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Liu J, Li M, Fu J, Dong M, Fan X, Zhong L, Xu G, Li Y, Xi Q. sTRBC1 and cyTRBC1 Expression Distinguishes Indolent T-Lymphoblastic Proliferations From T-Lymphoblastic Leukemia/Lymphoma. Am J Surg Pathol 2023; 47:1325-1331. [PMID: 37515427 DOI: 10.1097/pas.0000000000002103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/30/2023]
Abstract
Indolent T-lymphoblastic proliferation (iT-LBP) consists of a proliferation of non-neoplastic TdT + T cells in extrathymic tissues, requiring no treatment. However, due to overlapping clinical and histologic features, distinguishing iT-LBP from T-cell acute lymphoblastic leukemia/lymphoblastic lymphoma (T-ALL/LBL) can be challenging. Recently, flow cytometry-based evaluation of TRBC1 has been used to detect of T-cell clonality in TCRαβ + mature T-cell lymphomas and aid in the differential diagnosis between T-ALL and normal thymocytes. We present a case of iT-LBP with high-grade serous ovarian carcinoma (HGSOC). To investigate the potential utility of TRBC1 expression in distinguishing iT-LBP from T-ALL/LBL, we assessed both surface (s) and cytoplasmic (cy) TRBC1 expression patterns on blast cells from the patient with iT-LBP and HGSOC as well as 11 patients diagnosed with T-ALL/LBL. The results revealed that sTRBC1 and cyTRBC1 exhibited polytypic expression patterns in patient with iT-LBP and HGSOC, while cyTRBC1 showed monotypic expression in those with T-ALL/LBL. This suggests that evaluation of sTRBC1 and cyTRBC1 expression can serve as a simple, rapid, and effective approach to differentiate between iT-LBP and T-ALL/LBL.
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Affiliation(s)
| | | | | | | | | | - Ling Zhong
- Sichuan Provincial Key Laboratory for Human Disease Gene Study and Department of Laboratory Medicine, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu, Sichuan Province, China
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Ghezavati A, Liang CA, Mais D, Nazarullah A. Indolent T-lymphoblastic proliferation involving hepatocellular carcinoma-presentation in novel settings and comprehensive review of literature. J Hematop 2023; 16:167-175. [PMID: 38175402 DOI: 10.1007/s12308-023-00554-7] [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] [Received: 04/12/2023] [Accepted: 07/06/2023] [Indexed: 01/05/2024] Open
Abstract
Indolent T-lymphoblastic proliferation (iT-LBP) is a rare, non-clonal, extrathymic lymphoid proliferation with an immature T cell phenotype, indolent clinical course, and excellent prognosis. Although their pathogenesis is unclear, they are reported to be associated with Castleman disease, follicular dendritic cell tumors/sarcomas, angioimmunoblastic T cell lymphoma, hepatocellular carcinoma (HCC), myasthenia gravis, and acinic cell carcinoma. There are around 51 reported cases of iT-LBP in the literature. Recognition and accurate diagnosis of this entity is critical as it shares morphologic and immunophenotypic features with an aggressive malignancy-acute T cell leukemia/lymphoma (T-ALL). IT-LBP in HCC post-liver transplant and in metastatic sites has not been reported in the literature. Two case reports of patients presenting with recurrent and metastatic HCC in post-liver transplant settings are described. A 50-year-old man with an end-stage liver disease with HCC underwent liver transplant. A year later, he developed pulmonary metastasis with associated iT-LBP. A 69-year-old man underwent liver transplant for end-stage liver disease and HCC. Eighteen months later, he developed recurrent HCC in the transplanted liver and omental metastasis; both sites showed HCC with iT-LBP. iT-LBP in both patients expressed TdT, CD3, and CD4 and lacked CD34 and clonal T cell receptor gene rearrangements. On retrospective review, the pre-transplant HCC specimens lacked iT-LBP. We present two cases of iT-LBP associated with HCC in novel settings-in post-liver transplant patients and in recurrent/metastatic sites of HCC. In addition, a comprehensive literature review of clinical, histological, and immunophenotypic characteristics of reported cases of iT-LBP is presented.
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Affiliation(s)
- Alireza Ghezavati
- Department of Pathology, University of Texas Health Science Center at San Antonio, 7703 Floyd Curl Dr, San Antonio, TX, 78229, USA
| | - Christine A Liang
- Department of Pathology, South Texas Pathology Associates, San Antonio, TX, USA
| | - Daniel Mais
- Department of Pathology, University of Louisville Health, Kentucky, USA
| | - Alia Nazarullah
- Department of Pathology, University of Texas Health Science Center at San Antonio, 7703 Floyd Curl Dr, San Antonio, TX, 78229, USA.
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Saglam A, Singh K, Gollapudi S, Kumar J, Brar N, Butzmann A, Warnke R, Ohgami RS. Indolent T-lymphoblastic proliferation: A systematic review of the literature analyzing the epidemiologic, clinical, and pathologic features of 45 cases. Int J Lab Hematol 2022; 44:700-711. [PMID: 35577551 DOI: 10.1111/ijlh.13873] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Accepted: 04/25/2022] [Indexed: 11/26/2022]
Abstract
An indolent T-lymphoblastic proliferation (iT-LBP) is a rare benign disorder characterized by an abnormal expansion of immature T-cells, which morphologically can mimic malignancy. Since the first case was described in 1999, dozens more have been reported in the literature. However, the epidemiologic, clinical, pathologic, and biologic features of this disease have not been well described. Here, we retrospectively reviewed all known cases reported in the literature to better understand this entity. A PubMed search up to January 2022 highlighted 25 papers describing cases/case series of iT-LBP, one of which was a case presentation in a slide workshop. Except for 9 of the cases in one of the papers, where it was evident that the number of CD3+/TdT+ cells were too few to conform with a diagnosis of iT-LBP, all papers and all the cases reported were included in the study amounting to a total of 45 cases. Clinicopathologic characteristics were analyzed using descriptive statistics and frequencies. Our analysis highlighted the previously known association with Castleman disease and Castleman-like features and underlined its association with dendritic cell proliferations in general, as well as uncovering high frequency of concurrence with hepatocellular carcinoma and autoimmune diseases, most notably myasthenia gravis, paraneoplastic pemphigus and paraneoplastic autoimmune multiorgan syndrome. Furthermore, the co-expression of CD4 and CD8 and high prevalence of extranodal disease and recurrences were other less well described features that were revealed.
