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Davis MS, Spencer RK, Johnson CE, Elhage KG, Jin JQ, Hakimi M, Bhutani T, Liao W. Risk of Cutaneous T Cell Lymphoma with Psoriasis Biologic Therapies. Dermatol Ther (Heidelb) 2024; 14:15-30. [PMID: 38043065 PMCID: PMC10828324 DOI: 10.1007/s13555-023-01074-z] [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: 10/06/2023] [Accepted: 11/13/2023] [Indexed: 12/05/2023] Open
Abstract
BACKGROUND The risk of developing cutaneous T cell lymphoma (CTCL) in patients using psoriasis biologics has not been well characterized. The goals of this review were to investigate the incidence of CTCL in patients with psoriasis receiving biologic therapy in clinical trials and psoriasis registries, and to review cases of CTCL and biologic use reported in scientific publications. METHODS The US National Library of Medicine clinical trials database (clinicaltrials.gov) was queried to identify phase 3 and 4 clinical trials of the 12 biologic agents currently FDA approved for psoriatic disease. The incidence of CTCL in these trials was examined and summarized. To examine the incidence of CTCL in psoriasis registries, a Medline search was conducted. Finally, we performed a systematic review of CTCL cases reported in the literature. RESULTS Only two cases of CTCL were reported in 35,801 subjects with psoriasis receiving a biologic agent in the active arm of 108 psoriasis phase 3 clinical trials. One of these CTCL cases was determined by the investigator to be CTCL misdiagnosed as psoriasis prior to randomization. No cases of CTCL were reported in 5440 subjects with psoriasis in 34 phase 4 clinical trials. Only one case of CTCL was identified in 34,111 registry subjects. In the literature, tumor necrosis factor (TNF) inhibitors had the highest number of reported cases of CTCL (34 cases), followed by interleukin (IL)-17 inhibitors (7 cases), and IL-12/23 inhibitors (6 cases). No cases of CTCL were found to be reported with IL-23 inhibitors. CONCLUSION Our findings indicate that the development of CTCL is rare in the setting of psoriasis biologic use. Of the limited number of cases of CTCL found, most were in the setting of TNF inhibitor use and no cases of CTCL were reported in the setting of IL-23 inhibitor use.
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Affiliation(s)
- Mitchell S Davis
- Department of Dermatology, University of California San Francisco, Floor 04, Room N426, 2340 Sutter Street, Box 0808, San Francisco, CA, 94115, USA
| | - Riley K Spencer
- Department of Dermatology, University of California San Francisco, Floor 04, Room N426, 2340 Sutter Street, Box 0808, San Francisco, CA, 94115, USA
- Arizona College of Osteopathic Medicine, Midwestern University, Glendale, AZ, USA
| | - Chandler E Johnson
- Department of Dermatology, University of California San Francisco, Floor 04, Room N426, 2340 Sutter Street, Box 0808, San Francisco, CA, 94115, USA
- Medical College of Georgia, Augusta, GA, USA
| | - Kareem G Elhage
- Department of Dermatology, University of California San Francisco, Floor 04, Room N426, 2340 Sutter Street, Box 0808, San Francisco, CA, 94115, USA
| | - Joy Q Jin
- Department of Dermatology, University of California San Francisco, Floor 04, Room N426, 2340 Sutter Street, Box 0808, San Francisco, CA, 94115, USA
- School of Medicine, University of California San Francisco, San Francisco, CA, USA
| | - Marwa Hakimi
- Department of Dermatology, University of California San Francisco, Floor 04, Room N426, 2340 Sutter Street, Box 0808, San Francisco, CA, 94115, USA
| | - Tina Bhutani
- Department of Dermatology, University of California San Francisco, Floor 04, Room N426, 2340 Sutter Street, Box 0808, San Francisco, CA, 94115, USA
| | - Wilson Liao
- Department of Dermatology, University of California San Francisco, Floor 04, Room N426, 2340 Sutter Street, Box 0808, San Francisco, CA, 94115, USA.
