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Gabali AM, Jazaerly T, Chang CCJ, Cleveland R, Kass L. Simultaneous hepatosplenic T-cell lymphoma and myelofibrosis. Avicenna J Med 2014; 4:34-6. [PMID: 24761381 PMCID: PMC3994706 DOI: 10.4103/2231-0770.130343] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
Hepatosplenic T-cell lymphoma (HSTL) is a rare T-cell neoplasm of the lymphoid system. This type of lymphoma is characterized by sinusoidal infiltration of spleen, liver, bone marrow and lymph nodes by neoplastic lymphocytes. Here, we discuss a patient who had a left axillary lymph node biopsy with characteristic histological and immunohistochemical features of HSTL. In addition, infiltrating neoplastic T-cells and simultaneous characteristic features of myelofibrosis (MF) were also present in the bone marrow biopsy specimen. In contrast to secondary MF, primary MF is a progressive disease and may significantly affect the prognosis of coexisting HSTL. There are few reports in the literature talking about mild bone marrow fibrosis in association with T cell lymphoma, however marked increase in bone marrow fibrosis and HSTL never being reported. This case is shedding light on HSTL and marked increase in bone marrow fibrosis.
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Affiliation(s)
- Ali M Gabali
- Department of Pathology, Wayne State University, Detroit, MI 48201, USA
| | - Tarek Jazaerly
- Department of Pathology, MD Anderson Cancer Center, Houston, TX, USA
| | - Chung-Che Jeff Chang
- Department of Pathology and Laboratory Medicine, Weill Medical College of Cornell University, The Methodist Hospital Research Institute, Houston, TX, USA
| | - Ronald Cleveland
- Department of Pathology, Case Western Reserve University, Metro Health Medical Center, Cleveland, Ohio, USA
| | - Lawrence Kass
- Department of Pathology, Case Western Reserve University, Metro Health Medical Center, Cleveland, Ohio, USA
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Zhang W, Tsuda M, Yang GX, Tsuneyama K, He XS, Ansari AA, Ridgway WM, Coppel RL, Lian ZX, Leung PS, Gershwin ME. Lymphoma-like T cell infiltration in liver is associated with increased copy number of dominant negative form of TGFβ receptor II. PLoS One 2012; 7:e49413. [PMID: 23145171 PMCID: PMC3492285 DOI: 10.1371/journal.pone.0049413] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2012] [Accepted: 10/10/2012] [Indexed: 01/12/2023] Open
Abstract
Hepatosplenic T cell lymphoma (HSTCL) is a distinct and lethal subtype of peripheral T cell lymphoma with an aggressive course and poor outcome despite multiagent chemotherapy. Contradictory literature, an unknown etiology, and poor response to treatment highlight the need to define the malignant process and identify molecular targets with potential for successful therapeutic interventions. Herein, we report that mice homozygously expressing a dominant negative TGFβRII (dnTGFβRII) under the control of the CD4 promoter spontaneously develop lymphoma-like T cell infiltration involving both spleen and liver. Splenomegaly, hepatomegaly and liver dysfunction were observed in homozygous dnTGFβRII mice between 10 weeks and 10 months of age associated with a predominant infiltration of CD4−CD8−TCRβ+NK1.1+ or CD8+TCRβ+NK1.1− T cell subsets. Notch 1 and c-Myc expression at the mRNA levels were significantly increased and positively correlated with the cell number of lymphoid infiltrates in the liver of dnTGFβRII homozygous compared to hemizygous mice. Further, 2×104 isolated lymphoma-like cells transplant disease by adoptive cell transfers. Collectively, our data demonstrate that increased copy number of dnTGFβRII is critical for development of lymphoma-like T cell infiltration.