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Affiliation(s)
- Arzu Saglam
- Department of Pathology, Hacettepe University, Ankara, Turkey
| | - Kunwar Singh
- Department of Pathology, University of California San Francisco, San Francisco, California, USA
| | - Sumanth Gollapudi
- Department of Pathology, University of California San Francisco, San Francisco, California, USA
| | - Jyoti Kumar
- Department of Pathology, Stanford University, Stanford, California, USA
| | - Nivaz Brar
- Department of Pathology, Stanford University, Stanford, California, USA
| | - Alexandra Butzmann
- Department of Pathology, University of California San Francisco, San Francisco, California, USA
| | - Roger Warnke
- Department of Pathology, Stanford University, Stanford, California, USA
| | - Robert S Ohgami
- Department of Pathology, University of California San Francisco, San Francisco, California, USA
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Karki NR, Arfa AS, Savage N, Kutlar A. Indolent T-Lymphoblastic Proliferation in Idiopathic Multicentric Castleman Disease. Acta Haematol 2021; 145:214-220. [PMID: 34818661 DOI: 10.1159/000520240] [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] [Received: 06/22/2021] [Accepted: 10/14/2021] [Indexed: 11/19/2022]
Abstract
Benign and polyclonal proliferation of immature T cells in a lymph node with preserved morphological architecture is called indolent T-lymphoblastic proliferation (iT-LBP). Although overall rare, they have been described in association with both benign and malignant disorders including Castleman disease. We report the first case of idiopathic multicentric Castleman disease associated with iT-LBP, all previous reports of iT-LBP in Castleman disease were unicentric. A 37-year-old-male presented with 3 months of fevers and B-symptoms and was found to have enlargement of multiple bilateral lymph node sites on both sides of diaphragm along with splenomegaly. Anemia, elevated C-reactive protein, hypoalbuminemia, and elevated interleukin-6 levels were present. Biopsy of a lymph node showed features suggestive of idiopathic multicentric Castleman disease and iT-LBP. Bone marrow biopsy was unremarkable. Siltuximab and steroids were used to treat the condition.
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Affiliation(s)
- Nabin Raj Karki
- Division of Hematology/Oncology, Augusta University, Augusta, Georgia, USA
| | | | - Natasha Savage
- Department of Pathology, Augusta University, Augusta, Georgia, USA
| | - Abdullah Kutlar
- Division of Hematology/Oncology, Augusta University, Augusta, Georgia, USA
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Yuanyuan Z, Jianlan X, Yanlin Z, Xiaoge Z. Indolent T-lymphoblastic proliferation: a report of three cases. Virchows Arch 2021; 480:1121-1126. [PMID: 34482472 DOI: 10.1007/s00428-021-03184-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2020] [Revised: 08/02/2021] [Accepted: 08/11/2021] [Indexed: 01/28/2023]
Abstract
Indolent T-lymphoblastic proliferation (iT-LBP) is the extrathymic proliferation of nonclonal TdT + T cells and is typically associated with lymphoid disorders. Although one study revealed that iT-LBP occurred in angioimmunoblastic T-cell lymphoma, no other lymphoma-related cases have been reported. Here, we report three cases of concurrent iT-LBP and benign or malignant lymphoid disorders. The first patient had bilateral cervical lymph node enlargement, and the resected lymph node showed polyclonal precursor T-cells distributed between benign hyperplastic lymphoid follicles. In the second case, iT-LBP occurred in peripheral T-cell lymphoma with a follicular growth pattern, showing that precursor T-cells were distributed between neoplastic follicles composed of CD4 + and CXCL13 + T-cells. In the third case, polyclonal precursor T-cells were distributed between the neoplastic follicles of follicular lymphoma. In summary, our results indicate an association between iT-LBP and reactive lymphoid hyperplasia (case 1) and lymphoma (cases 2 and 3).
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Affiliation(s)
- Zheng Yuanyuan
- Department of Pathology, Beijing Friendship Hospital, Capital Medical University, Beijing, 100050, People's Republic of China
| | - Xie Jianlan
- Department of Pathology, Beijing Friendship Hospital, Capital Medical University, Beijing, 100050, People's Republic of China
| | - Zhang Yanlin
- Department of Pathology, Beijing Friendship Hospital, Capital Medical University, Beijing, 100050, People's Republic of China
| | - Zhou Xiaoge
- Department of Pathology, Beijing Friendship Hospital, Capital Medical University, Beijing, 100050, People's Republic of China.
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T-lymphoblastic leukemia/lymphoma with interfollicular growth pattern and Castleman-like morphologic features. J Hematop 2021. [DOI: 10.1007/s12308-021-00446-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
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7
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Scientific Advances and the Evolution of Diagnosis, Subclassification and Treatment of Lymphoma. Arch Med Res 2020; 51:749-764. [PMID: 32553461 DOI: 10.1016/j.arcmed.2020.05.022] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Accepted: 05/26/2020] [Indexed: 12/11/2022]
Abstract
The diagnosis of lymphoma has evolved tremendously over time. Initially, diagnosis of lymphoma was largely based on morphology alone. Over time, immunophenotyping using flow cytometry and immunohistochemistry, and then in situ hybridization, have contributed dramatically to the pathologist's ability to recognize, diagnose and subclassify lymphomas more precisely. In recent years, cytogenetic and molecular genetic techniques have developed that allow evaluation of abnormalities in lymphomas, leading to an understanding of their pathogenesis and opening the door to targeted therapies that will lead to better outcomes for lymphoma patients.