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Boh E, Kuraitis D, Jacobson A, Sikes M. Healthcare Provider Experience in Diagnosing and Treating Cutaneous T-Cell Lymphoma. Dermatol Ther (Heidelb) 2023; 13:835-842. [PMID: 36729236 PMCID: PMC9984617 DOI: 10.1007/s13555-023-00895-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2022] [Accepted: 01/26/2023] [Indexed: 02/03/2023] Open
Abstract
INTRODUCTION Cutaneous T-cell lymphoma (CTCL) is a rare, heterogeneous group of non-Hodgkin lymphomas characterized by various clinical, molecular, and histopathologic features of the skin. Variants of CTCL share many clinical features with common inflammatory skin diseases such as atopic dermatitis and psoriasis, making accurate and early diagnosis challenging in clinical settings. Inappropriate treatment or a delay in diagnosis can lead to increased morbidity and mortality. Here, we report findings from an online survey that investigated dermatology community practice, knowledge, and education surrounding CTCL. METHODS An electronic survey of ten questions was developed and approved by physician experts in CTCL to assess experiences in diagnosing and treating CTCL among healthcare providers (HCPs). The survey was deployed to 10,600 US dermatology HCPs, including medical doctors (MDs), doctors of osteopathic medicine (DOs), nurse practitioners (NPs), and physician assistants (PAs) and excluding HCPs associated with CTCL centers of excellence. RESULTS Among 44 HCPs who responded and were eligible for inclusion, 82% had diagnosed between one and ten CTCL cases in the last 5 years. Most respondents (91%) reported that they include CTCL in their differential diagnoses after patients do not respond to treatment of more common conditions. Patients with CTCL were frequently diagnosed with other inflammatory dermatoses-most commonly dermatitis and psoriasis-before a CTCL diagnosis, and many were treated with ineffective therapies for years. The most common length of time before a CTCL diagnosis was made was between 1 and 3 years, though 16% of HCPs reported that patients were treated for other diseases or skin conditions for ≥ 5 years. Two-thirds of HCPs agreed that further education surrounding CTCL is needed. CONCLUSIONS Given the infrequency of CTCL and its similar presentation to other common dermatologic conditions, increased education of CTCL is needed in the dermatology community to improve patient outcomes.
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Affiliation(s)
- Erin Boh
- Tulane University, 1430 Tulane Ave, New Orleans, LA, 70112, USA.
| | - Drew Kuraitis
- grid.265219.b0000 0001 2217 8588Tulane University, 1430 Tulane Ave, New Orleans, LA 70112 USA ,grid.240614.50000 0001 2181 8635Department of Dermatology, Roswell Park Comprehensive Cancer Center, Buffalo, NY USA
| | - Abby Jacobson
- grid.433688.20000 0004 0380 1655Ortho Dermatologics (a Division of Bausch Health US, LLC), Bridgewater, NJ USA
| | - Martha Sikes
- grid.433688.20000 0004 0380 1655Ortho Dermatologics (a Division of Bausch Health US, LLC), Bridgewater, NJ USA
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Diakomopoulos A, Dalamaga M, Papadavid E. Understanding the enigmatic association between mycosis fungoides and psoriasis: Report of two cases and review of the literature. Metabol Open 2021; 12:100148. [PMID: 34816115 PMCID: PMC8591362 DOI: 10.1016/j.metop.2021.100148] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2021] [Accepted: 11/02/2021] [Indexed: 01/04/2023] Open
Abstract
Psoriatic patients present an increased risk for developing lymphoma, particularly cutaneous T-cell lymphoma (CTCL). To what degree psoriasis itself through chronic immune stimulation, or the immunosuppressive medications used for its treatment or comorbidities (obesity, diabetes mellitus, etc), or lifestyle (smoking, alcohol, diet, etc) may play a role in the onset of MF is not yet clear. Psoriasis and Mycosis Fungoides (MF), the most common variant of CTCL, represent two distinct entities sharing common pathogenetic mechanisms and a wide spectrum of common clinical features associated with the abnormal activation of T-cells. The aim of this study is to explore the relationship between MF and psoriasis by presenting two cases with clinical and histopathologic features of both psoriasis and MF with a particular emphasis on the time of presentation of both disorders, the use of previous immunosuppressive drugs as well as the therapeutic management of patients. Biopsy of the cutaneous lesions before the introduction of biologics should be incorporated in clinical practice. Biopsy of the cutaneous lesion should also be performed in the case of appearance of psoriasiform lesions during biologic treatment for autoimmune disorders because this may represent an indolent form of MF. Psoriatic patients with poor or no-response to treatment should be examined thoroughly for MF using immunochemistry and, if necessary, molecular biology techniques. In concomitant MF and psoriasis, combination treatment may be beneficial for both entities. Finally, a large multicentric registry of MF patients who were treated for benign dermatoses (i.e. eczema, psoriasis) with classic immunosuppressive drugs and/or biologics is needed to collect data and further clarify the enigmatic relationship between psoriasis, MF and immunosuppressive treatment.
