, Japan
| | - Yukari Baba
- Department of Dermatology, Ome Municipal General Hospital,
Ome, Tokyo, Japan
| | - Eisaku Ito
- Department of Surgical Pathology, Ome Municipal General Hospital,
Ome, Tokyo, Japan
| | - Kenji Nagasaka
- Department of Rheumatology, Ome Municipal General Hospital,
4-16-5 Higashi-Ome, Ome, Tokyo 198-0042, Japan
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Bader-Meunier B, Fraitag S, Janssen C, Brochard K, Lamant L, Wouters C, Bodemer C. Clonal cytophagic histiocytic panniculitis in children may be cured by cyclosporine A. Pediatrics 2013; 132:e545-9. [PMID: 23858422 DOI: 10.1542/peds.2012-3256] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Cytophagic histiocytic panniculitis (CHP) is a rare panniculitis in childhood, associated either with nonmalignant conditions or with subcutaneous panniculitis-like T-cell lymphoma (SPTCL), and often also associated with macrophage activation syndrome (MAS). Discriminating between these 2 conditions is therapeutically important because nonmalignant CHP often improves under cyclosporine and prednisone, whereas most cases of SPLT may be best treated with more aggressive therapy. We report the cases of a 6-month-old boy and a 16-month-old girl who, after viral infection, developed multiple infiltrating skin nodules on the limbs and face, associated with MAS. Histopathologic findings for skin biopsy specimens revealed CHP associated with heavily cellular lobular panniculitis. Hemophagocytosis and immunohistochemical staining features were consistent with typical characteristics of in situ MAS in adipose tissue: the lymphocytes were mostly TCD8+ cells with an activated phenotype (human leukocyte antigen (HLA) -DR+) and expressed interferon-γ; CD68+ macrophages expressed tumor necrosis factor-α and interleukin-6. A monoclonal rearrangement of the T-cell receptor γ gene was present in skin tissue but not in peripheral blood or bone marrow lymphocytes. Cyclosporine A treatment resulted in the complete remission of cutaneous and systemic manifestations in both patients for 66 and 29 months, respectively. This report suggests that the diagnosis of a reactive T-cell lymphoproliferation should be the treatment of choice in young children with severe CHP, even if there is a SPTCL-like aspect with an in situ T-cell clonality. It also suggests that CSA is the optimal treatment of this condition and postulates the possible pathologic process underlying this efficacy.
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Hounoki H, Taki H, Tsuda R, Shinoda K, Nomoto K, Tobe K. Cytophagic histiocytic panniculitis in a 74-year-old man. Age Ageing 2013; 42:409-10. [PMID: 23507499 DOI: 10.1093/ageing/aft034] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Cytophagic histiocytic panniculitis is a chronic histiocytic disease of the subcutaneous adipose tissue characterised by lobular panniculitis with histiocytes containing blood cell fragments. It is also associated with marked systemic features such as fever, pancytopenia, hepatosplenomegaly, liver abnormalities and coagulopathy. We report a case of cytophagic histiocytic panniculitis in a 74-year-old man successfully treated using combination therapy with prednisolone and cyclosporine A.
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Affiliation(s)
- Hiroyuki Hounoki
- First Department of Internal Medicine, University of Toyama, 2630 Sugitani, Toyama, Toyama 930-0194, Japan
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Magro CM, Wang X. Indolent primary cutaneous γ/δ T-cell lymphoma localized to the subcutaneous panniculus and its association with atypical lymphocytic lobular panniculitis. Am J Clin Pathol 2012; 138:50-6. [PMID: 22706857 DOI: 10.1309/ajcpqgvltzq77vff] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
Abstract
The 2005 classification of lymphoma proposed the designation of subcutaneous panniculitis-like T-cell lymphoma exclusively for those tumors composed of α/β neoplastic cells. Subcutaneous lymphomas that comprised γ/δ T cells are termed primary cutaneous γ/δ T-cell lymphoma. The different clinical outcomes justified this separation; a more indolent course was characteristic of the α/β variants vs the poor 5-year survival of the γ/δ forms. We describe 5 patients with γ/δ T-cell lymphoma localized to the subcutis with a less aggressive clinical course. Two patients were alive 5 years after presentation, and in the remaining 3, the disease is in complete remission after simple intervention. Three patients had a waxing and waning phase, likely representing a prelymphomatous phase, which then progressed to an overt malignant tumor. Therefore, it is important to recognize that not all patients with γ/δ T-cell lymphomas have a poor prognosis.
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Krilis M, Miyakis S. Cytophagic histiocytic panniculitis with haemophagocytosis in a patient with familial multiple lipomatosis and review of the literature. Mod Rheumatol 2011; 22:158-62. [PMID: 21732050 DOI: 10.1007/s10165-011-0487-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2011] [Accepted: 06/02/2011] [Indexed: 11/25/2022]
Abstract
We report a patient with the extremely rare familial multiple lipomatosis syndrome, who developed the uncommon autoimmune disease cytophagic histiocytic panniculitis, manifested as inflammation of preexisting lipomas. Despite his initial critical condition and unsuccessful treatment with steroids, he responded to cyclosporin and remains well 15 years after diagnosis. In contrast with most previous reports, our patient stays dependent on cyclosporin; repeated attempts of discontinuing or substituting treatment were quickly followed by relapse. Haemophagocytic panniculitis is considered as a T-cell disorder, but its exact pathophysiological mechanism has not been clarified. Differential diagnosis of cytophagic histiocytic panniculitis mainly includes malignant histiocytosis, subcutaneous panniculitis-like T-cell lymphoma (SPTCL) and lupus erythematosus panniculitis (lupus profundus). We discuss the main clinical features, diagnostic challenges and treatment issues of this usually benign, but at times life-threatening autoimmune condition.
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MESH Headings
- Cyclosporine/therapeutic use
- Diagnosis, Differential
- Family Health
- Female
- Genetic Predisposition to Disease
- Histiocytic Sarcoma/diagnosis
- Histiocytosis, Non-Langerhans-Cell/complications
- Histiocytosis, Non-Langerhans-Cell/diagnosis
- Histiocytosis, Non-Langerhans-Cell/drug therapy
- Humans
- Lipomatosis, Multiple Symmetrical/diagnosis
- Lipomatosis, Multiple Symmetrical/drug therapy
- Lipomatosis, Multiple Symmetrical/genetics
- Lymphohistiocytosis, Hemophagocytic/complications
- Lymphohistiocytosis, Hemophagocytic/diagnosis
- Lymphohistiocytosis, Hemophagocytic/drug therapy
- Lymphoma, T-Cell/diagnosis
- Male
- Panniculitis/complications
- Panniculitis/diagnosis
- Panniculitis/drug therapy
- Pedigree
- Treatment Outcome
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Affiliation(s)
- Matthew Krilis
- Department of Medicine, Royal Prince Alfred Hospital, University of Sydney, Sydney, Australia.
