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Travassos DC, Silveira HA, Silva EV, Panucci BZM, da Silva Filho NC, Silva PVR, Bufalino A, León JE. Primary cutaneous CD8+ cytotoxic T-cell lymphoma of the face with intraoral involvement, presenting facial nerve palsy after chemotherapy. J Cutan Pathol 2022; 49:560-564. [PMID: 35001425 DOI: 10.1111/cup.14199] [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: 07/20/2021] [Revised: 01/05/2022] [Accepted: 01/07/2022] [Indexed: 12/01/2022]
Abstract
The primary cutaneous (PC) CD8+ T-cell lymphoproliferative disorders (LPDs) comprise clinically and histologically heterogeneous entities including mycosis fungoides, lymphomatoid papulosis, hydroa-vacciniforme-like LPD, subcutaneous panniculitis-like T-cell lymphoma (TCL), PC acral CD8+ TCL, PC CD8+ aggressive epidermotropic cytotoxic TCL, and PC peripheral T-cell lymphoma, not otherwise specified (PTCL-NOS). We describe a 33-year-old man who presented progressive facial swelling and lower lip involvement one year ago. Microscopy revealed an atypical small to medium-sized lymphoid proliferation exhibiting perivascular accentuation, adnexotropism and apoptotic cell debris, without surface epithelium involvement. The tumor cells were positive for CD3, CD8, granzyme B, perforin, MUM1/IRF4, and TCR-BF1. The Ki-67 labeling index was 48%. EBER1/2 was negative. Additional studies confirmed localized disease. The diagnosis favored PC-PTCL-NOS. Two months after completing chemotherapy, right-sided facial nerve palsy was diagnosed. CD8+ T-cell LPDs should be considered in the differential diagnosis when assessing facial swelling with intraoral involvement. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Daphine Caxias Travassos
- Oral Medicine, Department of Diagnosis and Surgery, Araraquara Dental School, São Paulo State University (Unesp), Araraquara, São Paulo, Brazil
| | - Heitor Albergoni Silveira
- Oral Medicine, Department of Diagnosis and Surgery, Araraquara Dental School, São Paulo State University (Unesp), Araraquara, São Paulo, Brazil.,Oral Pathology, Department of Stomatology, Public Oral Health, and Forensic Dentistry; Ribeirão Preto Dental School (FORP/USP); University of São Paulo, Ribeirão Preto, São Paulo, Brazil
| | - Evânio Vilela Silva
- Oral Medicine, Department of Diagnosis and Surgery, Araraquara Dental School, São Paulo State University (Unesp), Araraquara, São Paulo, Brazil.,Oral Pathology, Department of Stomatology, Public Oral Health, and Forensic Dentistry; Ribeirão Preto Dental School (FORP/USP); University of São Paulo, Ribeirão Preto, São Paulo, Brazil
| | - Beatriz Zamboni Martins Panucci
- Oral Pathology, Department of Stomatology, Public Oral Health, and Forensic Dentistry; Ribeirão Preto Dental School (FORP/USP); University of São Paulo, Ribeirão Preto, São Paulo, Brazil
| | - Nilson Coelho da Silva Filho
- Oral Medicine, Department of Diagnosis and Surgery, Araraquara Dental School, São Paulo State University (Unesp), Araraquara, São Paulo, Brazil
| | - Paula Verona Ragusa Silva
- Oral Medicine, Department of Diagnosis and Surgery, Araraquara Dental School, São Paulo State University (Unesp), Araraquara, São Paulo, Brazil
| | - Andreia Bufalino
- Oral Medicine, Department of Diagnosis and Surgery, Araraquara Dental School, São Paulo State University (Unesp), Araraquara, São Paulo, Brazil
| | - Jorge Esquiche León
- Oral Pathology, Department of Stomatology, Public Oral Health, and Forensic Dentistry; Ribeirão Preto Dental School (FORP/USP); University of São Paulo, Ribeirão Preto, São Paulo, Brazil
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2
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Kempf W, Petrella T, Willemze R, Jansen P, Berti E, Santucci M, Geissinger E, Cerroni L, Maubac E, Battistella M, Goodlad J, Guenova E, Lappalainen K, Ranki A, Craig P, Calonje E, Martin B, Whittaker S, Oschlies I, Wehkamp U, Nicolay JP, Wobser M, Scarisbruck J, Pimpinelli N, Stadler R, Kerl K, Quaglino P, Lin J, Chen L, Beer M, Emanuel P, Dalle S, Robson A. Clinical, histopathological and prognostic features of primary cutaneous acral CD8+ T-cell lymphoma and other dermal CD8+ cutaneous lymphoproliferations - Results of an EORTC Cutaneous Lymphoma Group Workshop. Br J Dermatol 2022; 186:887-897. [PMID: 34988968 DOI: 10.1111/bjd.20973] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2021] [Revised: 11/27/2021] [Accepted: 12/30/2021] [Indexed: 11/27/2022]
Abstract
BACKGROUND The differential diagnosis of atypical dermal non-epidermotropic CD8+lymphocytic infiltrates includes a heterogenous spectrum of lymphoproliferations with overlapping histological and phenotypic features, but divergent clinical manifestations and prognoses. As these neoplasms are rare, more data on their clinicopathological presentation and course are needed. OBJECTIVES To assess the clinical, histological, immunophenotypic features, outcome of and differences between dermal CD8+ lymphoproliferations. METHODS Retrospective analysis of a series of 47 patients and biopsies by the international EORTC Cutaneous Lymphoma Group. RESULTS The dermal CD8+ lymphoproliferations (n=46) could be assigned to one of the following 3 groups: (1) cutaneous acral CD8+ T-cell lymphoma (n=31), characterized mostly by a solitary nodule arising at acral sites, a monotonous dermal infiltrate of small to medium-sized CD8+ lymphocytes with a characteristic dot-like pattern of CD68, a low proliferation rate and an excellent prognosis; (2) primary cutaneous CD8+ peripheral T-cell lymphoma, unspecified/NOS (n=11), presenting with one or multiple rapidly evolving tumors, mostly medium-sized pleomorphic CD8+ tumor cells with expression of several cytotoxic markers and high proliferative activity. After chemotherapy or radiotherapy relapses occurred in one third and 1 of 11 patients died due to lymphoma (9%); (3) The third group (n=4) comprised cutaneous CD8+ lymphoproliferations associated with congenital immunodeficiency syndromes in 2 patients with persisting localized or disseminated violaceous to brownish plaques on the extremities, a histiocyte-rich infiltrate of mostly small CD8+ lymphocytes with subtle atypia and a protracted course, and papular CD8+ eruptions in two patients with acquired immunosuppression (HIV-infection, solid organ transplantation). CONCLUSIONS A constellation of distinct clinical, histopathologic and phenotypic features allows discrimination and assignment of dermal CD8+ infiltrates to distinct disease entities including cutaneous acral CD8+ T-cell lymphoma, primary cutaneous CD8+ peripheral T-cell lymphoma, unspecified/NOS and cutaneous CD8+ lymphoproliferations associated with congenital or acquired immunodeficiency syndromes. Primary cutaneous acral CD8+ lymphoma, assigned a provisional category in current lymphoma classifications, is a distinct and reproducible entity. A correct diagnosis is essential to avoid unnecessarily aggressive treatment for indolent CD8+ lymphoproliferations and to identify cases with underlying immunodeficiency or potential for dismal outcome.
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Affiliation(s)
- Werner Kempf
- Kempf und Pfaltz Histologische Diagnostik, Zurich, Switzerland.,Department of Dermatology, University Hospital Zurich, Zurich, Switzerland
| | - Tony Petrella
- Departement of Pathology, Hopital Maisonneuve-Rosemont, Montréal, Canada
| | - Rein Willemze
- Department of Dermatology, Leiden University Medical Center, Leiden, The Netherlands
| | - Patty Jansen
- Department of Clinical Pathology, Leiden University Medical Center, Leiden, The Netherlands
| | - Emilio Berti
- University of Milan, Director U.O.C of Dermatology Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico of Milan, Italy
| | - Marco Santucci
- Department of Health Sciences, University of Florence School of Human Health Sciences and Division of Histopathology and Molecular Diagnostics, Careggi University Hospital, Florence, Italy
| | - Eva Geissinger
- Institute of Pathology, University of Würzburg, Würzburg, Germany
| | - Lorenzo Cerroni
- Department of Dermatology, Medical University of Graz, Austria
| | - Eve Maubac
- Service de Dermatologie du Pr F. Caux, Hôpital Avicenne Bobigny Cedex, France
| | - Maxime Battistella
- Department of Pathology, Saint-Louis Hospital, Assistance Publique-Hôpitaux de Paris, Paris University, INSERM U976, Paris, France
| | | | - Emmanuella Guenova
- Department of Dermatology, University Hospital Zurich, Zurich, Switzerland.,Department of Dermatology, University Hospital Lausanne, Faculty of Biology and Medicine, University of Lausanne, CH-1011, Lausanne, Switzerland
| | | | - Annamari Ranki
- Skin and Allergy Hospital, Helsinki University Central Hospital, Finland
| | - Paul Craig
- Gloucestershire Hospitals NHS Foundation Trust Gloucestershire Cellular Pathology Laboratory, Cheltenham General Hospital, Cheltenham, Gloucestershire, UK
| | - Eduardo Calonje
- Department of Dermatopathology, St John's Institute of Dermatology, St Thomas' Hospital, London, England, UK
| | - Blanca Martin
- Department of Dermatopathology, St John's Institute of Dermatology, St Thomas' Hospital, London, England, UK
| | - Sean Whittaker
- St John's Institute of Dermatology, Guys and St Thomas NHS Foundation Trust, Lomdo, UK
| | - Ilske Oschlies
- Dept. of Pathology, Section Hematopathology and lymph node registry, University Hospital Schleswig-Holstein, Campus Kiel, Germany
| | - Ulrike Wehkamp
- Department of Dermatology and Allergology, University Hospital Schleswig-Holstein, Campus Kiel, Germany
| | - Jan P Nicolay
- Dept. of Dermatology, University Medical Center Mannheim, Germany
| | - Marion Wobser
- Department of Dermatology, Venereology and Allergology and Skin Cancer Center, University Hospital Wuerzburg, Wuerzburg, Germany
| | - Julia Scarisbruck
- Department of Dermatology, University Hospital Birmingham, Birmingham, UK
| | - Nicola Pimpinelli
- Dermatology Unit, Department of Health Sciences, University of Florence Medical School, Florence, Italy
| | - Rudi Stadler
- Dept. Dermatology, Venerology, Allergology and Phlebology, Johannes Wesling Klinikum Minden, University Clinic Ruhr-Universität Bochum, Minden, Germany
| | - Katrin Kerl
- Dept. of Dermatology, Ludwig-Maximilian University Hospital of Munich, Munich, Germany
| | - Pietro Quaglino
- Dermatologic Clinic, Dept Medical Sciences, University of Turin Medical School, Torino, Italy
| | - Jinran Lin
- Department of Dermatology, Huashan Hospital, Fudan University, Shanghai, China
| | - Lianjun Chen
- Department of Dermatology, Huashan Hospital, Fudan University, Shanghai, China
| | - Michaela Beer
- Kempf und Pfaltz Histologische Diagnostik, Zurich, Switzerland
| | - Patrick Emanuel
- Clinica Ricarda Palma, Lima, Peru and University of Auckland, Auckland, New Zealand
| | - Stephane Dalle
- Unit of Dermatology, Cancer Research center of Lyon, Hôpital Lyon Sud, Hospices Civils de Lyon, Université Claude Bernard Lyon 1, France
| | - Alistair Robson
- Institute of Oncology, Lisbon, Portugal, Portugal.,LDPath, London, UK