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Affiliation(s)
- Achilleas Diakomopoulos
- 2nd Department of Dermatology and Venereology, National and Kapodistrian University of Athens Medical School, Attikon Hospital, 1 Rimini Street, 12462, Athens, Chaidari, Greece
| | - Maria Dalamaga
- 2nd Department of Dermatology and Venereology, National and Kapodistrian University of Athens Medical School, Attikon Hospital, 1 Rimini Street, 12462, Athens, Chaidari, Greece.,Department of Biological Chemistry, Medical School, National & Kapodistrian University of Athens, 75 Mikras Asias Street, 11527, Athens, Greece
| | - Evangelia Papadavid
- 2nd Department of Dermatology and Venereology, National and Kapodistrian University of Athens Medical School, Attikon Hospital, 1 Rimini Street, 12462, Athens, Chaidari, Greece
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4
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Aquino TM, Calvarido MG, North JP. Interleukin 36 expression in psoriasis variants and other dermatologic diseases with psoriasis-like histopathologic features. J Cutan Pathol 2021; 49:123-132. [PMID: 34346097 DOI: 10.1111/cup.14115] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2021] [Revised: 05/30/2021] [Accepted: 07/14/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND Elevated epidermal interleukin (IL)-36 expression distinguishes psoriasis from eczematous dermatitis, but other psoriasiform dermatitides (PDs) have not been thoroughly investigated for IL-36 expression. In this study, we assess the IL-36 staining pattern (IL36-SP) in psoriasis variants and other PDs including lichen simplex chronicus (LSC), prurigo nodularis (PN), lichen planus (LP), tinea, pityriasis rubra pilaris (PRP), mycosis fungoides (MF), pemphigus foliaceus (PF), acute generalized exanthematous pustulosis (AGEP), impetigo (IMP), and syphilis (SY). METHODS IL-36 immunostaining was performed on 307 cases of psoriasis and various PDs. IL36-SP in the upper epidermis was graded on a scale of 0-4. RESULTS High IL36-SP occurred in all variants of psoriasis, as well as in AGEP, PRP, PN, tinea, IMP, and LP (P > 0.05). SY, PF, LSC, and MF showed a lower IL36-SP (P ≤ 0.05) compared with psoriasis. CONCLUSION All variants of psoriasis exhibit high IL36-SP. IL-36 staining can assist in differentiating MF, PF, SY, and LSC from psoriasis, particularly MF and LSC, which have consistent low IL-36 expression. AGEP, PRP, tinea, IMP, PN, and LP exhibit high IL-36 expression similar to psoriasis, indicating Th17 activation in these diseases.
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5
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Guglielmo A, Patrizi A, Bardazzi F, Pileri A. Erythroderma: psoriasis or lymphoma? A diagnostic challenge and therapeutic pitfall. Ital J Dermatol Venerol 2021; 157:154-157. [PMID: 33913668 DOI: 10.23736/s2784-8671.21.06891-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Psoriasis and lymphoma risk is widely debated, but few is known about misdiagnosis risk between erythrodermic psoriasis and lymphoma . In fact erythroderma might represent a clinical presentation of psoriasis, cutaneous T cell lymphomas and skin dissemination of systemic lymphomas. METHODS All patients referred to psoriasis outpatient service with a diagnosis of erythrodermic psoriasis were re-examined. Among them, all the patients with a subsequent lymphoma diagnosis were included. For each patient data concerning age, gender, age at erythroderma onset, age at lymphoma diagnosis, immune-suppressive therapy, type of lymphoma and relative stage, lymphoma treatment and outcome were obtained. RESULTS Twenty-five patients (15 females and 10 males) with a diagnosis of erythrodermic psoriasis were retrieved. Among them, 9 patients (5 males and 4 females) were affected by erythrodermic lymphoma, including 4 patients with Sèzary syndrome, 3 with mycosis fungoides, and 2 with peripheral T-cell lymphoma not otherwise specified. Prior to lymphoma diagnosis all the patients (9/9) received cyclosporine, two (2/9) of them methotrexate, one (1/9) azatioprine, and two (2/9) systemic corticosteroids. The prognosis of our patients was poor, due to immune-suppressive drugs administration in patients with undiagnosed lymphoma. The only exception was one (1/9) patient with Sèzary syndrome still alive with disease after 120 months of follow up. CONCLUSIONS In case of patients with erythroderma, multiple skin biopsies and specific peripheral blood studies like flow cytometry and T-cell receptor gene rearrangement analysis are required in order to avoid misdiagnosis risk between psoriasis and lymphoma.
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Affiliation(s)
- Alba Guglielmo
- Division of Dermatology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy.,Division of Dermatology, Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, Bologna, Italy
| | - Annalisa Patrizi
- Division of Dermatology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy - .,Division of Dermatology, Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, Bologna, Italy
| | - Federico Bardazzi
- Division of Dermatology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Alessandro Pileri
- Division of Dermatology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy.,Division of Dermatology, Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, Bologna, Italy
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6
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Hignett E, Seminario-Vidal L, Shulman K, Sami N. Cutaneous T-cell lymphoma mimicking palmoplantar pustular psoriasis: A rare variant. Australas J Dermatol 2021; 62:e280-e282. [PMID: 33386610 DOI: 10.1111/ajd.13544] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2020] [Revised: 11/21/2020] [Accepted: 11/28/2020] [Indexed: 11/30/2022]
Abstract
The development of pustular cutaneous T-cell lymphoma (CTCL) on the palms and soles is rare. Without confirmatory biopsy and molecular studies, CTCL can be misdiagnosed as many benign inflammatory skin diseases. We present a case of cutaneous T-cell lymphoma (CTCL) that mimicked palmoplantar pustular psoriasis, a rarely reported manifestation of the disease. We stress the importance of biopsy to confirm diagnoses, especially when preliminary diagnoses do not respond to empiric treatment.