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Affiliation(s)
- Weici Zhang
- Division of Rheumatology, Allergy and Clinical Immunology, University of California Davis, Davis, California, United States of America
| | - Masanobu Tsuda
- Division of Rheumatology, Allergy and Clinical Immunology, University of California Davis, Davis, California, United States of America
| | - Guo-Xiang Yang
- Division of Rheumatology, Allergy and Clinical Immunology, University of California Davis, Davis, California, United States of America
| | - Koichi Tsuneyama
- Diagnostic Pathology, Graduate School of Medicine and Pharmaceutical Science, University of Toyama, Toyama, Japan
| | - Xiao-Song He
- Division of Rheumatology, Allergy and Clinical Immunology, University of California Davis, Davis, California, United States of America
| | - Aftab A. Ansari
- Department of Pathology, Emory University School of Medicine, Atlanta, Georgia, United States of America
| | - William M. Ridgway
- Division of Immunology, Allergy and Rheumatology, University of Cincinnati College of Medicine, Cincinnati, Ohio, United States of America
| | - Ross L. Coppel
- Department of Microbiology, Monash University, Melbourne, Victoria, Australia
| | - Zhe-Xiong Lian
- Institute of Immunology, Hefei National Laboratory for Physical Sciences at Microscale and School of Life Sciences, University of Science and Technology of China, Hefei, China
| | - Patrick S.C. Leung
- Division of Rheumatology, Allergy and Clinical Immunology, University of California Davis, Davis, California, United States of America
| | - M. Eric Gershwin
- Division of Rheumatology, Allergy and Clinical Immunology, University of California Davis, Davis, California, United States of America
- * E-mail:
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Rashidi A, Lee ME, Fisher SI. Hepatosplenic αβ T-cell lymphoma associated with azathioprine therapy. Int J Hematol 2012; 95:592-4. [PMID: 22527855 DOI: 10.1007/s12185-012-1081-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2011] [Revised: 04/06/2012] [Accepted: 04/10/2012] [Indexed: 10/28/2022]
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Lu CL, Tang Y, Yang QP, Wang M, Zhao S, Bi CF, Jiang NG, Zhang WY, Liu JP, Xu X, Liu WP. Hepatosplenic T-cell lymphoma: clinicopathologic, immunophenotypic, and molecular characterization of17 Chinese cases. Hum Pathol 2011; 42:1965-78. [DOI: 10.1016/j.humpath.2011.01.034] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2010] [Revised: 12/16/2010] [Accepted: 01/07/2011] [Indexed: 10/18/2022]
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Hepatosplenic T-cell lymphoma and inflammatory bowel disease. J Crohns Colitis 2010; 4:511-22. [PMID: 21122554 DOI: 10.1016/j.crohns.2010.05.006] [Citation(s) in RCA: 84] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2010] [Revised: 05/19/2010] [Accepted: 05/19/2010] [Indexed: 02/08/2023]
Abstract
OBJECTIVE This article reviews the current literature and knowledge about hepatosplenic T-cell lymphoma (HSTCL), providing an overview of the clinical features, a description of its pathology and immunophenotypic traits in relation to other lymphomas. In addition, we explore the history of reported cases of hepatosplenic T-cell lymphoma in relation to the possible existence of a causal relationship between infliximab use and HSTCL. The treatments for HSTCL will be briefly addressed. METHODS A comprehensive literature search using multiple databases was performed. Keyword search phrases including "lymphoma," "hepatosplenic T-cell lymphoma," "Inflammatory bowel disease," "6-mercaptopurine," and "infliximab" were used in various combinations. In addition references from published papers were reviewed as well. RESULTS There are over 200 reported cases of HSTCL. Only 22 cases of hepatosplenic T-cell lymphoma are associated with IBD treatment. Clinicians usually reserve immunomodulators and biologics for moderate to severe IBD cases. The ultimate goal of therapy is to control inflammation and therefore allow mucosal healing. IBD patients demonstrating mucosal healing are less likely to undergo surgery and experience complications related to their disease. We manipulate the immune system with corticosteroids, immunomodulators, and biologics, therefore causing bone marrow suppression. With bone marrow suppression, malignant degeneration may begin through selective uncontrolled cell proliferation, initiating HSTCL development in the genetically susceptible. CONCLUSION Hepatosplenic T-cell lymphoma is a rare disease, often with a poor outcome. With the increasing number of reported cases of HSTCL linked to the use of infliximab, adalimumab, and AZA/6-MP, there appears to be an undeniable association of HSTCL development with the use of these agents. This risk is unquantifiable. When considering the rarity of cases and the multiple complications with uncontrolled disease, however, the benefit of treatment far outweighs the risk.