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Bakr F, Wain EM, Wong S, Palmer R, Robson A. Prominent Blasts in Primary Cutaneous CD4+ Small/Medium T-Cell Lymphoproliferative Disorder. A Reconsideration of Diagnostic Criteria. Am J Dermatopathol 2021; 43:e190-e196. [PMID: 33989212 DOI: 10.1097/dad.0000000000001979] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
ABSTRACT Primary cutaneous CD4+ small/medium T-cell lymphoproliferative disorder (PCSM-LPD), recently downgraded from a T-cell lymphoma, is a poorly characterized histopathological entity. Presenting as a solitary lesion that often grows rapidly, it may raise suspicion for a cutaneous B-cell lymphoma. However, classically, the dermal lymphoid proliferation is predominantly CD4+ with a follicular T-helper profile and a smaller B-cell fraction. Diagnostic uncertainty may arise when B cells are present in large numbers, a B-cell clone is present, or large cell populations are seen. To meet the diagnostic criterion of PCSM-LPD, large cells should not constitute more than 30% of the infiltrate. The 2 cases presented in this article caused diagnostic uncertainty owing to the observation of high numbers of large cells and in one case the presence of a B-cell clone, on the background of otherwise typical clinicopathological features of PCSM-LPD. We review the literature specifically regarding the prevalence of large cell populations and their immunophenotypic characteristics and in light of this discuss whether a current diagnostic criterion should be reconsidered.
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Affiliation(s)
- Farrah Bakr
- Department of Dermatology, St John's Institute of Dermatology, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom
| | - E Mary Wain
- Department of Dermatology, St John's Institute of Dermatology, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom
| | - Sharon Wong
- Consultant Dermatologist, HCA UK, London, United Kingdom
| | - Roy Palmer
- Department of Dermatology, The Princess Margaret Hospital, Windsor, Berkshire, United Kingdom
| | - Alistair Robson
- Consultant Dermatopathologist, LD Path, London, United Kingdom; and
- Serviço de Anatomia Patológica, Instituto Português de Oncologia de Lisboa Francisco Gentil, Lisboa, Portugal
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4
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Primary Cutaneous Acral CD8+ T-Cell Lymphoma—A Single Center Review of 3 Cases and Recent Literature Review. Am J Dermatopathol 2019; 41:644-648. [DOI: 10.1097/dad.0000000000001366] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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5
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Ormerod E, Murigu T, Pawade J, Beasley M, Dunnill G. Primary cutaneous acral CD8+ T‐cell lymphoma of the ear: A case report. J Cutan Pathol 2019; 46:790-793. [DOI: 10.1111/cup.13517] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2018] [Revised: 05/08/2019] [Accepted: 05/28/2019] [Indexed: 11/29/2022]
Affiliation(s)
- Emma Ormerod
- Dermatology DepartmentBristol Royal Infirmary Bristol UK
| | - Timothy Murigu
- Department of Cellular PathologySouthmead Hospital Bristol UK
| | - Joya Pawade
- Department of Cellular PathologySouthmead Hospital Bristol UK
| | | | - Giles Dunnill
- Dermatology DepartmentBristol Royal Infirmary Bristol UK
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6
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Kluk J, Kai A, Koch D, Taibjee SM, O'Connor S, Persic M, Morris S, Whittaker S, Cerroni L, Kempf W, Petrella T, Robson A. Indolent CD8-positive lymphoid proliferation of acral sites: three further cases of a rare entity and an update on a unique patient. J Cutan Pathol 2015; 43:125-36. [DOI: 10.1111/cup.12633] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2015] [Revised: 08/13/2015] [Accepted: 09/06/2015] [Indexed: 01/12/2023]
Affiliation(s)
- Justine Kluk
- Skin Tumour Unit; St John's Institute of Dermatology; London UK
| | - Anneke Kai
- Skin Tumour Unit; St John's Institute of Dermatology; London UK
| | - Dimitra Koch
- Department of Dermatology; Dorset County Hospital NHS Foundation Trust; Dorchester UK
| | - Saleem M. Taibjee
- Department of Dermatology; Dorset County Hospital NHS Foundation Trust; Dorchester UK
| | - Simon O'Connor
- Pathology Department; Nottingham University Hospitals NHS Trust; Nottingham UK
| | - Mojca Persic
- Department of Oncology; Derby Hospitals NHS Foundation Trust; Derby UK
| | - Stephen Morris
- Skin Tumour Unit; St John's Institute of Dermatology; London UK
| | - Sean Whittaker
- Skin Tumour Unit; St John's Institute of Dermatology; London UK
| | - Lorenzo Cerroni
- Department of Dermatology; Medical University of Graz; Graz Austria
| | - Werner Kempf
- Department of Dermatology; University Hospital; Zurich Switzerland
| | - Tony Petrella
- Department of Pathology; University of Dijon; Dijon France
| | - Alistair Robson
- Dermatopathology Department, St John's Institute of Dermatology; Guy's & St Thomas' NHS Foundation Trust; London UK
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7
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Miyagawa F, Iioka H, Fukumoto T, Kobayashi N, Asada H. A case of CD8(+) primary cutaneous peripheral T-cell lymphoma arising from tissue-resident memory T cells in the skin. Br J Dermatol 2015; 173:612-4. [PMID: 25645255 DOI: 10.1111/bjd.13687] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Affiliation(s)
- F Miyagawa
- Department of Dermatology, Nara Medical University School of Medicine, 840 Shijo, Kashihara, Nara, 634-8522, Japan.