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Affiliation(s)
- Emma Hignett
- University of Central Florida College of Medicine, Orlando, FL, USA
| | - Lucia Seminario-Vidal
- H. Lee Moffitt Cancer and Research Center, Cutaneous Oncology Program, Tampa, FL, USA
| | - Kenneth Shulman
- H. Lee Moffitt Cancer and Research Center, Cutaneous Oncology Program, Tampa, FL, USA
| | - Naveed Sami
- Department of Dermatology, University of Central Florida College of Medicine, Orlando, FL, USA
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7
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Yasuda T, Takagi T, Asai J, Katoh N, Kuroda J, Kuwahara Y, Morinaga Y, Konishi E, Uchiyama K, Naito Y, Itoh Y. Mycosis fungoides in a patient with ulcerative colitis on anti-tumor necrosis factor-alpha therapy. Clin J Gastroenterol 2020; 14:170-175. [PMID: 33219936 DOI: 10.1007/s12328-020-01277-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2020] [Accepted: 10/16/2020] [Indexed: 12/19/2022]
Abstract
A 46-year-old man with a history of ulcerative colitis (UC) for over 25 years was treated with infliximab for 7 years. He noticed gradually spreading erythema on his right lower abdomen, femur, and buttocks. Skin biopsy from the right lower abdomen revealed massive invasion of lymphocytes in the papillary dermis and epidermal layer. In conjunction with the findings of immunohistochemistry, the skin lesion was diagnosed as mycosis fungoides (MF) at infiltration stage. Infliximab was discontinued, and narrow-band ultraviolet light B therapy was initiated to treat the skin lesion. The patient achieved remission for MF following treatment and UC has not relapsed for more than 1 year with 5-aminosalicylic acid treatment alone. This is the first case of MF in a UC patient treated with anti-tumor necrosis factor-alpha (anti-TNFα). Lymphoma occurrence is a complication of treatment with anti-TNFα agent or thiopurine. However, there is no evidence regarding the relationship between MF and UC. Hence, these immunomodulatory agents may have triggered the occurrence of MF in this case. When treating UC patients with immunomodulatory agents, the possibility of MF or other types of lymphoma as rare complications must be considered.
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Affiliation(s)
- Takeshi Yasuda
- Department of Molecular Gastroenterology and Hepatology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, 465 Kawaramachi-Hirokoji, Kamigyo-ku, Kyoto, 602-8566, Japan
| | - Tomohisa Takagi
- Department of Molecular Gastroenterology and Hepatology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, 465 Kawaramachi-Hirokoji, Kamigyo-ku, Kyoto, 602-8566, Japan. .,Department for Medical Innovation and Translational Medical Science, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, 602-8566, Japan.
| | - Jun Asai
- Department of Dermatology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Norito Katoh
- Department of Dermatology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Junya Kuroda
- Division of Hematology and Oncology, Department of Medicine, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Yasumichi Kuwahara
- Department of Biochemistry and Molecular Biology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Yukiko Morinaga
- Department of Surgical Pathology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Eiichi Konishi
- Department of Surgical Pathology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Kazuhiko Uchiyama
- Department of Molecular Gastroenterology and Hepatology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, 465 Kawaramachi-Hirokoji, Kamigyo-ku, Kyoto, 602-8566, Japan
| | - Yuji Naito
- Department of Molecular Gastroenterology and Hepatology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, 465 Kawaramachi-Hirokoji, Kamigyo-ku, Kyoto, 602-8566, Japan
| | - Yoshito Itoh
- Department of Molecular Gastroenterology and Hepatology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, 465 Kawaramachi-Hirokoji, Kamigyo-ku, Kyoto, 602-8566, Japan
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8
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Biondo G, Cerroni L, Brunasso AMG, Sola S, Cota C, Javor S, Massone C. Risk of mycosis fungoides in psoriatic patients: a critical review. J Eur Acad Dermatol Venereol 2020; 34:1186-1195. [PMID: 31856345 DOI: 10.1111/jdv.16160] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2019] [Accepted: 11/26/2019] [Indexed: 12/18/2022]
Abstract
Psoriasis has been controversially associated with risk of non-Hodgkin lymphoma (NHL) and mycosis fungoides (MF). Also patients who developed MF after systemic treatment for psoriasis have been reported, and some authors suggested that the association between MF and psoriasis is not infrequent. We performed an extensive literature review in order to examine the risk of developing MF in psoriatic patients with a systematic search of the English-language databases. An increased risk for lymphoma overall in psoriatic patients has been found only by three out of seven studies. The risk of developing MF in psoriatic patients has been investigated by different studies in different populations and with different methodologies presenting bias and limitations, and it seems reasonable that misclassification between psoriasis and MF may explain the association reported. In contrast to the large number of psoriatic patients treated with biologicals, only 27 case reports of MF after biological therapy for psoriasis have been reported, and in 10 cases, the initial psoriasis diagnoses were then revised as MF. A true association between MF and psoriasis is possible, but the real incidence and prevalence are still unknown. The reported higher risk of developing MF in psoriatic patients should be reconsidered in the light of the bias of misclassification and the low magnitude reported in previous studies. There is not enough evidence to support a causal relation among biological therapies and MF in psoriatic patients.