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Miyabe Y, Murata Y, Baba Y, Ito E, Nagasaka K. Successful treatment of cyclosporine-A-resistant cytophagic histiocytic panniculitis with tacrolimus. Mod Rheumatol 2011; 21:553-6. [PMID: 21380742 DOI: 10.1007/s10165-011-0435-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2010] [Accepted: 02/14/2011] [Indexed: 11/27/2022]
Abstract
A 34-year-old woman with discoid lupus erythematosus and lupus profundus was admitted to our hospital showing signs of a fever, malaise, and abdominal swelling. Diagnosis of cytophagic histiocytic panniculitis (CHP) was made based on lobular panniculitis with a hemophagocytosis. Treatment with high doses of prednisolone combined with cyclosporine A (CsA) was not effective enough. However, after changing CsA to tacrolimus (TAC), CHP improved. Our case demonstrates that TAC may be a novel therapy for CHP.
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Affiliation(s)
- Yoshishige Miyabe
- Department of Rheumatology, Ome Municipal General Hospital, 4-16-5 Higashi-Ome, Ome, Tokyo, 198-0042, Japan
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Callen JP, Requena L. Cutaneous vasculitis and panniculitis. Rheumatology (Oxford) 2011. [DOI: 10.1016/b978-0-323-06551-1.00159-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Hara S, Henmi T, Kawakami A, Fujikawa K, Mukae H, Ishimatsu Y, Sakamoto N, Kakugawa T, Kaji K, Fujimoto M, Kuwana M, Tsukada T, Satoh K, Motomura M, Tamai M, Nakamura H, Ida H, Hayashi T, Origuchi T, Eguchi K, Kohno S. Clinical, serologic and magnetic resonance imaging of 3 cases of inflammatory myopathy with abundant macrophages in the Japanese population. Rheumatol Int 2010; 33:1059-64. [DOI: 10.1007/s00296-010-1662-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2010] [Accepted: 11/14/2010] [Indexed: 12/01/2022]
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Aronson IK, Worobec SM. Cytophagic histiocytic panniculitis and hemophagocytic lymphohistiocytosis: an overview. Dermatol Ther 2010; 23:389-402. [DOI: 10.1111/j.1529-8019.2010.01339.x] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
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Nemoto Y, Taniguchi A, Kamioka M, Nakaoka Y, Hiroi M, Yokoyama A, Enzan H, Daibata M. Epstein–Barr virus-infected subcutaneous panniculitis-like T-cell lymphoma associated with methotrexate treatment. Int J Hematol 2010; 92:364-8. [DOI: 10.1007/s12185-010-0642-5] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2010] [Revised: 07/04/2010] [Accepted: 07/09/2010] [Indexed: 12/19/2022]
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Soylu S, Gül Ü, Kiliç A, Heper AO, Kuzu I, Gönen Minareci B. A case with an indolent course of subcutaneous panniculitis-like T-cell lymphoma demonstrating Epstein-Barr virus positivity and simulating dermatitis artefacta. Am J Clin Dermatol 2010; 11:147-50. [PMID: 20141236 DOI: 10.2165/11311060-000000000-00000] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Abstract
Subcutaneous panniculitis-like T-cell lymphoma (SPTCL) is a rare form of cytotoxic T-cell lymphoma. The disease has a poor prognosis in patients with the complication of hemophagocytic syndrome, especially in those with Epstein-Barr virus (EBV) positivity. A 20-year-old woman presented with multiple, itchy, purplish nodules and excoriations on both of her upper limbs. The histopathologic, immunohistochemical staining, and clonal T-cell receptor gene rearrangement examinations of skin lesions revealed the diagnosis of SPTCL. In situ hybridization performed for EBV was positive. There were no findings suggesting systemic involvement of SPTCL, or hemophagocytic syndrome. The lesions improved with systemic corticosteroid therapy and radiotherapy, with no recurrence. We present a patient with a protracted course of SPTCL in whom EBV positivity was demonstrated. This apparent conflict may be explained by geographic and ethnic variations in EBV infection. Further studies may shed light on the real relationship between EBV-RNA and the course of SPTCL.
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Inflammatory myopathy with abundant macrophages and dermatomyositis: two stages of one disorder or two distinct entities? Acta Neuropathol 2009; 118:793-801. [PMID: 19590880 DOI: 10.1007/s00401-009-0570-8] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2009] [Revised: 07/02/2009] [Accepted: 07/02/2009] [Indexed: 10/20/2022]
Abstract
Inflammatory myopathy with abundant macrophages (IMAM) and dermatomyositis (DM) are considered to represent related disorders, since they share inflammatory infiltrates and skin alterations. In order to get more insight into these disorders, we addressed the cellular composition of the inflammatory infiltrates in muscle biopsies of 11 patients with IMAM and DM. In IMAM, inflammatory infiltrates predominantly consisted of CD68+ MRP14+ macrophages which weakly expressed TNF-α, a few CD3+ T cells with a prominent IL-10 expression, and single CD123+ plasmacytoid dendritic cells. In DM, infiltrates were mainly composed of CD3+ CD4+ T cells which expressed IL-10, numerous CD123+ plasmacytoid dendritic cells, and CD20+ B cells. The low number of CD68+ macrophages was of 25F9+ late inflammatory phenotype. Membrane attack complex was expressed in necrotic muscle fibers in IMAM and on endomysial capillaries in DM, respectively. Thus, in IMAM, the inflammatory reaction markedly differed from DM. These observations may lend support to the hypothesis that IMAM and DM are distinct with respect to their pathogenesis. Whether, alternatively, these differences in the cellular composition of the infiltrates and the cytokine profile rather reflect different stages of disease, will require the analysis of a larger series.