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Sirolimus for the Treatment of Airway Obstruction due to Indolent T-Lymphoblastic Proliferation. Case Reports Immunol 2020; 2019:1724083. [PMID: 31976096 PMCID: PMC6959153 DOI: 10.1155/2019/1724083] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2019] [Revised: 10/01/2019] [Accepted: 10/17/2019] [Indexed: 12/04/2022] Open
Abstract
Introduction Indolent T-lymphoblastic proliferation (iT-LBP) is a rare nonmalignant entity that presents as a proliferation of T-lymphoblasts. We report a first such case with a recurrent laryngeal obstruction presentation that was successfully controlled with Sirolimus. Case presentation This is the case of a 29-year-old female who presented with a recurrent significant lymphoid hyperplasia in the adenoid and tongue base region as well as a right cervical lymph node. After repeated adenoidectomies and tonsillectomies, and based on pathological and clinical findings she was diagnosed with iT-LBP. Trials of radiotherapy and immunotherapy with cyclosporine and rituximab all failed to control the progression of the disease. Sirolimus was finally able to restrict the growth and improve her symptoms. Conclusion While It-LBP does not usually require treatment, it is important to report cases in which treatment was crucial for the survival of the patient, and the effective role of Sirolimus in doing so, without any major adverse effects.
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Wenzinger C, Williams E, Gru AA. Updates in the Pathology of Precursor Lymphoid Neoplasms in the Revised Fourth Edition of the WHO Classification of Tumors of Hematopoietic and Lymphoid Tissues. Curr Hematol Malig Rep 2018; 13:275-288. [PMID: 29951888 DOI: 10.1007/s11899-018-0456-8] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
PURPOSE OF REVIEW Acute lymphoblastic leukemias (ALL) are malignant disorders of immature B or T cells that occur characteristically in children, usually under the age of 6 (75%). Approximately 6000 new cases of ALL are diagnosed each year in the USA, 80-85% of which represent B-ALL forms. Most presentations of B-ALL are leukemic, whereas T-ALL presents with a mediastinal mass, with or without leukemic involvement. The revised fourth edition of the World Health Organization (WHO) classification (2017) has introduced some changes in both B and T-ALL. Here, we summarize the categories of lymphoblastic leukemia/lymphomas as defined by the WHO and recent developments in the understanding of this group of hematologic malignancy. RECENT FINDINGS Two provisional categories of B-ALL have now been identified including B-ALL, BCR-ABL1-like, and B-ALL with iAMP21. The Philadelphia chromosome-like B-ALL includes forms of the disease that shares the expression profiling of B-ALL with t(9;22) but lack such rearrangement. The second one shows amplification of part of the chromosome 21. Both entities are associated with worse prognosis. Within the T-ALL group, an early precursor T cell form has now been introduced as a provisional category. Such group demonstrates expression of stem cell and myeloid markers in conjunction with the T cell antigens. The current review summarizes the recent updates to the WHO classification.
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MESH Headings
- Child, Preschool
- Chromosomes, Human, Pair 21/genetics
- Chromosomes, Human, Pair 21/metabolism
- Chromosomes, Human, Pair 9/genetics
- Chromosomes, Human, Pair 9/metabolism
- Female
- Fusion Proteins, bcr-abl/genetics
- Fusion Proteins, bcr-abl/metabolism
- Hematopoiesis
- Humans
- Infant
- Lymphoid Tissue/metabolism
- Lymphoid Tissue/pathology
- Male
- Precursor B-Cell Lymphoblastic Leukemia-Lymphoma/classification
- Precursor B-Cell Lymphoblastic Leukemia-Lymphoma/genetics
- Precursor B-Cell Lymphoblastic Leukemia-Lymphoma/metabolism
- Precursor B-Cell Lymphoblastic Leukemia-Lymphoma/pathology
- Precursor T-Cell Lymphoblastic Leukemia-Lymphoma/classification
- Precursor T-Cell Lymphoblastic Leukemia-Lymphoma/genetics
- Precursor T-Cell Lymphoblastic Leukemia-Lymphoma/metabolism
- Precursor T-Cell Lymphoblastic Leukemia-Lymphoma/pathology
- Translocation, Genetic
- World Health Organization
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Affiliation(s)
| | - Eli Williams
- Department of Pathology, University of Virginia, Charlottesville, VA, USA
| | - Alejandro A Gru
- Departments of Pathology & Dermatology, University of Virginia, 415 Lane Road, Hospital Expansion Bldg Room 3024, Charlottesville, VA, 22908, USA.
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Chauveau B, Le Loarer F, Bacci J, Baylac F, Dubus P, Ling C, Parrens M. [Indolent T-lymphoblastic proliferation in association with localized Castleman disease: A case report]. Ann Pathol 2018; 39:29-35. [PMID: 30554835 DOI: 10.1016/j.annpat.2018.09.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2018] [Revised: 07/18/2018] [Accepted: 09/03/2018] [Indexed: 01/09/2023]
Abstract
Herein we report the case of a 41-year-old woman who presented with pelvic pain. Magnetic Resonance Imaging exhibited a single pelvic mass, measuring 50mm long axis, alongside the right iliac vessels. Histological examination of the excision specimen showed a lymphoid tumor with features of localized Castleman disease, hyaline vascular type. Moreover we identified multiple interfollicular dark clusters, composed of cells morphologically resembling cortical thymocytes. Their immunophenotype was consistent with an intermediate stage of T-cell differentiation, with the expression of CD3, CD4, CD8, TdT, CD1a, CD99, CD2, CD5, CD7 and CD10, with 40% Ki67. After integration of clinical and molecular data, the retained diagnosis was an indolent T-cell lymphoblastic proliferation associated with hyaline vascular localized Castleman disease. The clinical course confirmed the indolent nature of the proliferation, despite a late local recurrence at 7 years of the initial diagnosis, without histological modification, due to an incomplete initial resection surgery.