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Affiliation(s)
- G Biondo
- Dermatology Unit, Galliera Hospital, Genoa, Italy
| | - L Cerroni
- Research Unit Dermatopathology, Department of Dermatology, Medical University of Graz, Graz, Austria
| | | | - S Sola
- Surgical Pathology, Galliera Hospital, Genoa, Italy
| | - C Cota
- Dermatology Unit, IRCCS INRCA, Ancona, Italy
| | - S Javor
- Dermatology Unit, Galliera Hospital, Genoa, Italy
| | - C Massone
- Dermatology Unit, Galliera Hospital, Genoa, Italy
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Avitan-Hersh E, Dias-Polak D, Ramon M, Zaaroura H, Sahar D, Bergman R. Follicular eruption with folliculotropic lymphocytic infiltrates associated with anti-tumor necrosis factor alpha therapy: Report and study of 3 cases. J Cutan Pathol 2019; 47:113-120. [PMID: 31595531 DOI: 10.1111/cup.13588] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2019] [Revised: 09/03/2019] [Accepted: 10/02/2019] [Indexed: 11/30/2022]
Abstract
BACKGROUND We have encountered three cases of follicular eruptions with folliculotropic infiltrates of non-atypical lymphocytes associated with anti-tumor necrosis factor alpha (TNF-α) therapy. METHODS Three patients aged 15 to 56 years treated with anti-TNF-α therapy (one with adalimumab, and two with infliximab) developed follicular eruptions characterized histopathologically by folliculotropic lymphocytic infiltrates. These were studied clinically, histopathologically, immunophenotypically, and molecularly. RESULTS All three cases were characterized histopathologically by folliculotropic cell infiltrates of non-atypical T (CD3+) lymphocytes with variable follicular exocytosis. Marked reduction in CD7 staining and marked predominance of CD4+ cells over CD8+ cells were observed in 1 and 2 cases, respectively. T-cell receptor (TCR) gene rearrangement studies were monoclonal in 1 case. Discontinuation of anti-TNF-α therapy in all three cases, with corticosteroid creams in 1 case, led to complete resolution. Rechallenge with adalimumab in 1 case resulted in exacerbation. Replacement of therapy with non-anti-TNF-α biologic agents in 2 cases was not associated with recurrence. CONCLUSION Follicular eruptions with folliculotropic lymphocytic infiltrates associated with anti-TNF-α therapy may show some immunophenotypical variations and/or monoclonal TCR gene rearrangements but lack sufficient cytomorphological features of folliculotropic MF. They may resolve with discontinuation of anti-TNF-α therapy.
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Affiliation(s)
- Emily Avitan-Hersh
- Department of Dermatology, Rambam Health Care Campus (RHCC), Haifa, Israel.,The Ruth and Bruce Rappaport Faculty of Medicine, Technion, Haifa, Israel
| | - David Dias-Polak
- Department of Dermatology, Rambam Health Care Campus (RHCC), Haifa, Israel
| | - Michal Ramon
- Department of Dermatology, Rambam Health Care Campus (RHCC), Haifa, Israel
| | - Hiba Zaaroura
- Department of Dermatology, Rambam Health Care Campus (RHCC), Haifa, Israel
| | - Dvora Sahar
- Department of Hematology, Rambam Health Care Campus (RHCC), Haifa, Israel
| | - Reuven Bergman
- Department of Dermatology, Rambam Health Care Campus (RHCC), Haifa, Israel.,The Ruth and Bruce Rappaport Faculty of Medicine, Technion, Haifa, Israel.,Department of Pathology, Rambam Health Care Campus (RHCC), Haifa, Israel
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10
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Fujii K, Kanekura T. Next-Generation Sequencing Technologies for Early-Stage Cutaneous T-Cell Lymphoma. Front Med (Lausanne) 2019; 6:181. [PMID: 31457014 PMCID: PMC6700355 DOI: 10.3389/fmed.2019.00181] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2019] [Accepted: 07/29/2019] [Indexed: 01/09/2023] Open
Abstract
The diagnosis of early stage cutaneous T-cell lymphoma is often difficult, particularly in mycosis fungoides (MF), because the clinical presentation, histological findings, and laboratory findings of MF resemble those of inflammatory skin diseases such as atopic dermatitis, psoriasis, and parapsoriasis en plaque. Furthermore, MF sometimes occurs with or after these inflammatory skin diseases. The current diagnostic criteria heavily rely on clinical impressions along with assessments of T cell clonality. To make a diagnosis of early-stage MF, the detection of a malignant clone is critical. T cell receptor (TCR) gene rearrangements have been detected by southern blotting or polymerase chain reaction for this purpose, but the results of these methods are insufficient. High-throughput TCR sequencing has provided insights into the complexities of the immune repertoire. Accordingly, his technique is more sensitive and specific than current methods, making it useful for the detection of early lesions and monitoring responses to therapy.