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Chanan-Khan A, Islam T, Alam A, Miller KC, Gibbs J, Barcos M, Czuczman MS, Paplham P, Hahn T, McCarthy P. Long-Term Survival With Allogeneic Stem Cell Transplant and Donor Lymphocyte Infusion Following Salvage Therapy with Anti-CD52 Monoclonal Antibody (Campath) in a Patient with α/β Hepatosplenic T-Cell Non-Hodgkin's Lymphoma. Leuk Lymphoma 2009; 45:1673-5. [PMID: 15370223 DOI: 10.1080/10428190310001609924] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Hepatosplenic T-cell non-Hodgkin's lymphoma (HSTCL) is a rare, aggressive form of NHL, with a median survival of approximately 8 months. We were able to successfully induce complete remission in a patient with alpha/beta HSTCL who was refractory to multiple prior chemotherapy regimens, using the humanized anti-CD52 monoclonal antibody alemtuzumab (Campath). Once disease was controlled, the patient was able to undergo allogeneic stem cell transplantation (SCT), which resulted in complete remission. Furthermore, upon relapse, we were able to re-induce complete clinical and molecular remission with donor lymphocyte infusions. At Day 655 (post-SCT), the patient remains in complete remission. These data suggest a potential role for alemtuzumab and allogeneic SCT in the treatment of T-cell NHL.
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MESH Headings
- Adult
- Alemtuzumab
- Antibodies, Monoclonal/therapeutic use
- Antibodies, Monoclonal, Humanized
- Antibodies, Neoplasm/therapeutic use
- Antineoplastic Agents/therapeutic use
- Humans
- Liver Neoplasms/metabolism
- Liver Neoplasms/mortality
- Liver Neoplasms/therapy
- Lymphocyte Transfusion
- Lymphoma, T-Cell/metabolism
- Lymphoma, T-Cell/mortality
- Lymphoma, T-Cell/therapy
- Male
- Receptors, Antigen, T-Cell, alpha-beta/metabolism
- Remission Induction
- Salvage Therapy
- Splenic Neoplasms/metabolism
- Splenic Neoplasms/mortality
- Splenic Neoplasms/therapy
- Stem Cell Transplantation
- Survival Rate
- Time Factors
- Tissue Donors
- Transplantation, Autologous
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Affiliation(s)
- Asher Chanan-Khan
- Department of Medicine, Roswell Park Cancer Institute, Buffalo, NY 14263, USA.
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Carmack S, Taddei T, Robert ME, Mistry P, Jain D. Increased T-cell sinusoidal lymphocytosis in liver biopsies in patients with chronic hepatitis C and mixed cryoglobulinemia. Am J Gastroenterol 2008; 103:705-11. [PMID: 17970837 DOI: 10.1111/j.1572-0241.2007.01603.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Mixed cryoglobulinemia (MC) has a strong association with hepatitis C virus (HCV) infection and is associated with a higher degree of fibrosis and poor response to therapy. Currently, there are no known histological findings on liver biopsy that correlate with the presence of MC in HCV-infected patients, although we have occasionally noted prominent sinusoidal lymphocytosis in MC patients. The goal of this study is to determine whether sinusoidal lymphocytosis is a histological marker of MC in liver biopsies from patients with chronic hepatitis C. The liver clinic database at our institution was searched for chronic hepatitis C patients with MC who underwent liver biopsy during 1999-2005. Ten such cases were identified and were included in the study. Ten chronic hepatitis C MC-negative cases were matched for age and stage of fibrosis to serve as controls. Histological features (sinusoidal lymphocytes, inflammatory activity, acidophil bodies, and fibrosis stage) were evaluated in each biopsy. Clinical and laboratory data (serum protein electrophoresis, liver enzymes, hepatitis C viral load, treatment status, comorbidities, etc.) were also recorded. Formalin-fixed, paraffin-embedded sections were submitted for immunohistochemical analysis using antibodies against CD3, CD20, CD4, CD8, and CD68. Sinusoidal lymphocytes were counted in 5 hpf (40x) on hematoxylin and eosin (H&E) stain, and on CD3 and CD20 immunostains. The number of CD68+ Kupffer cells was also counted in a similar fashion. In the MC-positive versus MC-negative cases, mean fibrosis stage (2.4 vs. 2.4), inflammatory grade (1.7 vs. 2.1), lymphocyte count (359 vs. 128/5 hpf), and Kupffer cell count (239 vs. 220/5 HPF) were assessed. There was a significant increase in sinusoidal T-cell lymphocytes (P < 0.05) in MC-positive cases as compared to MC-negative cases. Nearly all sinusoidal lymphocytes were CD8-positive cells in both groups. Other histological parameters did not differ in the two groups. MC-positive cases tended to have a lower viral load as compared to controls (P= 0.059). The role of sinusoidal T cells in the pathogenesis of MC is currently unknown. It is unclear if the presence of these cells implies ongoing antigenic stimulation that may lead to increased risk of lymphoma. This feature may be an important clue to predict the presence of MC, an HCV-associated phenomenon that has important implications for response to treatment and disease progression.