| | - H Iioka
- Department of Dermatology, Nara Medical University School of Medicine, 840 Shijo, Kashihara, Nara, 634-8522, Japan
| | - T Fukumoto
- Department of Dermatology, Nara Medical University School of Medicine, 840 Shijo, Kashihara, Nara, 634-8522, Japan
| | - N Kobayashi
- Department of Dermatology, Nara Medical University School of Medicine, 840 Shijo, Kashihara, Nara, 634-8522, Japan
| | - H Asada
- Department of Dermatology, Nara Medical University School of Medicine, 840 Shijo, Kashihara, Nara, 634-8522, Japan
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8
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Robson A, Assaf C, Bagot M, Burg G, Calonje E, Castillo C, Cerroni L, Chimenti N, Dechelotte P, Franck F, Geerts M, Gellrich S, Goodlad J, Kempf W, Knobler R, Massone C, Meijer C, Ortiz P, Petrella T, Pimpinelli N, Roewert J, Russell-Jones R, Santucci M, Steinhoff M, Sterry W, Wechsler J, Whittaker S, Willemze R, Berti E. Aggressive epidermotropic cutaneous CD8+ lymphoma: a cutaneous lymphoma with distinct clinical and pathological features. Report of an EORTC Cutaneous Lymphoma Task Force Workshop. Histopathology 2015; 67:425-41. [PMID: 24438036 DOI: 10.1111/his.12371] [Citation(s) in RCA: 71] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2013] [Accepted: 01/12/2014] [Indexed: 12/11/2022]
Abstract
AIMS Aggressive epidermotropic cutaneous CD8(+) lymphoma is currently afforded provisional status in the WHO classification of lymphomas. An EORTC Workshop was convened to describe in detail the features of this putative neoplasm and evaluate its nosological status with respect to other cutaneous CD8(+) lymphomas. METHODS AND RESULTS Sixty-one CD8(+) cases were analysed at the workshop; clinical details, often with photographs, histological sections, immunohistochemical results, treatment and patient outcome were discussed and recorded. Eighteen cases had distinct features and conformed to the diagnosis of aggressive epidermotropic cutaneous CD8(+) lymphoma. The patients typically present with widespread plaques and tumours, often ulcerated and haemorrhagic, and histologically have striking pagetoid epidermotrophism. A CD8(+) /CD45RA(+) /CD45RO(-) /CD2(-) /CD5(-) /CD56(-) phenotype, with one or more cytotoxic markers, was found in seven of 18 patients, with a very similar phenotype in the remainder. The tumours seldom involve lymph nodes, but mucosal and central nervous system involvement are not uncommon. The prognosis is poor, with a median survival of 12 months. Examples of CD8(+) mycosis fungoides, lymphomatoid papulosis and Woringer-Kolopp disease presented the typical features well documented in the CD4(+) forms of those diseases. CONCLUSIONS Aggressive epidermotropic cutaneous CD8(+) lymphoma is a distinct lymphoma that warrants inclusion as a distinct entity in future revisions of lymphoma classifications.