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Affiliation(s)
- Kazuyasu Fujii
- Department of Dermatology, Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima, Japan
| | - Takuro Kanekura
- Department of Dermatology, Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima, Japan
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11
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Dequidt L, Franck N, Sanchez‐Pena P, Dalle S, Adamski H, Boulinguez S, Ingen‐Housz‐Oro S, Ram‐Wolff C, Boccara O, Bonnet N, Cortes B, Gouraud A, Grange F, Le Corre Y, Quereux G, De Masson A, Schmutz J, Skowron F, Verneuil L, Beylot‐Barry M. Cutaneous lymphomas appearing during treatment with biologics: 44 cases from the French Study Group on Cutaneous Lymphomas and French Pharmacovigilance Database. Br J Dermatol 2019; 181:616-618. [DOI: 10.1111/bjd.17834] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- L. Dequidt
- Dermatology Department University Hospital Bordeaux France
- INSERM U1053 Bordeaux Research in Translational Oncology Team 3 Oncogenesis of Cutaneous Lymphomas University of Bordeaux France
| | - N. Franck
- Dermatology Department AP‐HP Cochin Hospital Paris France
| | - P. Sanchez‐Pena
- Pharmacovigilance Centre Medical Pharmacology Department University Hospital Bordeaux France
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - M. Beylot‐Barry
- Dermatology Department University Hospital Bordeaux France
- INSERM U1053 Bordeaux Research in Translational Oncology Team 3 Oncogenesis of Cutaneous Lymphomas University of Bordeaux France
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12
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Shamim H, Johnson EF, Gibson LE, Comfere N. Mycosis fungoides with spongiosis: A potential diagnostic pitfall. J Cutan Pathol 2019; 46:645-652. [DOI: 10.1111/cup.13477] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2018] [Revised: 04/04/2019] [Accepted: 04/09/2019] [Indexed: 12/17/2022]
Affiliation(s)
- Huma Shamim
- Department of DermatologyMayo Clinic Rochester Rochester Minnesota
| | - Emma F. Johnson
- Department of DermatologyMayo Clinic Rochester Rochester Minnesota
| | - Lawrence E. Gibson
- Department of DermatologyMayo Clinic Rochester Rochester Minnesota
- Department of Laboratory Medicine and PathologyMayo Clinic Rochester Rochester Minnesota
| | - Nneka Comfere
- Department of DermatologyMayo Clinic Rochester Rochester Minnesota
- Department of Laboratory Medicine and PathologyMayo Clinic Rochester Rochester Minnesota
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Nikolaou V, Gerochristou M, Marinos L, Economidi A, Voudouri D, Rigopoulos D, Stratigos AJ. Lymphoprolipherative skin reactions induced by anti-TNFα: an open question. J DERMATOL TREAT 2019; 31:99-102. [DOI: 10.1080/09546634.2019.1579889] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- Vasiliki Nikolaou
- 1st Department of Dermatology “Andreas Syggros” Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Maria Gerochristou
- 1st Department of Dermatology “Andreas Syggros” Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Leonidas Marinos
- Hemopathology Department, “Evangelismos” Hospital, Athens, Greece
| | - Afroditi Economidi
- 1st Department of Dermatology “Andreas Syggros” Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Dimitra Voudouri
- 1st Department of Dermatology “Andreas Syggros” Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Dimitris Rigopoulos
- 1st Department of Dermatology “Andreas Syggros” Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Alexander J Stratigos
- 1st Department of Dermatology “Andreas Syggros” Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece
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Partarrieu‐Mejías F, Díaz‐Corpas T, Pérez‐Ferriols A, Alegre‐de Miquel V. Mycosis fungoides after treatment with tumor necrosis factor‐alpha inhibitors for psoriasis: progression or onset? Int J Dermatol 2019; 58:e103-e105. [DOI: 10.1111/ijd.14367] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
| | | | - Amparo Pérez‐Ferriols