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Affiliation(s)
- Susanne Carmack
- Department of Pathology, Yale University School of Medicine, New Haven, Connecticut 06520-8023, USA
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Abstract
Abstract
Peripheral T-cell lymphomas (PTLs) are uncommon, accounting for fewer than 10% of all non-Hodgkin lymphomas. Success in therapy of the PTLs has lagged behind that of aggressive B-cell lymphomas, and most PTLs have a poor prognosis. The molecular pathogenesis of most PTLs is also poorly understood. In the WHO classification, clinical features, in conjunction with morphological and immunophenotypic criteria, are relied on to define most disease entities.
Functionally, T-cell lymphomas are related to the two major arms of the immune system, the innate and adaptive immune systems. NK cells and T cells of the innate immune system recognize antigen in the absence of MHC antigens and are involved in mucosal immunity. The lymphomas derived from these cells often involve cutaneous and mucosal sites. The expression of cytotoxic molecules in these lymphomas may predispose to apoptosis by tumor cells and normal bystander cells. Hepatosplenic T-cell lymphoma is a systemic disease derived from functionally immature innate effector cells, most often of γδ T-cell origin. In contrast, most nodal T-cell lymphomas belong to the adaptive immune system.
Angioimmunoblastic T-cell lymphoma (AILT) is mostly likely derived from follicular helper T-cells (TFH), a finding that explains many of its pathological and clinical features. Studies of these neoplasms may assist in further unraveling the functional diversity of their normal counterparts.
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Affiliation(s)
- Elaine S Jaffe
- Laboratory of Pathology, Center for Cancer Research, National Cancer Institute, Bethesda, MD 20892, USA.
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Mansour MR, Dogan A, Morris EC, Khwaja A, Linch DC, Mackinnon S, Peggs KS. Allogeneic transplantation for hepatosplenic αβ T-cell lymphoma. Bone Marrow Transplant 2005; 35:931-4. [PMID: 15778731 DOI: 10.1038/sj.bmt.1704897] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Jaffe ES, Krenacs L, Raffeld M. Classification of cytotoxic T-cell and natural killer cell lymphomas. Semin Hematol 2003; 40:175-84. [PMID: 12876666 DOI: 10.1016/s0037-1963(03)00132-x] [Citation(s) in RCA: 90] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Mature or peripheral T-cell lymphomas are uncommon, accounting for only 10% to 15% of all non-Hodgkin's lymphomas. The classification of these neoplasms has been controversial. In contrast to B-cell lymphomas, cytologic features have not been useful in defining disease entities, and cytologic grade has not helped predict the clinical course. Similarly, many entities of T-cell or natural killer (NK) cell derivation do not have a specific immunophenotype. Clinical features are of major importance in defining T-cell and NK cell neoplasms, and in some cases the clinical syndrome, may be more important than the precise cell of origin. The majority of cytotoxic T-cell and NK cell lymphomas arise in extranodal sites. The expression of cytotoxic molecules in these lymphomas may predispose to apoptosis by tumor cells and normal bystander cells. Three major categories of extranodal T/NK cell tumors are recognized in the World Health Organization (WHO) classification: extranodal NK/T, nasal-type; enteropathy-type; and subcutaneous panniculitis-like. Epstein Barr virus (EBV) is closely linked to nasal NK/T-cell lymphoma, but shows geographic and racial variations in other subtypes. Tumors resembling the prototype of nasal NK/T-cell lymphoma occur in a variety of extranodal sites, and are referred to as nasal-type. Hepatosplenic T-cell lymphoma is a more systemic disease derived from functionally immature