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Koh MJA, Sadarangani SP, Chan YC, Chan MY, Tan AM, Tan SH, Tay YK, Ng SB. Aggressive subcutaneous panniculitis-like T-cell lymphoma with hemophagocytosis in two children (subcutaneous panniculitis-like T-cell lymphoma). J Am Acad Dermatol 2009; 61:875-81. [DOI: 10.1016/j.jaad.2009.01.045] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2008] [Revised: 11/20/2008] [Accepted: 01/25/2009] [Indexed: 11/28/2022]
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23
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Ghobrial IM, Weenig RH, Pittlekow MR, Qu G, Kurtin PJ, Ristow K, Ansell SM. Clinical outcome of patients with subcutaneous panniculitis-like T-cell lymphoma. Leuk Lymphoma 2009; 46:703-8. [PMID: 16019507 DOI: 10.1080/10428190500051380] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Subcutaneous panniculitis-like T-cell lymphoma (SPTCL) is a rare form of cytotoxic T-cell lymphoma. The objective of this study was to characterize the clinical presentation, treatment, and prognosis of patients with SPTCL. Twenty-one patients with SPTCL were seen at Mayo Clinic (Rochester, Minnesota, USA) between July 1973 and June 2004. The median age at diagnosis was 42 years (range 23-80 years) and 15 (71%) were women. Constitutional symptoms occurred in 14 (67%) patients, including fever, serositis, arthralgias and myalgias. The Eastern Cooperative Oncology Group performance score was poor (3-4) in 3 (15%) patients. Liver enzymes (at least 2 enzymes, Aspartate aminotransferase (AST), alkaline phosphatase and/or lactate dehydrogenase) were elevated in 11 (52%) patients. Therapy consisted of chemotherapy in 13 (62%) patients, or other therapeutic interventions in 8 (38%) patients, including surgical excision, corticosteroids alone or in combination with either plaquenil, colchicine, hydroxychoroquine, or azathioprine. Bone marrow transplantation was performed in 5 (24%) patients, 3 autologous and 2 allogeneic. The median overall survival from diagnosis was 15 months (range 0.1-104 months). Two groups of patients were identified and categorized as having a favorable or unfavorable disease course. The factors associated with an unfavorable disease course were a low white blood cell count or elevated lactate dehydrogenase. Patients treated aggressively with stem cell transplantation appeared to have an improved overall survival.
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Affiliation(s)
- Irene M Ghobrial
- Division of Hematology, Department of Internal Medicine, Mayo Clinic College of Medicine, Rochester, Minnesota 55905, USA
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Gau JP, Yang CF, Liu JH, Yu YB, Tzeng CH, Chen PM. Subcutaneous panniculitis-like T cell lymphoma: familial aggregation while different response to chemotherapy. Int J Hematol 2008; 89:63-65. [DOI: 10.1007/s12185-008-0202-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2008] [Revised: 09/23/2008] [Accepted: 10/13/2008] [Indexed: 11/28/2022]
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Chim CS, Loong F, Ng WK, Kwong YL. Use of fludarabine-containing chemotherapeutic regimen results in durable complete remission of subcutaneous panniculitis-like T-cell lymphoma. Am J Clin Dermatol 2008; 9:396-8. [PMID: 18973407 DOI: 10.2165/0128071-200809060-00007] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Abstract
Subcutaneous panniculitis-like T-cell lymphoma (SPTCL) is a rare lymphoma. The optimal therapy for SPTCL is undefined and the results of treatment with anthracycline-containing chemotherapy for aggressive cases have remained poor. A 27-year-old woman with multifocal and aggressive CD8+ SPTCL was treated with the purine analog fludarabine in combination with mitoxantrone and dexamethasone (FND). The patient achieved complete remission after one course of treatment. After completion of six courses of FND, the patient has remained in remission for more than 3 years. FND may be an effective treatment for aggressive SPTCL.
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Panniculitis. INDIAN JOURNAL OF RHEUMATOLOGY 2007. [DOI: 10.1016/s0973-3698(10)60059-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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27
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Chen RL, Hsu YH, Ueda I, Imashuku S, Takeuchi K, Tu BPH, Chuang SS. Cytophagic histiocytic panniculitis with fatal haemophagocytic lymphohistiocytosis in a paediatric patient with perforin gene mutation. J Clin Pathol 2007; 60:1168-9. [PMID: 17601962 PMCID: PMC2014859 DOI: 10.1136/jcp.2007.049551] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/13/2007] [Indexed: 11/04/2022]
Affiliation(s)
- Rong-Long Chen
- Division of Paediatric Hematology/Oncology, Cancer Centre, Chi-Mei Medical Centre, Liou Ying Campus, Tainan, Taiwan
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Deji N, Sugimoto T, Fujimoto T, Aoyama M, Takeda N, Sakaguchi M, Uzu T, Kashiwagi A. Emergence of panniculitis and haemophagocytic syndrome in a patient with chronic systemic lupus erythematosus. Lupus 2007; 16:363-5. [PMID: 17576740 DOI: 10.1177/0961203307077560] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Panniculitis rarely occurs in the course of systemic lupus erythematosus (SLE). When it occurs, it is thought to be mainly lupus erythematosus panniculitis (LEP). Here we describe a 32-year old Japanese woman with chronic SLE, who simultaneously presented facial lymphocytic lobular panniculitis and pancytopenia due to haemophagocytic syndrome. She showed several auto-antibodies against trilineage haematopoetic cells, an anti-cardiolipin antibody, and no evidence of viral infection, indicating that her haemophagocytic syndrome might be autoimmune-associated haemophagocytic syndrome. The panniculitis and haemophagocytic syndrome presented simultaneously, and these manifestations were dramatically improved with corticosteroid therapy; therefore, the lymphocytic lobular panniculitis could be linked to autoimmune-associated haemophagocytic syndrome in this case.
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Affiliation(s)
- N Deji
- The Department of Medicine, Shiga University of Medical Science, Seta, Otsu, Japan
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Abstract
BACKGROUND Cutaneous lymphomas have many morphologic forms and clinical features. Lymphoma presents rarely with a constellation of nodules, panniculitis, and localized lipoatrophy. The histopathologic similarities of lymphoma and connective tissue disease panniculitis may create a diagnostic challenge. METHODS We retrospectively reviewed the case of a 47-year-old man who presented 15 years earlier with recurrent fevers, fatigue, tender subcutaneous nodules, and facial, trunk, and extremity lipoatrophy. RESULTS Initial biopsy of a cutaneous nodule showed lymphohistiocytic panniculitis without atypical inflammatory cells. Serologic tests showed negative connective tissue serologies, yet the initial clinical impression was most consistent with lupus panniculitis. Initially, the patient was treated with oral prednisone; later, steroid-sparing agents were used with modest improvement evidenced by resolution of his systemic symptoms and stabilization of the cutaneous findings. A decade later, more pronounced facial lipoatrophy, new facial nodules, and posterior thigh pain developed. Laboratory testing showed leukopenia, elevated liver and muscle enzymes, hypertriglyceridemia, and a low level of high-density lipoprotein. Biopsy of a new chin nodule indicated peripheral T-cell lymphoma, whereas an evaluation for systemic malignant involvement was negative. The patient was started on chemotherapy, which resulted in stabilization of the lipoatrophy and decreasing size and frequency of the cutaneous nodules, but the posterior thigh pain persisted. CONCLUSIONS We report a rare case of lymphoma presenting as nodules and profound lipoatrophy, which exemplifies the complexity of lymphomas. Profound lipoatrophy and panniculitis may be an unusual and diagnostically challenging presentation of cutaneous lymphoma.