- Department of Dermatology Consorcio Hospital General Universitario de Valencia Valencia Spain
| | - Victor Alegre‐de Miquel
- Department of Dermatology Consorcio Hospital General Universitario de Valencia Valencia Spain
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An Immune Suppression-associated EBV-positive Anaplastic Large Cell Lymphoma With a BRAF V600E Mutation. Am J Surg Pathol 2019; 43:140-146. [DOI: 10.1097/pas.0000000000001174] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Pham AK, Carter JB, Ratcliffe NR, Fuld AD, Lansigan F, Burnside NJ, Guill MA, Zug KA, Jarvis LA, LeBlanc RE. Tumor-stage mycosis fungoides in palmoplantar localization with large-cell transformation and partial CD30 expression shows complete response to brentuximab vedotin. J Cutan Pathol 2018. [DOI: 10.1111/cup.13140] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Anh Khoa Pham
- Section of Dermatology, Department of Surgery; Dartmouth-Hitchcock Medical Center, Geisel School of Medicine; Lebanon, New Hampshire
| | - Joi B. Carter
- Section of Dermatology, Department of Surgery; Dartmouth-Hitchcock Medical Center, Geisel School of Medicine; Lebanon, New Hampshire
| | - Nora R. Ratcliffe
- Department of Pathology and Laboratory Medicine, Dartmouth-Hitchcock Medical Center; Geisel School of Medicine; Lebanon, New Hampshire
- Department of Pathology and Laboratory Medicine; White River Junction VA Medical Center; White River Junction Vermont
| | - Alexander D. Fuld
- Section of Hematology and Oncology, Department of Medicine; Dartmouth-Hitchcock Medical Center, Geisel School of Medicine; Lebanon, New Hampshire
- Department of Hematology and Oncology; White River Junction VA Medical Center; White River Junction Vermont
| | - Frederick Lansigan
- Section of Hematology and Oncology, Department of Medicine; Dartmouth-Hitchcock Medical Center, Geisel School of Medicine; Lebanon, New Hampshire
| | - Nancy J. Burnside
- Department of Dermatology; White River Junction VA Medical Center; White River Junction Vermont
| | - Marshall A. Guill
- Section of Dermatology, Department of Surgery; Dartmouth-Hitchcock Medical Center, Geisel School of Medicine; Lebanon, New Hampshire
- Department of Dermatology; White River Junction VA Medical Center; White River Junction Vermont
| | - Kathryn A. Zug
- Section of Dermatology, Department of Surgery; Dartmouth-Hitchcock Medical Center, Geisel School of Medicine; Lebanon, New Hampshire
| | - Lesley A. Jarvis
- Department of Radiation Oncology, Dartmouth-Hitchcock Medical Center; Geisel School of Medicine; Lebanon, New Hampshire
| | - Robert E. LeBlanc
- Department of Pathology and Laboratory Medicine, Dartmouth-Hitchcock Medical Center; Geisel School of Medicine; Lebanon, New Hampshire
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Anderson ME, Nagy-Szakal D, Jain K, Patrone CC, Frattini MG, Lipkin WI, Geskin LJ. Highly Sensitive Virome Capture Sequencing Technique VirCapSeq-VERT Identifies Partial Noncoding Sequences but no Active Viral Infection in Cutaneous T-Cell Lymphoma. J Invest Dermatol 2018; 138:1671-1673. [PMID: 29427587 DOI: 10.1016/j.jid.2018.01.024] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2017] [Revised: 12/28/2017] [Accepted: 01/02/2018] [Indexed: 11/18/2022]
Affiliation(s)
- Mary E Anderson
- Department of Dermatology, Columbia University Medical Center, New York, New York, USA
| | - Dorottya Nagy-Szakal
- Center for Infection and Immunity, Mailman School of Public Health, Columbia University Medical Center, New York, New York, USA
| | - Komal Jain
- Center for Infection and Immunity, Mailman School of Public Health, Columbia University Medical Center, New York, New York, USA
| | - Christina C Patrone
- Department of Dermatology, Columbia University Medical Center, New York, New York, USA
| | - Mark G Frattini
- Department of Medicine, Columbia University Medical Center, New York, New York, USA
| | - W Ian Lipkin
- Center for Infection and Immunity, Mailman School of Public Health, Columbia University Medical Center, New York, New York, USA
| | - Larisa J Geskin
- Department of Dermatology, Columbia University Medical Center, New York, New York, USA.