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Affiliation(s)
| | - Chalid Assaf
- Department of Dermatology, Charité-University Medicine, Berlin, Germany
| | - Martine Bagot
- Department of Pathology, Universite Paris, Paris, France
| | - Gunter Burg
- Department of Dermatology and Venereology, University of Zurich, Zurich, Switzerland
| | | | | | - Lorenzo Cerroni
- Department of Dermatology Medical, University of Graz, Graz, Austria
| | - Nicola Chimenti
- Department of Dermatology, University of L'Aquila, Rome, Italy
| | - Pierre Dechelotte
- Department of Pathology, University of Clermont-Ferrand, Clermont-Ferrand, France
| | - Frederic Franck
- Department of Pathology, University of Clermont-Ferrand, Clermont-Ferrand, France
| | - Maria Geerts
- Department of Dermatology, Ghent University Hospital, Gent, Belgium
| | - Sylke Gellrich
- Department of Dermatology, Charité-University Medicine, Berlin, Germany
| | - John Goodlad
- Department of Pathology, Western General Hospital, Edinburgh, UK
| | - Werner Kempf
- Department of Dermatology and Venereology, University of Zurich, Zurich, Switzerland
| | - Robert Knobler
- Department of Dermatology, University of Vienna, Vienna, Austria
| | - Cesare Massone
- Department of Dermatology Medical, University of Graz, Graz, Austria
| | - Chris Meijer
- Department of Pathology, VU University Medical Center, Amsterdam, the Netherlands
| | - Pablo Ortiz
- Hospital Universitario, Universidad Complutense, Madrid, Spain
| | - Tony Petrella
- Departmentof Pathology, Dijon's University Hospital, Dijon, France
| | - Nicola Pimpinelli
- Division of Dermatology, University of Florence Medical School, Florence, Italy
| | - Joclim Roewert
- Department of Dermatology, Charité-University Medicine, Berlin, Germany
| | | | - Marco Santucci
- Division of Pathological Anatomy, University of Florence, Florence, Italy
| | - Mattias Steinhoff
- Department of Dermatology, Charité-University Medicine, Berlin, Germany
| | - Wolfram Sterry
- Department of Dermatology, Charité-University Medicine, Berlin, Germany
| | - Janine Wechsler
- Department of Pathology Henri-Mondor Hospital, University Paris-Val-de-Marne, Paris, France
| | | | - Rein Willemze
- Department of Dermatology, Leiden University, Leiden, the Netherlands
| | - Emilio Berti
- Department of Dermatology, Fondazione IRCCS Ca' Granda - Ospedale Maggiore Policlinico and Università degli Studi di Milano-Bicocca, Milan, Italy
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9
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Multicenter case series of indolent small/medium-sized CD8+ lymphoid proliferations with predilection for the ear and face. Am J Dermatopathol 2014; 36:402-8. [PMID: 24394306 DOI: 10.1097/dad.0b013e3182a74c7a] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
We report 7 cases of a CD8 lymphoid proliferation of the ear and face with a cytotoxic T-cell phenotype, but an indolent clinical course. All patients presented with stable or slowly growing asymptomatic lesions on the ear, nose, or lower eyelid. Histopathology showed a dense diffuse dermal infiltrate of small- to medium-sized atypical lymphocytes without destructive features. The lymphocytes were positive for CD3, CD8, β-F1, and TIA-1 and negative for CD4, CD30, CD56, granzyme B, and PD-1. Of note, the proliferation index was low in available cases. All patients remained in complete remission at median follow-up of 14 months regardless of treatment modality. Staging was negative for extracutaneous disease in all patients. The clinically indolent behavior and histopathologic phenotype together with a low proliferation index (10%-15%) emphasize the importance of accurate diagnosis and appropriate clinical management to avoid overtreatment and complications of therapy.
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10
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Abstract
In 2007, Petrella et al described a series of patients with clonally restricted, well-differentiated, nonepidermotropic, CD8-dominant lymphocytic infiltrates localized to the facial area. The clinical course described was indolent. A CD8 variant of primary cutaneous pleomorphic T-cell lymphoma has been proposed; however, there are many dissimilar features. The authors encountered 2 patients with CD8⁺ indolent lymphoid proliferation of the face, localized to the eyelid. Both patients were males in their 30s presenting with localized lesions of the eyelids. The biopsies showed an effacing lymphocytic infiltrate that spanned the sampled dermis. The lymphocytes were well differentiated, exhibiting mild nuclear contour irregularity. The infiltrate was predominated by CD8⁺ lymphocytes demonstrating TIA expression. There was a minimal B-cell component in 1 case, whereas another showed a significant degree of B-cell hyperplasia. They both underwent complete excision without recurrence. CD8⁺ indolent lymphoid proliferation has a reproducible clinical and morphologic presentation that warrants categorization as a distinct form of indolent lymphoproliferative disease, preferentially involving older adults with the most common site being the ear, recognizing that the nose, acral surfaces, and eyelids can also be involved.
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11
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Ally MS, Robson A. A review of the solitary cutaneous T-cell lymphomas. J Cutan Pathol 2014; 41:703-14. [DOI: 10.1111/cup.12353] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2013] [Revised: 11/20/2013] [Accepted: 12/16/2013] [Indexed: 12/30/2022]
Affiliation(s)
- Mina S. Ally
- Department of Dermatology; Stanford University School of Medicine; Redwood City CA USA
| | - Alistair Robson
- St. John's Institute of Dermatology; St. Thomas' Hospital; London UK
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12
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Kutlubay Z, Engin B, Kote E, Aydin O, Demirkesen C, Oguz O. A case of CD8+ small/medium-sized pleomorphic T-cell lymphoma: clinical and histopathological differential diagnosis. Br J Dermatol 2014; 170:204-6. [DOI: 10.1111/bjd.12549] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- Z. Kutlubay
- Department of Dermatology; Cerrahpasa Medical Faculty; Istanbul University; Istanbul Turkey
| | - B. Engin
- Department of Dermatology; Cerrahpasa Medical Faculty; Istanbul University; Istanbul Turkey
| | - E. Kote
- Department of Dermatology; Cerrahpasa Medical Faculty; Istanbul University; Istanbul Turkey
| | - O. Aydin
- Department of Pathology; Cerrahpasa Medical Faculty; Istanbul University; Istanbul Turkey
| | - C. Demirkesen
- Department of Pathology; Cerrahpasa Medical Faculty; Istanbul University; Istanbul Turkey
| | - O. Oguz
- Department of Dermatology; Cerrahpasa Medical Faculty; Istanbul University; Istanbul Turkey