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Affiliation(s)
- James A Yiannias
- Department of Dermatology, Mayo Clinic, Scottsdale, AZ 85259, USA
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Carrera E, Lobrinus JA, Spertini O, Gherardi RK, Kuntzer T. Dermatomyositis, lobar panniculitis and inflammatory myopathy with abundant macrophages. Neuromuscul Disord 2006; 16:468-71. [PMID: 16809038 DOI: 10.1016/j.nmd.2006.05.008] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2005] [Revised: 05/10/2006] [Accepted: 05/16/2006] [Indexed: 10/24/2022]
Abstract
Dermatomyositis (DM) is a rare treatable muscle disorder with a reported favorable outcome in most patients. A localized skin/muscle involvement in a DM patient raises questions of definition and causes such as lymphoma, or relapse. We describe here a young treated DM patient who presented a focal biopsy-proven destructive myositis and dermatitis restricted to the left thigh 15 months after the onset of a treated dermatomyositis. There was evidence of subcutaneous lobular panniculitis, somewhat resembling cytophagic histocytic panniculitis associated with a focal inflammatory myopathy with abundant macrophages that destroyed the sartorius muscle. Mild signs of hemophagocytosis and T-CD3 lymphocytosis were present in the bone marrow, but no monoclonal T-lymphocyte expansion was observed, as searched by autoradiography of the totality of TcR Vgamma families. The patient improved with prednisone and azathioprine. We conclude that this focal complication suggests a continuum between dermatomyositis, CHP, and IMAM, the three syndromes where T-cell activation plays an important role.
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Affiliation(s)
- Emmanuel Carrera
- Neurology Service, Lausanne University Hospital CHUV, Lausanne, Switzerland
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Massone C, Lozzi GP, Egberts F, Fink-Puches R, Cota C, Kerl H, Cerroni L. The protean spectrum of non-Hodgkin lymphomas with prominent involvement of subcutaneous fat. J Cutan Pathol 2006; 33:418-25. [PMID: 16776717 DOI: 10.1111/j.0303-6987.2006.00493.x] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
BACKGROUND Subcutaneous T-cell lymphoma (STCL) represents a controversial entity and a confused concept in the field of cutaneous T-cell lymphomas (CTCLs). Recently, alpha/beta+/CD8+ STCL has been recognized by the new World Health Organization (WHO)-European Organization for Research and Treatment of Cancer (EORTC) classification of primary cutaneous lymphomas as a distinct entity in the group of CTCLs. OBSERVATIONS We reviewed a series of 53 biopsies from 26 patients (F : M = 19:7; median age: 48; range 18-87) of cutaneous B- and T-cell lymphomas characterized by prominent involvement of the subcutaneous tissue. We could classify our cases according to the following seven categories--(i) STCL: n = 16; (ii) extranodal NK/T-cell lymphoma, nasal type: n = 2; (iii) cutaneous gamma/delta T-cell lymphoma: n = 2; (iv) anaplastic CD30+ large T-cell lymphoma: n = 1; (v) diffuse large B-cell lymphoma, secondary cutaneous: n = 3; (vi) lymphoplasmacytic lymphoma, secondary cutaneous: n = 1; (vii) specific cutaneous manifestations of myelogenous leukemia: n = 1. CONCLUSIONS We demonstrated the protean nature of lymphomas with prominent involvement of the subcutaneous fat tissues. The term STCL should be restricted to a homogeneous group of cases characterized morphologically by an exclusive involvement of subcutaneous tissues, immunohistochemically by a T-cytotoxic alpha/beta phenotype, and biologically by a relatively good prognosis.
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Affiliation(s)
- Cesare Massone
- Department of Dermatology, Medical University of Graz, Graz, Austria
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32
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Burg G, Kempf W, Cozzio A, Feit J, Willemze R, S Jaffe E, Dummer R, Berti E, Cerroni L, Chimenti S, Diaz-Perez JL, Grange F, Harris NL, Kazakov DV, Kerl H, Kurrer M, Knobler R, Meijer CJLM, Pimpinelli N, Ralfkiaer E, Russell-Jones R, Sander C, Santucci M, Sterry W, Swerdlow SH, Vermeer MH, Wechsler J, Whittaker S. WHO/EORTC classification of cutaneous lymphomas 2005: histological and molecular aspects. J Cutan Pathol 2006; 32:647-74. [PMID: 16293178 DOI: 10.1111/j.0303-6987.2005.00495.x] [Citation(s) in RCA: 215] [Impact Index Per Article: 11.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
UNLABELLED The new WHO/EORTC classification for cutaneous lymphomas comprises mature T-cell and natural killer (NK)-cell neoplasms, mature B-cell neoplasms, and immature hematopoietic malignancies. It reflects the unique features of lymphoproliferative diseases of the skin, and at the same time it is as compatible as possible with the concepts underlying the WHO classification for nodal lymphomas and the EORTC classification of cutaneous lymphomas. This article reviews the histological, phenotypical, and molecular genetic features of the various nosological entities included in this new classification. These findings always have to be interpreted in the context of the clinical features and biologic behavior. AIM To review the histological, phenotypical and molecular genetic features of the various nosological entities of the new WHO/EORTC classification for cutaneous lymphomas. METHODS Extensive review of the literature cited in Medline and own data of the authors. RESULTS The WHO/EORTC classification of cutaneous lymphomas comprises mature T-cell and NK-cell neoplasms, mature B-cell neoplasms and immature hematopoietic malignancies. It reflects the unique features of primary cutaneous lymphoproliferative diseases. CONCLUSION This classification is as much as possible compatible with the concept of the WHO classification for nodal lymphomas and the EORTC classification of cutaneous lymphomas. The histological, phenotypical and molecular genetic features always have to be interpreted in the context of the clinical features and biologic behavior.