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Martinez-Escala ME, Posligua AL, Wickless H, Rutherford A, Sable KA, Rubio-Gonzalez B, Zhou XA, Kaplan JB, Pro B, Choi J, Querfeld C, Rosen ST, Guitart J. Progression of undiagnosed cutaneous lymphoma after anti-tumor necrosis factor-alpha therapy. J Am Acad Dermatol 2018; 78:1068-1076. [PMID: 29307643 DOI: 10.1016/j.jaad.2017.12.068] [Citation(s) in RCA: 38] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2017] [Revised: 12/20/2017] [Accepted: 12/25/2017] [Indexed: 01/21/2023]
Abstract
BACKGROUND Cutaneous lymphoma diagnosed after anti-tumor necrosis factor-α therapy (anti-TNF-α) has been reported in the literature, yet a clear link between both events remains elusive. OBJECTIVE To review our experience with cutaneous lymphoma diagnosed during or after the use of anti-TNF-α therapies. METHODS This is a multicenter retrospective study and a literature review. RESULTS A total of 22 cases, including 20 cutaneous T-cell lymphomas (CTCLs) and 2 cutaneous B-cell lymphomas, were identified. In the CTCL group, 75% of the patients received an anti-TNF-α agent for a presumed inflammatory skin condition. Mycosis fungoides and Sézary syndrome were the most common subtypes of CTCL diagnosed. Advanced disease (stage IIB to IVA) was commonly seen at time of diagnosis and required aggressive therapy, including stem cell transplant in 3 patients; 2 patients in whom cutaneous B-cell lymphomas was diagnosed had an indolent course. A total of 31 cases were gathered from a literature search. LIMITATIONS This is a retrospective study. CONCLUSIONS Our findings suggest that the disease of most of the identified patients was misdiagnosed as psoriasis or eczema; therefore, a comprehensive morphologic and molecular review of skin biopsy specimens and peripheral blood samples should be considered before initiation of anti-TNF-α therapy in patients with poorly defined dermatitis or atypical presentations of psoriasis.
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Affiliation(s)
| | - Alba L Posligua
- Department of Dermatology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Heather Wickless
- Department of Dermatology, University of Texas Southwestern, Dallas, Texas
| | - Audrey Rutherford
- Department of Dermatology, University of Texas Southwestern, Dallas, Texas
| | - Kimberly A Sable
- Department of Dermatology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Belen Rubio-Gonzalez
- Division of Dermatology, City of Hope Comprehensive Cancer Center, Duarte, California; Beckman Research Institute, Duarte, California
| | - Xiaolong A Zhou
- Department of Dermatology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Jason B Kaplan
- Division of Hematology/Oncology, Robert H. Lurie Comprehensive Cancer Center, Northwestern University, Chicago, Illinois
| | - Barbara Pro
- Division of Hematology/Oncology, Robert H. Lurie Comprehensive Cancer Center, Northwestern University, Chicago, Illinois
| | - Jaehyuk Choi
- Department of Dermatology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Christiane Querfeld
- Division of Dermatology, City of Hope Comprehensive Cancer Center, Duarte, California; Beckman Research Institute, Duarte, California
| | - Steven T Rosen
- Division of Dermatology, City of Hope Comprehensive Cancer Center, Duarte, California; Beckman Research Institute, Duarte, California
| | - Joan Guitart
- Department of Dermatology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois.
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Nikolaou V, Marinos L, Moustou E, Papadavid E, Economidi A, Christofidou E, Gerochristou M, Tasidou A, Economaki E, Stratigos A, Antoniou C. Psoriasis in patients with mycosis fungoides: a clinicopathological study of 25 patients. J Eur Acad Dermatol Venereol 2017; 31:1848-1852. [DOI: 10.1111/jdv.14365] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2017] [Accepted: 03/27/2017] [Indexed: 01/26/2023]
Affiliation(s)
- V. Nikolaou
- Cutaneous Lymphoma Clinic; “Andreas Sygros” Hospital for Skin Diseases; Athens Greece
| | - L. Marinos
- Hemopathology Department; “Evangelismos Hospital”; Athens Greece
| | - E. Moustou
- Cutaneous Lymphoma Clinic; “Andreas Sygros” Hospital for Skin Diseases; Athens Greece
| | - E. Papadavid
- Cutaneous Lymphoma Clinic; “Andreas Sygros” Hospital for Skin Diseases; Athens Greece
| | - A. Economidi
- Cutaneous Lymphoma Clinic; “Andreas Sygros” Hospital for Skin Diseases; Athens Greece
| | - E. Christofidou
- Pathology Department; “Andreas Sygros” Hospital for Skin Diseases; Athens Greece
| | - M. Gerochristou
- Cutaneous Lymphoma Clinic; “Andreas Sygros” Hospital for Skin Diseases; Athens Greece
| | - A. Tasidou
- Hemopathology Department; “Evangelismos Hospital”; Athens Greece
| | - E. Economaki
- Hemopathology Department; “Evangelismos Hospital”; Athens Greece
| | - A. Stratigos
- Cutaneous Lymphoma Clinic; “Andreas Sygros” Hospital for Skin Diseases; Athens Greece
| | - C. Antoniou
- Cutaneous Lymphoma Clinic; “Andreas Sygros” Hospital for Skin Diseases; Athens Greece
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