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Affiliation(s)
- Bertrand Chauveau
- Service de pathologie, hôpital Haut-Lévêque, CHU de Bordeaux, avenue Magellan, 33600 Pessac, France; Université de Bordeaux, Campus de Carreire, 146, rue Léo-Saignat CS 61292, 33076 Bordeaux cedex, France.
| | - François Le Loarer
- Service de biopathologie, institut Bergonié, 229, cours de l'Argonne, 33000 Bordeaux, France; Université de Bordeaux, Campus de Carreire, 146, rue Léo-Saignat CS 61292, 33076 Bordeaux cedex, France
| | - Julia Bacci
- Service de biopathologie, institut Bergonié, 229, cours de l'Argonne, 33000 Bordeaux, France
| | - François Baylac
- SCP Lhomme-Baylac-cabinet d'anatomie et cytologie pathologiques, 182, rue de Périgueux, 16000 Angoulême, France
| | - Pierre Dubus
- Université de Bordeaux, Campus de Carreire, 146, rue Léo-Saignat CS 61292, 33076 Bordeaux cedex, France; Service de biologie des tumeurs et tumorothèque, hôpital Haut-Lévêque, CHU de Bordeaux, avenue Magellan, 33600 Pessac, France
| | - Catherine Ling
- Service de pathologie, hôpital Haut-Lévêque, CHU de Bordeaux, avenue Magellan, 33600 Pessac, France; Université de Bordeaux, Campus de Carreire, 146, rue Léo-Saignat CS 61292, 33076 Bordeaux cedex, France
| | - Marie Parrens
- Service de pathologie, hôpital Haut-Lévêque, CHU de Bordeaux, avenue Magellan, 33600 Pessac, France; Université de Bordeaux, Campus de Carreire, 146, rue Léo-Saignat CS 61292, 33076 Bordeaux cedex, France
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Pizzi M, Brignola S, Righi S, Agostinelli C, Bertuzzi C, Pillon M, Semenzato G, Rugge M, Sabattini E. Benign TdT-positive cells in pediatric and adult lymph nodes: a potential diagnostic pitfall. Hum Pathol 2018; 81:131-137. [PMID: 29969607 DOI: 10.1016/j.humpath.2018.06.027] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2018] [Revised: 06/15/2018] [Accepted: 06/18/2018] [Indexed: 12/12/2022]
Abstract
Benign terminal deoxynucleotidyl transferase (TdT)-positive cells have been documented in a variety of nonhematopoietic tissues. Scant data are, however, available on their presence in nonneoplastic lymph nodes. This study is aimed to (1) characterize the presence/distribution of benign TdT-positive cells in pediatric and adult reactive lymph nodes and (2) define the phenotype and nature of such elements. This retrospective study considered 141 reactive lymph nodes from pediatric and adult patients without history of neoplastic disease. TdT-positive cells were characterized by immunohistochemical and morphometric analyses, and their presence was correlated with the clinical-pathological features. The nature of TdT-positive cells was investigated by (1) double immunostaining for early lymphoid cell markers and (2) assessment of TdT expression in fetal lymph nodes. Sparse TdT-positive cells were documented in all pediatric cases and in most (76%) adult lymph nodes. TdT-positive cell density was higher in children than adults (15.9/mm2 versus 8.6/mm2; P < .05). TdT positivity did not correlate with any clinical or histological parameter, and double immunostaining disclosed a phenotype compatible with early lymphoid precursors (positivity for CD34 and CD10, and variable expression of CD7). A very high TdT-positive cell density (802.4/mm2) was reported in all fetal lymph nodes. In conclusion, TdT-positive cells are a common finding in pediatric and adult lymph nodes. The interstitial distribution and low number of such cells allow for the differential diagnosis with precursor lymphoid neoplasms. The high density in fetal lymph nodes and the phenotype of such cells suggest their belonging to an immature lymphoid subset gradually decreasing with age.
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Affiliation(s)
- Marco Pizzi
- General Pathology and Cytopathology Unit, Department of Medicine-DIMED, University of Padova, 35121 Padova, Italy.
| | - Stefano Brignola
- General Pathology and Cytopathology Unit, Department of Medicine-DIMED, University of Padova, 35121 Padova, Italy
| | - Simona Righi
- Haematopathology Unit, Sant'Orsola University Hospital, Department of Hematology and Oncology/Department of Experimental Diagnostic and Specialty Medicine, 40138 Bologna, Italy
| | - Claudio Agostinelli
- Haematopathology Unit, Sant'Orsola University Hospital, Department of Hematology and Oncology/Department of Experimental Diagnostic and Specialty Medicine, 40138 Bologna, Italy
| | - Clara Bertuzzi
- Haematopathology Unit, Sant'Orsola University Hospital, Department of Hematology and Oncology/Department of Experimental Diagnostic and Specialty Medicine, 40138 Bologna, Italy
| | - Marta Pillon
- Clinic of Paediatric Haemato-Oncology, Department of Women's and Children's Health, University of Padova, 35128 Padova, Italy
| | - Gianpietro Semenzato
- Hematology & Clinical Immunology Unit, Department of Medicine-DIMED, University of Padova, 35128 Padova, Italy
| | - Massimo Rugge
- General Pathology and Cytopathology Unit, Department of Medicine-DIMED, University of Padova, 35121 Padova, Italy
| | - Elena Sabattini
- Haematopathology Unit, Sant'Orsola University Hospital, Department of Hematology and Oncology/Department of Experimental Diagnostic and Specialty Medicine, 40138 Bologna, Italy
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Quesada AE, Young KH, Medeiros LJ, Thakral B. Indolent T-lymphoblastic proliferation associated with low grade follicular dendritic cell sarcoma and Castleman disease. Pathology 2018; 50:351-352. [DOI: 10.1016/j.pathol.2017.09.017] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2017] [Revised: 08/27/2017] [Accepted: 09/03/2017] [Indexed: 10/17/2022]
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13
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Yasuda H, Tsutsui M, Ota Y, Tanaka M, Komatsu N. Indolent T-lymphoblastic proliferation concomitant with acinic cell carcinoma mimicking T-lymphoblastic lymphoma: case report and literature review. Histopathology 2017; 72:862-866. [PMID: 29143359 DOI: 10.1111/his.13433] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2017] [Accepted: 11/08/2017] [Indexed: 11/28/2022]
Abstract
AIMS Indolent T-lymphoblastic proliferation (iT-LBP) is a non-clonal benign condition showing extrathymic proliferation of T-lymphoblasts positive for CD3, CD4, CD8, and TdT. Isolated iT-LBP has been observed, but the majority of iT-LBPs have been seen in conjunction with other disorders, including Castleman disease, hepatocellular carcinoma, follicular dendritic cell tumours, angioimmunoblastic T-cell lymphoma, myasthenia gravis, and acinic cell carcinoma (ACC). The clinical course of iT-LBP is indolent, and no therapy is usually required. A major concern is misdiagnosis as T-lymphoblastic lymphoma, and a correct diagnosis of iT-LBP often requires not only pathological analysis but also careful monitoring of the clinical course. The aim of this study was to broaden the knowledge of pathologists and physicians concerning this as yet not well-recognised entity. METHODS AND RESULTS We report a case of iT-LBP concomitant with ACC, along with a literature review of all 14 cases of iT-LBP reported to date. CONCLUSIONS iT-LBP should always be considered as a differential diagnosis of T-lymphoblastic lymphoma, as the two disorders show extremely similar traits.