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MESH Headings
- Europe
- Humans
- Immunophenotyping
- International Agencies
- Killer Cells, Natural/immunology
- Killer Cells, Natural/pathology
- Lymphoma/classification
- Lymphoma/genetics
- Lymphoma/immunology
- Lymphoma/pathology
- Lymphoma, B-Cell/classification
- Lymphoma, B-Cell/genetics
- Lymphoma, B-Cell/immunology
- Lymphoma, B-Cell/pathology
- Lymphoma, T-Cell, Cutaneous/classification
- Lymphoma, T-Cell, Cutaneous/genetics
- Lymphoma, T-Cell, Cutaneous/immunology
- Lymphoma, T-Cell, Cutaneous/pathology
- Skin Neoplasms/classification
- Skin Neoplasms/genetics
- Skin Neoplasms/immunology
- Skin Neoplasms/pathology
- World Health Organization
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Affiliation(s)
- Günter Burg
- Department of Dermatology, University Hospital Zurich, Switzerland.
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Abstract
T-cell non-Hodgkin lymphomas (NHLs) are uncommon malignancies. The current WHO/EORTC classification recognizes 9 distinct clinicopathologic peripheral T-cell NHLs. These disorders have unique characteristics and require individualized diagnostic and therapeutic strategies. Tremendous progress has been made in recent years in the understanding of the pathogenesis of these disorders. Specific chromosomal translocations and viral infections are now known to be associated with certain lymphomas. In this review, we describe their clinical and pathologic features. We also discuss the use of molecular studies in the diagnostic work-up of T-cell lymphomas. Because of the rarity of these disorders and the lack of well-designed clinical trials, the treatment of peripheral T-cell NHLs is often challenging. Additional studies are required to learn more about the biology of these diseases, which may lead to more optimal and possibly targeted therapies.
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Affiliation(s)
- Mujahid A Rizvi
- Division of Hematology/Oncology, Department of Medicine, Northwestern University Feinberg School of Medicine, 676 N St Clair St, Ste 850, Chicago, IL 60611, USA.
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Hartleb M, Pluta A, Szczepanski W, Nowak A, Stachura J, Gutkowski K. Cytophagic hemorrhagic panniculitis and severe steatohepatitis: challenging combination. J Gastroenterol Hepatol 2005; 20:1468-70. [PMID: 16105145 DOI: 10.1111/j.1440-1746.2005.03942.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/09/2022]
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35
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Eser B, Altuntas F, Er O, Kontas O, Ferahbas A, Cetin M, Unal A. A case of subcutaneous panniculitis-like T-cell lymphoma with haemophagocytosis developing secondary to chemotherapy. J Eur Acad Dermatol Venereol 2004; 18:713-5. [PMID: 15482305 DOI: 10.1111/j.1468-3083.2004.01043.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
A 45-year-old woman presented with fever, generalized skin lesions and multiple lymphadenopathies. In her past history she had had six courses of cyclophosphamide and cisplatin combination chemotherapy 7 years ago because of an ovarian carcinoma. We found pancytopenia in the peripheral blood examination. Skin biopsy showed diffuse subcutaneous infiltration reminiscent of panniculitis but composed of malignant lymphoid cells that were of T lineage. Bone marrow biopsy showed normocellular myeloid tissue with abundant haemophagocytic macrophages. Subcutaneous panniculitis-like T-cell lymphoma with haemophagocytic syndrome was diagnosed. This is the first case reported of subcutaneous panniculitis-like lymphoma occurring secondary to chemotherapy.
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Affiliation(s)
- B Eser
- Department of Hematology-Oncology, Erciyes University School of Medicine, Kayseri, Turkey.
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36
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Go RS, Wester SM. Immunophenotypic and molecular features, clinical outcomes, treatments, and prognostic factors associated with subcutaneous panniculitis-like T-cell lymphoma: a systematic analysis of 156 patients reported in the literature. Cancer 2004; 101:1404-13. [PMID: 15368328 DOI: 10.1002/cncr.20502] [Citation(s) in RCA: 156] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BACKGROUND Subcutaneous panniculitis-like T-cell lymphoma (SPTCL) is an uncommon type of skin lymphoma. The natural history, optimal treatment strategy, and prognostic factors associated with this malignancy are not well defined. METHODS The authors performed a systematic analysis of all patients with SPTCL reported on in the English-language medical literature, with emphasis on specific clinical features, experiences involving the use of radiotherapy and systemic agents, and prognostic factors predictive of treatment response and clinical outcome. RESULTS One hundred fifty-six patients with SPTCL were identified in the literature. Hemophagocytic syndrome (HPS) was a presenting feature in 37% of patients, and > 90% of patients required treatment at diagnosis. Prednisone was used frequently as initial therapy in patients who had less aggressive disease at presentation; however, durable complete remissions (CR) were infrequent. Anthracycline-based chemotherapy regimens were the most commonly used and most effective systemic treatment options, producing long-term CR in approximately 30% of patients. Among patients who received high-dose chemotherapy and stem cell transplantation (HDT-SCT) for refractory or recurrent disease, 92% achieved CR, with a median response duration of > or = 14 months. The presence of HPS at diagnosis and expression of the gamma/delta T-cell receptor (TCR) by tumor cells were associated with poor survival, whereas age was not. After a median follow-up of 24 months, 48% of patients died of disease. The median survival duration was 27 months. CONCLUSIONS SPTCL has an aggressive natural history. Nonetheless, a subgroup of patients with SPTCL can have long-term disease remission following anthracycline-based initial therapy or subsequent HDT-SCT. HPS and the TCR phenotype may be useful prognostic markers for patients with this malignancy.
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Affiliation(s)
- Ronald S Go
- Department of Internal Medicine, Gundersen Lutheran Medical Center, La Crosse, WI 54601, USA.