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13
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Ally MS, Prasad Hunasehally RY, Rodriguez-Justo M, Martin B, Verdolini R, Attard N, Child F, Attygalle A, Whittaker S, Morris S, Robson A. Evaluation of follicular T-helper cells in primary cutaneous CD4+ small/medium pleomorphic T-cell lymphoma and dermatitis. J Cutan Pathol 2013; 40:1006-13. [DOI: 10.1111/cup.12234] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2013] [Revised: 05/06/2013] [Accepted: 06/09/2013] [Indexed: 12/13/2022]
Affiliation(s)
| | | | | | | | | | | | - Fiona Child
- St John's Institute of Dermatology; London UK
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14
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Wobser M, Petrella T, Kneitz H, Kerstan A, Goebeler M, Rosenwald A, Geissinger E. Extrafacial indolent CD8-positive cutaneous lymphoid proliferation with unusual symmetrical presentation involving both feet. J Cutan Pathol 2013; 40:955-61. [PMID: 24102688 DOI: 10.1111/cup.12213] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2013] [Revised: 07/09/2013] [Accepted: 08/17/2013] [Indexed: 12/28/2022]
Abstract
Indolent CD8+ cutaneous lymphoid proliferation represents a recently described entity among cutaneous T-cell lymphomas that typically presents with solitary skin lesions on the face or at acral sites and usually follows an indolent clinical course. Histopathologically, this entity is characterized by a dense dermal infiltrate of non-epidermotropic, small- to medium-sized pleomorphic CD8+ T-cells of the non-activated cytotoxic phenotype showing a clear-cut grenz zone and a low proliferation index. Distinction from otherwise aggressive T-cell lymphomas bearing a cytotoxic CD8+ phenotype is fundamental. We herein present an unusual case of indolent CD8+ cutaneous lymphoid proliferation presenting in bilateral symmetrical distribution on both feet and lacking the otherwise described grenz zone. Our case widens the spectrum of possible clinical and histomorphological variations of this entity. Taking into account the distinctive and unique clinical and microscopic features of all hitherto published cases of indolent CD8+ cutaneous lymphoid proliferation we suppose that this lymphoma subtype has to be included as a new and distinct entity in the World Health Organisation (WHO)-/European Organisation for Research and Treatment of Cancer (EORTC)-classification of cutaneous lymphomas.
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Affiliation(s)
- Marion Wobser
- Department of Dermatology, University Hospital Wuerzburg, Wuerzburg, Germany
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Miyagawa F, Fukumoto T, Yurugi S, Nakamine H, Asada H. CD8+ primary cutaneous peripheral T-cell lymphoma in an 18-year-old woman. J Dermatol 2013; 40:571-2. [DOI: 10.1111/1346-8138.12151] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Affiliation(s)
- Fumi Miyagawa
- Department of Dermatology; Nara Medical University School of Medicine; Nara; Japan
| | - Takaya Fukumoto
- Department of Dermatology; Nara Medical University School of Medicine; Nara; Japan
| | - Satoshi Yurugi
- Department of Dermatology; Nara Medical University School of Medicine; Nara; Japan
| | - Hirokazu Nakamine
- Department of Pathology and Immunology Division; Kansai University for Health Sciences; Osaka; Japan
| | - Hideo Asada
- Department of Dermatology; Nara Medical University School of Medicine; Nara; Japan
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Primary Cutaneous CD8+ Small- to Medium-Sized Lymphoproliferative Disorder in Extrafacial Sites. Am J Dermatopathol 2013; 35:159-66. [DOI: 10.1097/dad.0b013e31825c3a33] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
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Greenblatt D, Ally M, Child F, Scarisbrick J, Whittaker S, Morris S, Calonje E, Petrella T, Robson A. Indolent CD8+lymphoid proliferation of acral sites: a clinicopathologic study of six patients with some atypical features. J Cutan Pathol 2012. [DOI: 10.1111/cup.12045] [Citation(s) in RCA: 58] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Affiliation(s)
- Danielle Greenblatt
- St John's Institute of Dermatology; Guys' and St Thomas' NHS Foundation Trust; London; UK
| | - Mina Ally
- St John's Institute of Dermatology; Guys' and St Thomas' NHS Foundation Trust; London; UK
| | - Fiona Child
- St John's Institute of Dermatology; Guys' and St Thomas' NHS Foundation Trust; London; UK
| | - Julia Scarisbrick
- Department of Dermatology; University Hospital Birmingham; Birmingham; UK
| | - Sean Whittaker
- St John's Institute of Dermatology; Guys' and St Thomas' NHS Foundation Trust; London; UK
| | - Stephen Morris
- St John's Institute of Dermatology; Guys' and St Thomas' NHS Foundation Trust; London; UK
| | - Eduardo Calonje
- Department of Dermatopathology; St John's Institute of Dermatology, Guys' and St Thomas' NHS Foundation Trust; London; UK
| | - Tony Petrella
- Department of Pathology; Dijon's University Hospital and the Centre de Pathologie; Dijon; France
| | - Alistair Robson
- Department of Dermatopathology; St John's Institute of Dermatology, Guys' and St Thomas' NHS Foundation Trust; London; UK
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Milley S, Bories N, Balme B, Thomas L, Dalle S. [Indolent CD8+ lymphoid proliferation on the nose]. Ann Dermatol Venereol 2012; 139:812-7. [PMID: 23237279 DOI: 10.1016/j.annder.2012.09.012] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2012] [Revised: 07/23/2012] [Accepted: 09/06/2012] [Indexed: 11/30/2022]
Abstract
BACKGROUND Indolent non-epidermotropic CD8+ lymphoid proliferation of the ear was recently reported in the literature by Petrella et al. This is a distinct entity related to cutaneous T-cell lymphomas. Herein, we report a case of indolent CD8+ lymphoid proliferation of the ear involving the nasal crest and we relate a number of cases recently published in the literature. PATIENTS AND METHODS An 87-year-old woman consulted for a pigmented papular lesion of the nasal crest present for 9 years that had begun to regress spontaneously. The remainder of the examination revealed nothing of note. The biopsy showed dense lymphoid infiltration within the dermis. Immunohistochemical analysis supported the diagnosis of indolent CD8+ lymphoid proliferation. Treatment with moderate topical corticosteroids was initiated. DISCUSSION This novel entity is characterised by the presence of relatively non-symptomatic infiltrated lesions in the ear, which can occur bilaterally. Histological findings are frequently worrying with the presence of a dense cellular infiltrate comprising a relatively monomorphous population of CD8+ lymphocytes, although progression is usually indolent.