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Affiliation(s)
- Hajime Yasuda
- Department of Haematology, Juntendo University School of Medicine, Tokyo, Japan
| | - Miyuki Tsutsui
- Department of Haematology, Juntendo University School of Medicine, Tokyo, Japan
| | - Yasunori Ota
- Department of Pathology, Research Hospital, Institute of Medical Science, University of Tokyo, Tokyo, Japan
| | - Masaru Tanaka
- Department of Haematology, Juntendo University School of Medicine, Tokyo, Japan
| | - Norio Komatsu
- Department of Haematology, Juntendo University School of Medicine, Tokyo, Japan
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14
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Yuan J, Gali VL, Perry DA, Fu K, Qureishi H, Amador-Ortiz C, Greiner T, Pirruccello SJ. Flow Cytometric Characteristics of Extrathymic Thymocytes in Adenoid Tissue: A Case Report and Comparison to Normal Thymus and Thymoma. CYTOMETRY PART B-CLINICAL CYTOMETRY 2017; 94:357-362. [DOI: 10.1002/cyto.b.21514] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Affiliation(s)
- Ji Yuan
- Department of Pathology and Microbiology; University of Nebraska Medical Center; Omaha Nebraska
| | - Vasantha L. Gali
- Department of Pathology; Sanford School of Medicine; Sioux Falls Sanford
| | - Deborah A. Perry
- Department of Pathology; Children's Hospital and Medical Center; Omaha Nebraska
| | - Kai Fu
- Department of Pathology and Microbiology; University of Nebraska Medical Center; Omaha Nebraska
| | - Hina Qureishi
- Department of Pathology and Microbiology; University of Nebraska Medical Center; Omaha Nebraska
| | - Catalina Amador-Ortiz
- Department of Pathology and Microbiology; University of Nebraska Medical Center; Omaha Nebraska
| | - Timothy Greiner
- Department of Pathology and Microbiology; University of Nebraska Medical Center; Omaha Nebraska
| | - Samuel J. Pirruccello
- Department of Pathology and Microbiology; University of Nebraska Medical Center; Omaha Nebraska
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15
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Yuan J, Gali VL, Perry DA, Fu K, Qureishi H, Amador-Ortiz C, Greiner T, Pirruccello SJ. Flow cytometric characteristics of extrathymic thymocytes in adenoid tissue: A case report and comparison to normal thymus and thymoma. CYTOMETRY. PART B, CLINICAL CYTOMETRY 2017. [PMID: 28165662 DOI: 10.1002/cyto.b.21516] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/26/2016] [Revised: 11/21/2016] [Accepted: 12/15/2016] [Indexed: 11/07/2022]
Abstract
BACKGROUND Normal thymocyte precursors in secondary lymphoid organs have previously been described. It is important to recognize normal thymocyte precursors by flow cytometry to differentiate them from T-cell lymphoblastic leukemia. METHODS A 3-year-old boy status 2 years post-allogenic cardiac transplant underwent adenoidectomy to exclude post-transplant lymphoproliferative disorder. Microscopic, immunohistochemical, and flow cytometry analyses of the adenoid were performed. RESULTS By flow cytometry, a population of CD45+(dim)/CD7+(bright)/CD3- cells were observed at 1.0% of lymphocytes. These cells expressed CD10, partial CD34, and exhibited acquisition of CD4 followed by CD8. Within the brighter CD45+ lymphocytes, a population of CD3-/CD4+/CD8+ thymocytes and a similarly sized population of CD4+/CD8+ cells exhibiting acquisition of low-density CD3 were identified. By immunostaining, clusters of TdT+/CD1a+/CD4+/CD8+ T-cells were identified in the interfollicular areas. Compared to normal thymus, thymocytes in the adenoid tissue lacked the classic CD4xCD8 winged differentiation profile but showed a normal early precursor pattern. CONCLUSIONS Thymocytes in adenoid show a similar differentiation pattern to thymus and thymoma. However, the classic winged pattern of common thymocyte differentiation may not be readily apparent in thymocytes differentiating outside of the thymus. Recognition of the early thymocyte precursor antigen acquisition profile can be crucial to correct interpretation. © 2017 International Clinical Cytometry Society.