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37
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Sugita K, Kobayashi M, Hino R, Ohta T, Ohshima K, Tokura Y. A Japanese case of typical epstein-barr virus non-associated subcutaneous panniculitis-like T-cell lymphoma. J Dermatol 2004; 31:253-4. [PMID: 15187351 DOI: 10.1111/j.1346-8138.2004.tb00668.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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38
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Massone C, Chott A, Metze D, Kerl K, Citarella L, Vale E, Kerl H, Cerroni L. Subcutaneous, Blastic Natural Killer (NK), NK/T-cell, and Other Cytotoxic Lymphomas of the Skin: A Morphologic, Immunophenotypic, and Molecular Study of 50 Patients. Am J Surg Pathol 2004; 28:719-35. [PMID: 15166664 DOI: 10.1097/01.pas.0000126719.71954.4f] [Citation(s) in RCA: 184] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
A new group of subcutaneous, natural killer (NK), NK/T-cell, and other cytotoxic T-cell lymphomas of the skin has been recently described, and some have been included as distinct clinicopathologic entities in the classification of hematologic malignancies recently proposed by the World Health Organization. In the European Organization for Research and Treatment of Cancer classification for cutaneous lymphomas, they would be classified either as CD30- large T-cell lymphoma, small/medium pleomorphic T-cell lymphoma, or subcutaneous T-cell lymphoma. Precise clinicopathologic and prognostic features of all of them have not yet been well characterized. We studied retrospectively 81 biopsies from 50 patients with subcutaneous, blastic natural killer (NK), NK/T-cell, or other non-mycosis fungoides cytotoxic T-cell lymphomas of the skin. Clinical, morphologic, phenotypical, and genetic features and data on Epstein-Barr virus association allowed us to classify our cases according to the following 7 categories: a) subcutaneous "panniculitis-like" T-cell lymphoma (SPTCL): 10 cases (estimated 5-year survival: 80%); b) blastic NK-cell lymphoma: 12 cases (estimated 5-year survival: 0%); c) nasal-type extranodal NK/T-cell lymphoma: 5 patients (estimated 5-year survival: 0%); d) epidermotropic CD8+ T-cell lymphoma: 5 cases (estimated 5-year survival: 0%); e) cutaneous gamma/delta T-cell lymphoma: 8 cases (estimated 5-year survival: 0%); f) cutaneous alpha/beta pleomorphic T-cell lymphoma: 8 cases (estimated 5-year survival: 0%); and g) cutaneous medium/large pleomorphic T-cell lymphoma, not otherwise specified: 2 cases. Our study shows that these cutaneous lymphomas can be classified according to precise diagnostic categories. With the exception of SPTCL, analysis of follow-up data from our patients showed that these groups of lymphomas are characterized by an aggressive course, regardless of the diagnostic category.
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MESH Headings
- Adult
- Aged
- CD8 Antigens
- Female
- Humans
- Immunophenotyping
- Ki-1 Antigen/analysis
- Killer Cells, Natural/pathology
- Lymphoma, Large B-Cell, Diffuse/classification
- Lymphoma, Large B-Cell, Diffuse/pathology
- Lymphoma, T-Cell, Cutaneous/classification
- Lymphoma, T-Cell, Cutaneous/mortality
- Lymphoma, T-Cell, Cutaneous/pathology
- Male
- Middle Aged
- Panniculitis/pathology
- Skin Neoplasms/classification
- Skin Neoplasms/mortality
- Skin Neoplasms/pathology
- Survival Rate
- T-Lymphocytes/pathology
- T-Lymphocytes, Cytotoxic/pathology
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Wells J, Kosky CA, Scolyer RA, Lee S, Bye PTP, Young GAR, Davies L. Unusual case of subcutaneous panniculitis-like T-cell lymphoma. Australas J Dermatol 2004; 45:114-8. [PMID: 15068459 DOI: 10.1111/j.1440-0960.2004.00058.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
An unusual case of subcutaneous panniculitis-like T-cell lymphoma is presented involving multiple organ systems, which eventually culminated in rapid demise from the haemophagocytic syndrome, after an initial protracted course. A 44-year-old man presented in April 2001 with bronchiolitis obliterans organising pneumonia that initially responded well to corticosteroids. However, the condition relapsed on attempted prednisone withdrawal in January 2002 and the patient was noted to have developed truncal subcutaneous nodules. Initial skin biopsy revealed lobular panniculitis, with negative microbiological culture. In July 2002, mononeuritis multiplex was diagnosed after the patient presented with paresthesiae and was treated with pulse cyclophosphamide therapy. By November 2002 there was ulceration of the subcutaneous nodules. Repeat skin biopsy revealed subcutaneous panniculitis-like T-cell lymphoma. The clinical manifestations were supportive of an unifying diagnosis of malignancy involving pulmonary, cutaneous and nervous systems. Combination chemotherapy with fludarabine, mitoxantrone and dexamethasone was commenced. However, the patient deteriorated, with fevers, weight loss, pancytopenia and laboratory features consistent with the haemophagocytic syndrome. Despite maximal supportive therapy the patient succumbed to his disease.
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Affiliation(s)
- Jillian Wells
- Department of Dermatology, Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia.
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40
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Seçmeer G, Sakalli H, Gök F, Ozen S, Kara A, Cengiz AB, Ceyhan M, Gürgey A, Gögüs S, Kanra G. Fatal cytophagic histiocytic panniculitis. Pediatr Dermatol 2004; 21:246-9. [PMID: 15165205 DOI: 10.1111/j.0736-8046.2004.21312.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Individual cases of so-called Weber-Christian disease with a bleeding diathesis have been reported for several years. These were originally diagnosed as Weber-Christian disease, but have been recategorized on review as a chronic, visceral, and cutaneous histiocytic (cytophagic) panniculitis, progressing to liver dysfunction and jaundice and a terminal hemorrhagic diathesis. We report here a rare catastrophic form of systemic panniculitis in an adolescent girl. Despite compelling clinical evidence, the diagnosis was made only on postmortem biopsies.
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Affiliation(s)
- Gülten Seçmeer
- Department of Pediatrics, Hacettepe University Faculty of Medicine, Ankara, Turkey
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Shani-Adir A, Lucky AW, Prendiville J, Murphy S, Passo M, Huang FS, Paller AS. Subcutaneous panniculitic T-cell lymphoma in children: response to combination therapy with cyclosporine and chemotherapy. J Am Acad Dermatol 2004; 50:S18-22. [PMID: 14726859 DOI: 10.1016/s0190-9622(03)00746-1] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
We describe 2 adolescent boys with facial swelling and/or subcutaneous nodules and fever. Extensive evaluation, including several biopsy specimens, led to a diagnosis of subcutaneous panniculitic T-cell lymphoma, an entity rarely seen in children. Both patients were treated with oral cyclosporine in an effort to suppress the cytokine release from T-cells that has been thought to induce the hemophagocytic syndrome. The patients responded dramatically to cyclosporine treatment with defervescence of the fever and reduction in number and size of the subcutaneous nodules. Subsequent therapy with multidrug chemotherapy achieved complete remission in the first patient. This report suggests the value of cyclosporine as a first-line agent coupled with chemotherapy in the treatment of patients with subcutaneous panniculitic T-cell lymphoma. A clinicopathologic review of 8 described pediatric cases of subcutaneous panniculitic T-cell lymphoma is also presented.