cytotoxic cells, usually gammadelta T-cell origin. Cytotoxic T-cell lymphomas of mature gammadelta T-cell origin most often arise in mucocutaneous sites, and may resemble the prototypes of extranodal T/NK cell lymphoma: nasal, enteropathy-associated, and panniculitis-like. Cytotoxic T/NK cell lymphomas occur with increased frequency in the setting of immune suppression, especially following organ transplantation. The nodal T-cell lymphoma most often exhibiting a cytotoxic immunophenotype is anaplastic large cell lymphoma (ALCL). Primary cutaneous ALCL frequently but not invariably expresses cytotoxic molecules. While the majority of extranodal neoplasms are derived from innate immune effector cells of NK cell and T-cell origin (gammadelta greater than alphabeta), most nodal cytotoxic T-cell lymphomas probably belong to the adaptive immune system. Studies of these neoplasms may assist in unraveling the diversity of their normal counterparts.
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Affiliation(s)
- Elaine S Jaffe
- Center for Cancer Research, National Cancer Institute, Bethesda, MD, USA
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Abstract
In contrast to B-cell lymphomas, the literature on the splenic pathology of peripheral T-cell and NK-cell lymphomas is limited. Several different patterns of splenic involvement can be observed in peripheral T-cell and NK-cell lymphomas: 1) solitary or multiple fleshy nodule, which is seen predominantly in tumors rich in large cells; 2) diffuse red pulp involvement, which is the commonest pattern; 3) colonization of periarteriolar shealth; and 4) patchy haphazard involvement. However, the miliary small nodule pattern commonly observed in low-grade B-cell lymphomas is practically never seen. In hepatosplenic T-cell lymphoma and T-cell large granular lymphocyte leukemia, the pattern of splenic involvement is rather stereotyped, with diffuse red pulp infiltration and preservation of the sinus/pulp cord architecture, and without formation of nodules. The pattern of involvement is variable from case to case in peripheral T-cell lymphoma unspecified, and there can be associated prominent hemophagocytosis or a masking component of epithelioid granulomas. Aggressive NK cell leukemia and extranodal NK/T cell lymphoma show predominatly red pulp involvement, although the tumor cell density can vary from field to field; blood vessel walls are commonly infiltrated and there can be areas of necrosis.
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Affiliation(s)
- John K C Chan
- Department of Pathology, Queen Elizabeth Hospital, Kowloon, Hong Kong, SAR, China.
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Dong J, Chong YY, Meyerson HJ. Hepatosplenic alpha beta T-cell lymphoma: a report of an S100-positive case. Arch Pathol Lab Med 2003; 127:e119-22. [PMID: 12653597 DOI: 10.5858/2003-127-e119-htlaro] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Hepatosplenic T-cell lymphoma is an uncommon neoplasm characterized by a lymphoid infiltrate within the sinusoids of the liver, spleen, and bone marrow, without significant nodal involvement. The majority of cases express the gammadelta T-cell receptor and are associated with an isochromosome 7q cytogenetic abnormality. Recently, a small number of cases have been reported that express the alphabeta T-cell receptor. Here, we report our findings of a case of an S100-positive hepatosplenic alphabeta T-cell lymphoma in a 20-year-old woman who presented with pancytopenia and hepatosplenomegaly. The case adds to the growing literature of hepatosplenic alphabeta T-cell lymphomas.
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Affiliation(s)
- Jingyu Dong
- Department of Pathology, Case Western Reserve University and University Hospitals of Cleveland, Cleveland, Ohio 44106, USA
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