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Affiliation(s)
- Ji Yuan
- Department of Pathology and Microbiology, University of Nebraska Medical Center, Omaha, Nebraska
| | - Vasantha L Gali
- Department of Pathology, Sanford School of Medicine, Sioux Falls, South Dakota
| | - Deborah A Perry
- Department of Pathology, Children's Hospital and Medical Center, Omaha, Nebraska
| | - Kai Fu
- Department of Pathology and Microbiology, University of Nebraska Medical Center, Omaha, Nebraska
| | - Hina Qureishi
- Department of Pathology and Microbiology, University of Nebraska Medical Center, Omaha, Nebraska
| | - Catalina Amador-Ortiz
- Department of Pathology and Microbiology, University of Nebraska Medical Center, Omaha, Nebraska
| | - Timothy Greiner
- Department of Pathology and Microbiology, University of Nebraska Medical Center, Omaha, Nebraska
| | - Samuel J Pirruccello
- Department of Pathology and Microbiology, University of Nebraska Medical Center, Omaha, Nebraska
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16
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Wang S, He G. 2016 Revision to the WHO classification of acute lymphoblastic leukemia. J Transl Int Med 2016; 4:147-149. [PMID: 28191537 DOI: 10.1515/jtim-2016-0040] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Affiliation(s)
- Shuai Wang
- Department of Hematology, The First Affiliated Hospital of Nanjing Medical University, Jiangsu Province Hospital, Nanjing 210029, Jiangsu Province, China
| | - Guangsheng He
- Department of Hematology, The First Affiliated Hospital of Nanjing Medical University, Jiangsu Province Hospital, Nanjing 210029, Jiangsu Province, China
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17
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Ohgami RS, Natkunam Y, Warnke RA. Indolent T-lymphoblastic proliferation: a name with specific meaning. Hum Pathol 2015; 46:1785-6. [DOI: 10.1016/j.humpath.2015.07.026] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2015] [Accepted: 07/27/2015] [Indexed: 11/15/2022]
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18
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Nathwani BN, Kansal R, Yiakoumis X, Pangalis GA. Indolent T-lymphoblastic proliferation: a name with specific meaning—reply. Hum Pathol 2015; 46:1786-7. [DOI: 10.1016/j.humpath.2015.07.025] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2015] [Accepted: 07/27/2015] [Indexed: 11/29/2022]
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19
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Kansal R, Nathwani BN, Yiakoumis X, Moschogiannis M, Sachanas S, Stefanaki K, Pangalis GA. Exuberant cortical thymocyte proliferation mimicking T-lymphoblastic lymphoma within recurrent large inguinal lymph node masses of localized Castleman disease. Hum Pathol 2015; 46:1057-61. [DOI: 10.1016/j.humpath.2015.03.007] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2015] [Revised: 02/08/2015] [Accepted: 03/13/2015] [Indexed: 10/23/2022]
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20
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Woo CG, Huh J. TdT+ T-Lymphoblastic Proliferation in Castleman Disease. J Pathol Transl Med 2015; 49:1-4. [PMID: 25812651 PMCID: PMC4357412 DOI: 10.4132/jptm.2014.11.17] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2014] [Revised: 10/24/2014] [Accepted: 11/17/2014] [Indexed: 12/03/2022] Open
Affiliation(s)
- Chang Gok Woo
- Department of Pathology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Jooryung Huh
- Department of Pathology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
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21
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Indolent T-lymphoblastic proliferation with disseminated multinodal involvement and partial CD33 expression. Am J Surg Pathol 2014; 38:1298-304. [PMID: 24618611 DOI: 10.1097/pas.0000000000000197] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Although indolent T-lymphoblastic proliferations (iT-LBP) are rare, this diagnosis should be excluded in any patient with an extrathymic proliferation of immature TdT+T cells. Unlike T-lymphoblastic leukemia/lymphoma, patients with iT-LBP do not require chemotherapy. We report a case of iT-LBP with disseminated multinodal involvement in an otherwise healthy 49-year-old woman. Multiple lymph node biopsies were performed over the course of several months demonstrating persistent and anatomically diffuse involvement. Over 18 months, and without therapy, she has remained healthy, and her lymphadenopathy significantly improved. No bone marrow or peripheral blood involvement was ever identified. Atypical T cells showed an immunophenotypic spectrum of T-cell antigen expression with partial CD33 on a subset of T cells detected by both flow cytometry and immunohistochemistry. Both T-cell clonality and Human Androgen Receptor Assay (HUMARA) studies, performed on lymph node biopsy specimens, were negative. This case represents the first detailed clinical, morphologic, molecular, and immunophenotypic description of disseminated multinodal involvement by nonclonal iT-LBP with partial CD33 expression on T cells.
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22
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Buscone S, Garavello W, Pagni F, Gaini RM, Cattoretti G. Nasopharyngeal tonsils (adenoids) contain extrathymic corticothymocytes. PLoS One 2014; 9:e98222. [PMID: 24858437 PMCID: PMC4032319 DOI: 10.1371/journal.pone.0098222] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2014] [Accepted: 04/29/2014] [Indexed: 11/19/2022] Open
Abstract
Adenoidal tissue (also known as nasopharyngeal tonsils) of 58% of humans in the pediatric age group contains immature T-lymphoid cells with the phenotype of thymocytes (TdT+,CD1abc+, cytoplasmic CD3+, coexpressing CD4 and CD8, lacking an Intraepithelial Lymphocyte-associated phenotype). The notable difference in comparison to palatine tonsils is the clustering in groups and sheets, comprising hundreds or thousands of cells (1.7%±0.2 of total T cells). The thymic epithelium is morphologically and phenotypically absent. Adenoids share with tonsils and lymph nodes the presence of immature B cell precursors (TdT+, CD1a-, Pax5+, Surrogate light chain±), however in these latter the presence of TdT+, CD1a+, Pax5- precursors is absent or limited to individual cells. Human adenoids are distinct among the Waldeyer's ring lymphoid tissue because of the known embryogenic derivation from the third pharyngeal pouch, from which the thymus develops; in addition, they may display phenotypic incomplete features of a vestigial thymus.