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Affiliation(s)
- Ayelet Shani-Adir
- Division of Dermatology, Children's Memorial Hospital, 2300 Children's Plaza, Chicago, IL 60614, USA
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42
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Smoller BR, Santucci M, Wood GS, Whittaker SJ. Histopathology and genetics of cutaneous T-cell lymphoma. Hematol Oncol Clin North Am 2003; 17:1277-311. [PMID: 14710885 DOI: 10.1016/s0889-8588(03)00115-1] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
There is emerging evidence that genomic and chromosomal instability are features of CTCL, including variants such as MF, Sézary syndrome, and primary cutaneous CD30+ LCAL, and that specific chromosomal abnormalities are common. Additional resolution of specific regions of chromosomal loss and gain are required to define putative genes that may be of fundamental pathogenetic importance in CTCL. Inactivation of well-defined cell cycle and TSG are common as for other types of NHL. The prognostic significance of these abnormalities in CTCL has yet to be determined. The dysregulation of specific transcription factors is of interest, but requires further study. It is hoped that greater understanding of these molecular abnormalities will permit the development of CTCL-specific therapies that alleviate suffering and prolong survival.
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MESH Headings
- Chromosome Aberrations
- Chromosomes, Human/genetics
- Chromosomes, Human/ultrastructure
- Genetic Techniques
- Humans
- Immunophenotyping
- Killer Cells, Natural/pathology
- Lymphoma, B-Cell/diagnosis
- Lymphoma, B-Cell/pathology
- Lymphoma, T-Cell, Cutaneous/classification
- Lymphoma, T-Cell, Cutaneous/diagnosis
- Lymphoma, T-Cell, Cutaneous/genetics
- Lymphoma, T-Cell, Cutaneous/pathology
- Mycosis Fungoides/diagnosis
- Mycosis Fungoides/pathology
- Neoplasm Staging
- Signal Transduction/genetics
- Skin Neoplasms/classification
- Skin Neoplasms/diagnosis
- Skin Neoplasms/genetics
- Skin Neoplasms/pathology
- T-Lymphocyte Subsets/pathology
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Affiliation(s)
- Bruce R Smoller
- Department of Pathology, University of Arkansas for Medical Sciences, 4301 West Markham Street, Little Rock, AR 72205, USA.
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43
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Bassez G, Authier FJ, Lechapt-Zalcman E, Delfau-Larue MH, Plonquet A, Coquet M, Illa I, Gherardi RK. Inflammatory myopathy with abundant macrophages (IMAM): a condition sharing similarities with cytophagic histiocytic panniculitis and distinct from macrophagic myofasciitis. J Neuropathol Exp Neurol 2003; 62:464-74. [PMID: 12769186 DOI: 10.1093/jnen/62.5.464] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
We describe the unreported pattern of inflammatory myopathy with abundant macrophages (IMAM) as a main differential diagnosis of postimmunization aluminum hydroxide-induced macrophagic myofasciitis (MMF). IMAM was mainly detected among patients with a dermatomyositis (DM)-like disease. Among 113 muscle biopsies from DM patients collected from 1974 to 2000, intensity of macrophage infiltration was highly variable: 41.5% (-/+); 34.5% (+); 17% (++): and 7% (+++). The 27 patients from groups (++) and (+++) had a similar pattern of macrophagic infiltration and were considered to have IMAM. They were compared to 40 MMF patients. In IMAM, macrophage infiltrates were diffuse and correlated positively with both T cell infiltrates and acute muscle fiber damage, and showed pictures of hemophagocytosis (21/27). Connective tissue structures were infiltrated by noncohesive, ribbon-forming collections of large basophilic macrophages containing no crystalline inclusions. In MMF, macrophage infiltrates were focal and formed compact well-delineated aggregates of granular PAS+ cells, loaded with crystalline aluminum hydroxide particles, in the absence of either hemophagocytosis or conspicuous muscle damage. Review of the literature indicates similarities between IMAM and "cytophagic histiocytic panniculitis" (CHP), a condition characterized by T cell-triggered macrophage hyperactivation. Both IMAM and CHP, but not MMF, may be associated with a life-threatening hemophagocytic syndrome.
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Affiliation(s)
- Guillaume Bassez
- Systeme Neuromusculaire et Inflammation (INSERM, EMI 0011, Université Paris XII-Val de Marne), Département de Pathologie, Hôpital Henri Mondor, Créteil, France
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44
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Reimer P, Rüdiger T, Müller J, Rose C, Wilhelm M, Weissinger F. Subcutaneous panniculitis-like T-cell lymphoma during pregnancy with successful autologous stem cell transplantation. Ann Hematol 2003; 82:305-9. [PMID: 12707721 DOI: 10.1007/s00277-003-0647-8] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2003] [Accepted: 03/13/2003] [Indexed: 10/25/2022]
Abstract
We report a 35-year-old pregnant woman with progressive subcutaneous panniculitis-like T-cell lymphoma (SPTCL). During pregnancy chemotherapy with cyclophosphamide, doxorubicin, vincristine, and prednisone (CHOP) stabilized the disease for 4 months before new manifestations appeared. After delivery of a healthy girl, myeloablative radiochemotherapy followed by autologous stem cell transplantation could be performed leading to complete remission.
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Affiliation(s)
- P Reimer
- Medizinische Poliklinik, University of Wuerzburg, Klinikstr. 6-8, 97070, Wuerzburg, Germany.