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Affiliation(s)
- S Milley
- Service de dermatologie, centre hospitalier Lyon-Sud, 165, chemin du Grand-Revoyet, 69495 Pierre-Bénite cedex, France
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Zeng W, Nava VE, Cohen P, Ozdemirli M. Indolent CD8-positive T-cell lymphoid proliferation of the ear: a report of two cases. J Cutan Pathol 2012; 39:696-700. [PMID: 22612273 DOI: 10.1111/j.1600-0560.2012.01917.x] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
The current classification of primary cutaneous T-cell lymphoma (CTCL) of the World Health Organization (WHO) includes primary cutaneous CD8-positive aggressive epidermotropic cytotoxic T-cell lymphoma as a provisional entity awaiting cumulative data. Recent reports identify CD3/CD8-positive clonal T-cell lymphoid proliferations arising in the ear and nose that behave indolently and therefore defy currently established subclassification. Here, we report two cases of clonal CD8-positive/granzyme-B-negative T-cell lymphoid proliferations that arose in the ear and behaved indolently. Collectively, these cases suggest that an additional category of cutaneous indolent CD8-positive T-cell lymphoma may be necessary among the existing classification schemes.
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Affiliation(s)
- Weifen Zeng
- Department of Pathology, Georgetown University Hospital, Washington, DC 20007, USA
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Fernandez-Flores A. Comments on cutaneous lymphomas: since the WHO-2008 classification to present. Am J Dermatopathol 2011; 34:274-84. [PMID: 22126841 DOI: 10.1097/dad.0b013e31821b8bfe] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
The last classification of lymphomas of the World Health Organization in 2008 made a few changes from the preceding classification. Although useful, at the same time, it has posed new questions, concerns, and dilemmas which have been raised in the literature. The current report highlights some of these controversies, of each of these primary cutaneous entities, going through cutaneous mature T-cell and NK-cell neoplasms, mature B-cell neoplasms, precursor neoplasms, and other entities, which for several reasons do not fit in the previous categories. It also reviews some advances on many of these lymphomas published in the last 2 years.
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Ryan AJA, Robson A, Hayes BD, Sheahan K, Collins P. Primary cutaneous peripheral T-cell lymphoma, unspecified with an indolent clinical course: a distinct peripheral T-cell lymphoma? Clin Exp Dermatol 2011; 35:892-6. [PMID: 20456402 DOI: 10.1111/j.1365-2230.2010.03849.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Primary cutaneous peripheral T-cell lymphomas (PTL), unspecified, are rare lymphomas, with a poor prognosis. They grow and disseminate rapidly, leading to widespread disease. We report a case of PTL, unspecified occurring on the nose. Despite its aggressive histology, this tumour behaved indolently. It is remarkably similar, clinically and histologically, to four recently described cases that occurred on the ear.
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Affiliation(s)
- A J A Ryan
- Department of Dermatology, St Vincent's University Hospital, Dublin, Ireland.
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Géraud C, Goerdt S, Klemke C. Primary cutaneous CD8+ small/medium-sized pleomorphic T-cell lymphoma, ear-type: a unique cutaneous T-cell lymphoma with a favourable prognosis. Br J Dermatol 2011; 164:456-8. [DOI: 10.1111/j.1365-2133.2010.10105.x] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Swick BL, Baum CL, Venkat AP, Liu V. Indolent CD8+ lymphoid proliferation of the ear: report of two cases and review of the literature. J Cutan Pathol 2010; 38:209-15. [DOI: 10.1111/j.1600-0560.2010.01647.x] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
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Suchak R, O'Connor S, McNamara C, Robson A. Indolent CD8-positive lymphoid proliferation on the face: part of the spectrum of primary cutaneous small-/medium-sized pleomorphic T-cell lymphoma or a distinct entity? J Cutan Pathol 2009; 37:977-81. [PMID: 19891656 DOI: 10.1111/j.1600-0560.2009.01448.x] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
We report two cases of a CD8-positive lymphoid proliferation presenting as solitary lesions on the ear and nose, respectively. Histopathologically, both cases were characterized by a diffuse non-epidermotropic dermal proliferation of clonal medium-sized CD8-positive T-lymphocytes with a lymphoblast-like appearance, having cells with large folded nuclei, prominent nucleoli and ample amphophilic or pale eosinophilic cytoplasm. Staging procedures excluded systemic involvement, and both lesions were successfully treated with localised radiotherapy without evidence of recurrence after 12 and 24 months' follow up, respectively. Previously reported cases on the ear had similar clinicopathological and immunophenotypical features, and together raise the possibility of a distinct entity, an indolent CD8-positive lymphoid proliferation.