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Affiliation(s)
- Serena Buscone
- Anatomic Pathology, Department of Surgery and Translational Medicine, Universitá degli Studi di Milano-Bicocca, Milano, Italy
| | - Werner Garavello
- Otolaryngology, Department of Surgery and Translational Medicine, Universitá degli Studi di Milano-Bicocca, Milano, Italy
| | - Fabio Pagni
- Anatomic Pathology, Department of Surgery and Translational Medicine, Universitá degli Studi di Milano-Bicocca, Milano, Italy
- Pathology, Azienda Ospedaliera San Gerardo, Monza, Italy
| | - Renato Maria Gaini
- Otolaryngology, Department of Surgery and Translational Medicine, Universitá degli Studi di Milano-Bicocca, Milano, Italy
| | - Giorgio Cattoretti
- Anatomic Pathology, Department of Surgery and Translational Medicine, Universitá degli Studi di Milano-Bicocca, Milano, Italy
- Pathology, Azienda Ospedaliera San Gerardo, Monza, Italy
- * E-mail:
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23
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T-lymphoblastic proliferation and florid multifocal follicular dendritic cell proliferation occurring in hyaline-vascular Castleman disease in a patient with a possible familial predisposition. J Hematop 2013. [DOI: 10.1007/s12308-013-0184-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
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24
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Indolent T-lymphoblastic proliferation (iT-LBP): a review of clinical and pathologic features and distinction from malignant T-lymphoblastic lymphoma. Adv Anat Pathol 2013; 20:137-40. [PMID: 23574769 DOI: 10.1097/pap.0b013e31828d17ec] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
In recent years, a new pathologic entity has emerged: indolent T-lymphoblastic proliferation (iT-LBP). iT-LBPs share immunophenotypic similarities with T-lymphoblastic lymphoma; however, T-lymphoblastic proliferations are clinically indolent, and unlike the malignant counterpart, these expansions of nonclonal terminal deoxynucleotidyl transferase (TdT)+ T cells do not require treatment. Here we review the clinical and pathologic features, which are required for an accurate diagnosis of an iT-LBP. We demonstrate specific criteria can be used to accurately diagnose iT-LBP, notably: (1) confluent groups of TdT+ T cells in a biopsy specimen, (2) relative preservation of surrounding normal lymphoid architecture, (3) TdT+ T cells without morphologic atypia, (4) absence of thymic epithelium, (5) nonclonal TdT+ T cells, (6) immunophenotype of developmentally normal immature thymic T cells, and (7) clinical evidence of indolence (follow-up >6 mo without progression).
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25
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TdT+ T-lymphoblastic Populations Are Increased in Castleman Disease, in Castleman Disease in Association With Follicular Dendritic Cell Tumors, and in Angioimmunoblastic T-cell Lymphoma. Am J Surg Pathol 2012; 36:1619-28. [DOI: 10.1097/pas.0b013e318264e223] [Citation(s) in RCA: 58] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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26
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MacDonald DH, Clark I, Naresh KN. The Hammersmith Hospital hematopathology case of the month: paraspinal B lymphoblastic lymphoma – problems in diagnosis and initial indolent behavior. Leuk Lymphoma 2010; 51:1913-9. [PMID: 20858095 DOI: 10.3109/10428194.2010.511357] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
We describe a young man who presented with neurological signs and symptoms, and with a paraspinal soft tissue mass involving the vertebral body at T4. The patient was treated with dexamethasone prior to neurosurgical decompression and debulking. Biopsy showed features of a small B-cell lymphoma possibly of follicle center cell origin. The patient achieved complete remission with radiotherapy. However, he experienced relapse 10 months later with a soft tissue mass close to and involving the posteroinferior aspect of the sternum. Biopsy of the recurrent lesion showed features of B lymphoblastic leukemia/lymphoma. The first biopsy was revisited to demonstrate the lymphoblastic immunophenotype of the lesional cells. The 'indolent' appearance of the cells in the first biopsy was attributable to treatment with dexamethasone prior to the biopsy.
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Affiliation(s)
- Donald H MacDonald
- Department of Haematology, Hammersmith Hospital & Imperial College, London, UK
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27
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Eun S, Jeon YK, Jang JJ. Hepatocellular carcinoma with immature T-cell (T-lymphoblastic) proliferation. J Korean Med Sci 2010; 25:309-12. [PMID: 20119589 PMCID: PMC2811303 DOI: 10.3346/jkms.2010.25.2.309] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2008] [Accepted: 08/27/2008] [Indexed: 01/20/2023] Open
Abstract
Indolent T-lymphoblastic proliferation has been rarely reported in the upper aerodigestive tract. The lymphoid cells associated with this condition have the morphological and phenotypical features of immature thymocytes. However, their pathogenesis and biology are unknown. We present an unusual type of tumor infiltrating lymphocytes in a case with hepatocellular carcinoma, presumed to be a T-lymphoblastic proliferation. A 58-yr-old female patient presented with indigestion and a palpable epigastric mass. The abdominal computed tomography revealed a mass in the S6 region of the liver. A hepatic segmentectomy was performed. Microscopic examination showed dense isolated nests of monomorphic lymphoid cells within the tumor. Immunohistochemically, the lymphoid cells were positive for CD3, terminal deoxymucleotide transferase (TdT) and CD1a. In addition, they showed dual expression of CD4 and CD8. The polymerase chain reaction used to examine the T-cell antigen receptor gamma gene rearrangement showed polyclonal T-cell proliferation. This is the second case of hepatocellular carcinoma combined with indolent T-lymphoblastic proliferation identified by an unusual tumor infiltrating lymphocytes.