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45
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Ravikanti L, Singh V. Subcutaneous panniculitic T-cell lymphoma presenting as pyrexia of unknown origin in pregnancy: A case report and literature review. Aust N Z J Obstet Gynaecol 2003; 43:166-8. [PMID: 14712977 DOI: 10.1046/j.0004-8666.2003.00035.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Affiliation(s)
- Lakshmi Ravikanti
- Department of Obstetrics and Gynaecology, Waikato Hospital, Hamilton, New Zealand
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46
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Santucci M, Pimpinelli N, Massi D, Kadin ME, Meijer CJLM, Müller-Hermelink HK, Paulli M, Wechsler J, Willemze R, Audring H, Bernengo MG, Cerroni L, Chimenti S, Chott A, Díaz-Pérez JL, Dippel E, Duncan LM, Feller AC, Geerts ML, Hallermann C, Kempf W, Russell-Jones R, Sander C, Berti E. Cytotoxic/natural killer cell cutaneous lymphomas. Report of EORTC Cutaneous Lymphoma Task Force Workshop. Cancer 2003; 97:610-27. [PMID: 12548603 DOI: 10.1002/cncr.11107] [Citation(s) in RCA: 208] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
BACKGROUND Cutaneous lymphomas expressing a cytotoxic or natural killer (NK) cell phenotype represent a group of lymphoproliferative disorders for which there is currently much confusion and little consensus regarding the best nomenclature and classification. METHODS This study analyzes 48 cases of primary cutaneous lymphoma expressing cytotoxic proteins and/or the NK cell marker, CD56. These cases were collected for a workshop of the European Organization for Research and Treatment of Cancer Cutaneous Lymphoma Task Force, to better clarify the clinical, morphologic, and phenotypic features of these uncommon tumors. RESULTS Several categories with different clinical and pathologic features were delineated: 1) aggressive, CD8+, epidermotropic, cytotoxic T-cell lymphoma; 2) mycosis fungoides, cytotoxic immunophenotype variant; 3) subcutaneous panniculitis-like T-cell lymphoma; 4) NK/T-cell lymphoma, nasal type; 5) CD4+, NK cell lymphoma; 6) blastoid NK cell lymphoma; (7) intravascular NK-like lymphoma; and 8) cytotoxic, peripheral T-cell lymphoma. CONCLUSIONS Our data show that primary cutaneous cytotoxic/NK cell lymphomas include distinct groups of diseases, clinically, histologically, and biologically. Because the finding of a cytotoxic phenotype often has prognostic significance, the routine use of cytotoxic markers in the diagnosis and classification of cutaneous lymphomas should be expanded.
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MESH Headings
- CD4-Positive T-Lymphocytes/immunology
- CD56 Antigen/immunology
- CD8-Positive T-Lymphocytes/immunology
- Humans
- Immunophenotyping
- Killer Cells, Natural/immunology
- Lymphoma/classification
- Lymphoma/immunology
- Lymphoma/pathology
- Lymphoma, T-Cell, Cutaneous/classification
- Lymphoma, T-Cell, Cutaneous/immunology
- Lymphoma, T-Cell, Cutaneous/pathology
- Lymphoma, T-Cell, Peripheral/classification
- Lymphoma, T-Cell, Peripheral/immunology
- Lymphoma, T-Cell, Peripheral/pathology
- Membrane Proteins/immunology
- Mycosis Fungoides/immunology
- Mycosis Fungoides/pathology
- Panniculitis/immunology
- Panniculitis/pathology
- Phenotype
- Poly(A)-Binding Proteins
- Proteins
- RNA-Binding Proteins/immunology
- Skin Neoplasms/classification
- Skin Neoplasms/immunology
- Skin Neoplasms/pathology
- T-Cell Intracellular Antigen-1
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Affiliation(s)
- Marco Santucci
- Department of Human Pathology and Oncology, University of Florence Medical School, Florence, Italy.
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47
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Kim YC, Kim SC, Yang WI, Go JH, Vandersteen DP. Extranodal NK/T-cell lymphoma with extensive subcutaneous involvement, mimicking subcutaneous panniculitis-like T cell lymphoma. Int J Dermatol 2002; 41:919-21. [PMID: 12492989 DOI: 10.1046/j.1365-4362.2002.01577.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Affiliation(s)
- You Chan Kim
- Department of Dermatology, Dankook University College of Medicine, Cheonan, Korea
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48
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Török L, Gurbity TP, Kirschner A, Krenács L. Panniculitis-like T-cell lymphoma clinically manifested as alopecia. Br J Dermatol 2002; 147:785-8. [PMID: 12366431 DOI: 10.1046/j.1365-2133.2002.04924.x] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
A 45-year-old women presented with multifocal scalp lesions with the clinical impression of alopecia areata. Histological findings first suggested cytophagic histiocytic panniculitis, although a 'burned-out' panniculitis-like T-cell lymphoma could not be excluded. After a 20-month follow-up period, assessment of the T-cell receptor gamma-chain gene rearrangement verified the diagnosis of subcutaneous panniculitis-like T-cell lymphoma. This case is interesting because of its isolated scalp manifestation as well as its indolent course.
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Affiliation(s)
- L Török
- Department of Dermatology, County Hospital, Nagykörösi u. 15, 6000 Kecskemét, Hungary.
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49
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Abstract
The classification of inflammatory disorders of the subcutaneous tissue has mystified dermatologists for decades. Overlapping clinical and histologic features, and a lack of specific treatments have added to the confusion. This article initially classifies the various panniculititides by their primary histopathologic pattern: (1) septal panniculitis without vasculitis, (2) septal panniculitis with vasculitis, (3) lobular panniculitis without vasculitis, and (4) lobular panniculitis with vasculitis. Subsequently, we describe the key clinical findings in the most important forms of panniculitis. We begin with the most common form of panniculitis, erythema nodosum. Indeed, in many patients suspected of having panniculitis, a worthwhile question to consider initially might be, "Is this, or is this not, erythema nodosum?" before engaging in an elaborate (and expensive) exercise in differential diagnosis.
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Affiliation(s)
- Maryanna C Ter Poorten
- Department of Dermatology, Medical University of South Carolina, 96 Jonathan Lucas Street, Suite 623, PO Box 250618, Charleston, SC 29425, USA
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50
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Liu V, McKee PH. Cutaneous T-cell lymphoproliferative disorders: approach for the surgical pathologist: recent advances and clarification of confused issues. Adv Anat Pathol 2002; 9:79-100. [PMID: 11917163 DOI: 10.1097/00125480-200203000-00001] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Cutaneous T-cell lymphoproliferative disorders (CTCLs) remain a subject of confusion and controversy. In this review, the authors discuss diagnostic criteria and classification, including the role of immunohistochemistry and gene rearrangement studies. In addition, cutaneous T-cell pseudolymphomas, the current status of parapsoriasis and other premalignant syndromes, and the clinicopathological variants of mycosis fungoides are discussed. CD30-positive lymphoproliferative disorders and a number of rare variants of CTCL including granulamatous slack skin, subcutaneous (panniculitic) T-cell lymphoma, gamma-delta cutaneous lymphoma, NK/NK-like T-cell lymphoma, and primary cutaneous CD8-positive epidermotropic cytotoxic T-cell lymphoma are also considered.
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Affiliation(s)
- Vincent Liu
- Department of Pathology, Brigham & Women's Hospital, Boston, Massachusetts 02115, USA
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