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Affiliation(s)
- Ravi Suchak
- St John's Institute of Dermatology, St Thomas' Hospital, London
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Primary cutaneous CD4+ small-/medium-sized pleomorphic T-cell lymphoma: a cutaneous nodular proliferation of pleomorphic T lymphocytes of undetermined significance? A study of 136 cases. Am J Dermatopathol 2009; 31:317-22. [PMID: 19461234 DOI: 10.1097/dad.0b013e31819f19bb] [Citation(s) in RCA: 131] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Patients with skin nodules characterized by the infiltrate of pleomorphic small/medium T lymphocytes are currently classified as "primary cutaneous CD4+ small-/medium-sized pleomorphic T-cell lymphoma" (SMPTCL) or as T-cell pseudolymphoma. The distinction is often arbitrary, and patients with similar clinicopathologic features have been included in both groups. We studied 136 patients (male:female = 1:1; median age: 53 years, age range: 3-90 years) with cutaneous lesions that could be classified as small-/medium-sized pleomorphic T-cell lymphoma according to current diagnostic criteria. All but 3 patients presented with solitary nodules located mostly on the head and neck area (75%). Histopathologic features were characterized by nonepidermotropic, nodular, or diffuse infiltrates of small- to medium-sized pleomorphic T lymphocytes. A monoclonal rearrangement of the T-cell receptor-gamma gene was found in 60% of tested cases. Follow-up data available for 45 patients revealed that 41 of them were alive without lymphoma after a median time of 63 months (range: 1-357 months), whereas 4 were alive with cutaneous disease (range: 2-16 months). The incongruity between the indolent clinical course and the worrying histopathologic and molecular features poses difficulties in classifying these cases unambiguously as benign or malignant, and it may be better to refer to them with a descriptive term such as "cutaneous nodular proliferation of pleomorphic T lymphocytes of undetermined significance," rather than forcing them into one or the other category. On the other hand, irrespective of the name given to these equivocal cutaneous lymphoid proliferations, published data support a nonaggressive therapeutic strategy, particularly for patients presenting with solitary lesions.
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Beltraminelli H, Müllegger R, Cerroni L. Indolent CD8+ lymphoid proliferation of the ear: a phenotypic variant of the small-medium pleomorphic cutaneous T-cell lymphoma? J Cutan Pathol 2009; 37:81-4. [PMID: 19602068 DOI: 10.1111/j.1600-0560.2009.01278.x] [Citation(s) in RCA: 56] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Recently, Petrella et al. described four patients with an unusual CD8+ lymphoid proliferation arising on the ear. These cases do not correspond clearly to any recognized category of cutaneous T-cell lymphoma (CTCL) described in the World Health Organization (WHO)/European Organization for Research and Treatment of Cancer (EORTC) 2005 classification. METHODS AND RESULTS Three patients (all men; median age 64; range: 61-69) presented with plaques or small tumors localized on the ears. All lesions showed histopathologically a dense, diffuse infiltration of lymphocytes within the entire dermis without epidermotropism. Cytomorphology revealed predominance of medium-sized pleomorphic lymphocytes. Immunohistochemistry showed a cytotoxic phenotype (CD3 + /CD4 -/CD8 +). Polymerase chain reaction (PCR) analysis of the T-cell receptor (TCR)-gamma gene revealed a monoclonal rearrangement in two of three patients. Follow-up data of two patients were available; one is alive without skin or systemic manifestations of the disease after 28 months, whereas the other is alive with persistent skin disease after 7 months. CONCLUSIONS Our observation confirms that some patients present with a peculiar lymphoid proliferation of small-medium pleomorphic cytotoxic lymphocytes located on the ear, probably representing a phenotypic variant of the cutaneous small/medium pleomorphic T-cell lymphoma (CSMPTCL). These cases should not be misinterpreted as a high-grade cytotoxic lymphoma.
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Affiliation(s)
- Helmut Beltraminelli
- Research Unit Dermatopathology, Department of Dermatology, Medical University of Graz, Austria
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The Applicability of the New WHO-EORTC Classification of Primary Cutaneous Lymphomas to a Single Referral Center. Am J Dermatopathol 2008; 30:37-44. [DOI: 10.1097/dad.0b013e31815f9841] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
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Indolent CD8-positive lymphoid proliferation of the ear: a distinct primary cutaneous T-cell lymphoma? Am J Surg Pathol 2008; 31:1887-92. [PMID: 18043044 DOI: 10.1097/pas.0b013e318068b527] [Citation(s) in RCA: 109] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
The authors report 4 cases of cutaneous lymphoproliferation unusual by their histology and their clinical presentation. Each presented with a history of a slow growing nodule on the ear. Despite the indolent clinical evolution, the histology suggested a high-grade lymphoma. All lesions consisted of a dense, diffuse proliferation of monomorphous medium-sized T cells throughout the dermis and subcutis. There was no epidermotropism and a grenz zone was clearly present in each case. The tumor cells displayed irregular blastlike nuclei, with small nucleoli and clear chromatin and had a CD3+, CD8+, CD4+, TIA1+, granzyme B(-)immunophenotype with a loss of other T-cell antigens. The 3 cases with available material for polymerase chain reaction studies displayed a monoclonal T-cell rearrangement of the T-cell receptor-gamma chain. These cases do not correspond to a recognized cutaneous T-cell lymphoma as described in the recent WHO/EORTC classification. The apparent striking propensity for the ear suggests that they might represent a specific entity. Further cases are needed to confirm this hypothesis. It is important for such indolent lesions to be known to avoid over treatment.
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