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Affiliation(s)
- Shin Eun
- Department of Pathology, Seoul National University College of Medicine, Seoul, Korea
| | - Youn Kyung Jeon
- Department of Pathology, Seoul National University College of Medicine, Seoul, Korea
| | - Ja June Jang
- Department of Pathology, Seoul National University College of Medicine, Seoul, Korea
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28
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Kim WY, Kim H, Jeon YK, Kim CW. Follicular dendritic cell sarcoma with immature T-cell proliferation. Hum Pathol 2009; 41:129-33. [PMID: 19740517 DOI: 10.1016/j.humpath.2009.05.014] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2009] [Revised: 04/22/2009] [Accepted: 05/22/2009] [Indexed: 01/28/2023]
Abstract
Follicular dendritic cell sarcoma is characterized by proliferation of spindled to ovoid cells reminiscent of follicular dendritic cells. However, the association of follicular dendritic cell sarcoma with a dense infiltration of immature T cells has not hitherto been reported. We report an unusual case of follicular dendritic cell sarcoma of the mesentery with immature T-cell proliferation in a 68-year-old man. The infiltrating immature T cells demonstrated expression of CD3, CD1a, TdT, and coexpression of CD4 and CD8 by immunohistochemistry. In addition, the patient was subsequently diagnosed with myasthenia gravis and paraneoplastic pemphigus and died of distant metastasis within 2 years after initial diagnosis of follicular dendritic cell sarcoma. The aggressive clinical course of this case contrasts with the indolent course of follicular dendritic cell sarcomas, and thus, the prognostic implications of follicular dendritic cell sarcoma with immature T-cell proliferation require clarification. The complication of myasthenia gravis and paraneoplastic pemphigus may suggest that immature T-cell proliferation has an autoimmunity-related systemic influence.
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Affiliation(s)
- Wook Youn Kim
- Department of Pathology and Tumor Immunity Medical Research Center, Seoul National University College of Medicine, Seoul 110-799, Korea
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29
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Qian YW, Weissmann D, Goodell L, August D, Strair R. Indolent T-lymphoblastic proliferation in Castleman lymphadenopathy. Leuk Lymphoma 2009; 50:306-8. [DOI: 10.1080/10428190802645079] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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30
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Wang ZM, Xiao WB, Zheng SS, Sun K, Wang LJ. Hepatocellular carcinoma with indolent T-lymphoblastic proliferation. Leuk Lymphoma 2009; 47:2424-6. [PMID: 17107923 DOI: 10.1080/10428190600822151] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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31
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Abstract
To investigate the occurrence of lymphoid progenitor cells in human tonsils, we studied tonsils from children and adults by immunohistochemistry by using a panel of antibodies to antigens associated with lymphoid progenitor cells, including terminal deoxynucleotidyl transferase (TdT), CD10 (CALLA), CD34, CD99 (p30/32mic2), and CD117 (c-kit), and compared them to reactive lymph nodes. Lymphoid progenitor cells, positive for TdT, CD10, and CD99, but not CD34 or CD117, were readily identified in tonsils from children and adults (TdT, 14 of 15; CD10, 15 of 15; CD99, 11 of 15), but were rarely present in lymph nodes (TdT, 1 of 8; CD10, 1 of 8; CD99, 0 of 8). Lymphoid progenitor cells in tonsils were localized to discrete foci at the periphery of lymphoid lobules adjacent to fibrous septae. Lymphoid progenitor cells are present in human tonsils, and the tonsils are a potential site of postnatal lymphopoiesis. The presence of lymphoid progenitor cells in human tonsils should not be confused with lymphoblastic lymphoma or leukemia.
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Affiliation(s)
- James A Strauchen
- Mount Sinai School of Medicine, Department of Pathology, New York, NY 10029, USA
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32
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Strauchen JA, Miller LK. Terminal deoxynucleotidyl transferase-positive cells in human tonsils. Am J Clin Pathol 2001; 116:12-6. [PMID: 11447741 DOI: 10.1309/m8v2-dwpb-dvx1-ubpc] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
Abstract
To study the possible cellular origin of recently recognized indolent terminal deoxynucleotidyl transferase (TdT)-positive T-lymphoblastic proliferations of the tonsils and oropharynx, we studied normal human tonsils for the presence of TdT-positive cells. TdT-positive cells were readily demonstrated in the tonsils from 15 children and adults by immunohistochemical staining. TdT-positive cells were distributed in discrete foci at the periphery of lobules of lymphoid tissue and adjacent to fibrous septa and had the morphologic features of small to medium-sized lymphocytes. Double-antibody staining indicated the TdT-positive cells had the phenotype of uncommitted early lymphoid precursors (CD3-, CD79a-, CD10-). Foci of TdT-positive cells were not identified in 6 reactive lymph nodes studied as controls. These studies indicate that tonsils, like bone marrow and thymus, are sites of lymphopoiesis. The presence of TdT-positive precursor cells in human tonsils may be a factor in the pathogenesis of recently described indolent T-lymphoblastic proliferations involving the tonsils and oropharynx. The presence of TdT-positive cells in human tonsils should not be misinterpreted as evidence of lymphoblastic lymphoma or leukemia.
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Affiliation(s)
- J A Strauchen
- Dept of Pathology, Mount Sinai School of Medicine, One Gustave Levy Place, New York, NY 10029, USA
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Strauchen JA. Indolent T-lymphoblastic proliferation: report of a case with an 11-year history and association with myasthenia gravis. Am J Surg Pathol 2001; 25:411-5. [PMID: 11224614 DOI: 10.1097/00000478-200103000-00018] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
T-lymphoblastic lymphoma is a high-grade malignant lymphoma with frequent occurrence in young males, mediastinal involvement, and systemic dissemination. Indolent T-lymphoblastic proliferations have rarely been recognized. In the present case, we report on an indolent T-lymphoblastic proliferation involving the oropharynx in a patient with myasthenia gravis with multiple local recurrences over an 11-year period without evidence of systemic dissemination. The T-lymphoblasts were consistently positive for terminal deoxynucleotidyl transferase (TdT), CD1, CD3, CD4, and CD8, corresponding to an intermediate thymocyte stage of differentiation. No cytokeratin-positive thymic epithelial cells were identified, ruling out an ectopic thymus or thymoma. T-receptor gene rearrangement studies by Southern blot revealed no monoclonal CT-beta rearrangement. Indolent T-lymphoblastic proliferations of undetermined clonality may rarely occur; predilection for involvement of oropharynx and possible association with myasthenia gravis are suggested.
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Affiliation(s)
- J A Strauchen
- Department of Pathology, Mount Sinai School of Medicine, New York, NY 10029, USA.
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