1
|
Chiang CT, Chuang SS, Lin HF, Li WH, Chiang YY, Chen BJ. Primary Cutaneous Peripheral T-Cell Lymphoma With Follicular Helper T-Cell Phenotype: Report of 2 Epstein-Barr Virus-Positive Cases. Am J Dermatopathol 2023; 45:73-80. [PMID: 36669068 DOI: 10.1097/dad.0000000000002254] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
ABSTRACT Primary cutaneous T-cell lymphoma is distinct from nodal T-cell lymphoma clinically and pathologically. Recently, primary cutaneous follicular helper T-cell lymphoma (PC-TFHL) has been described as a peripheral T-cell lymphoma with T-follicular helper (TFH) cell phenotype. PC-TFHL usually presents as multiple plaques and nodules of skin with an indolent clinical course, but without association with Epstein-Barr virus. In this article, we report 2 rare cases of PC-TFHL which are Epstein-Barr virus-positive and with an aggressive clinical course. We discuss the challenges in the differential diagnoses, particularly with primary cutaneous extranodal NK/T-cell lymphoma, and nodal T-cell lymphoma of TFH origin with secondary cutaneous involvement.
Collapse
Affiliation(s)
- Chien-Ta Chiang
- Pathologist, Department of Pathology, Far Eastern Memorial Hospital, New Taipei City, Taiwan
| | - Shih-Sung Chuang
- Pathologist, Department of Pathology, Chi-Mei Medical Center, Tainan, Taiwan
| | - Hsuen-Fu Lin
- Hematologist Oncologist, Department of Hematology and Medical Oncology, Mennonite Christian Hospital, Hualien, Taiwan
| | - Wei-Hsuan Li
- Dermatologist, Department of Dermatology, Mennonite Christian Hospital, Hualien, Taiwan
| | - Ying-Yi Chiang
- Dermatologist, Department of Dermatology, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan
- Department of Dermatology, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Bo-Jung Chen
- Pathologist, Department of Pathology, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan ; and
- Department of Pathology, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| |
Collapse
|
2
|
Wang L, Rocas D, Dalle S, Sako N, Pelletier L, Martin N, Dupuy A, Tazi N, Balme B, Vergier B, Beylot-Barry M, Carlotti A, Bagot M, Battistella M, Chaby G, Ingen-Housz-Oro S, Gaulard P, Ortonne N. Primary cutaneous peripheral T-cell lymphomas with a T-follicular helper phenotype: an integrative clinical, pathological and molecular case series study. Br J Dermatol 2022; 187:970-980. [PMID: 35895386 PMCID: PMC10087773 DOI: 10.1111/bjd.21791] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Revised: 07/04/2022] [Accepted: 07/22/2022] [Indexed: 12/24/2022]
Abstract
BACKGROUND Primary cutaneous peripheral T-cell lymphomas with a T-follicular helper phenotype (pcTFH-PTCL) are poorly characterized, and often compared to, but not corresponding with, mycosis fungoides (MF), Sézary syndrome, primary cutaneous CD4+ lymphoproliferative disorder, and skin manifestations of angioimmunoblastic T-cell lymphomas (AITL). OBJECTIVES We describe the clinicopathological features of pcTFH-PTCL in this original series of 23 patients, and also characterize these cases molecularly. METHODS Clinical and histopathological data of the selected patients were reviewed. Patient biopsy samples were also analysed by targeted next-generation sequencing. RESULTS All patients (15 men, eight women; median age 66 years) presented with skin lesions, without systemic disease. Most were stage T3b, with nodular (n = 16), papular (n = 6) or plaque (atypical for MF, n = 1) lesions. Three (13%) developed systemic disease and died of lymphoma. Nine (39%) patients received more than one line of chemotherapy. Histologically, the lymphomas were CD4+ T-cell proliferations, usually dense and located in the deep dermis (n = 14, 61%), with the expression of at least two TFH markers (CD10, CXCL13, PD1, ICOS, BCL6), including three markers in 16 cases (70%). They were associated with a variable proportion of B cells. Eight patients were diagnosed with an associated B-cell lymphoproliferative disorder (LPD) on biopsy, including Epstein-Barr virus (EBV)-positive diffuse large B-cell lymphoma (n = 3), EBV+ LPD (n = 1) and monotypic plasma cell LPD (n = 4). Targeted sequencing showed four patients to have a mutated TET2-RHOAG17V association (as frequently seen in AITL) and another a TET2/DNMT3A/PLCG1/SETD2 mutational profile. The latter patient, one with a TET2-RHOA association, and one with no detected mutations, developed systemic disease and died. Five other patients showed isolated mutations in TET2 (n = 1), PLCG1 (n = 2), SETD2 (n = 1) or STAT5B (n = 1). CONCLUSIONS Patients with pcTFH-PTCL have pathological and genetic features that overlap with those of systemic lymphoma of TFH derivation. Clinically, most remained confined to the skin, with only three patients showing systemic spread and death. Whether pcTFH-PTCL should be integrated as a new subgroup of TFH lymphomas in future classifications is still a matter of debate. What is already known about this topic? There is a group of cutaneous lymphomas that express T-follicular helper (TFH) markers that do not appear to correspond to existing World Health Organization diagnostic entities. These include mycosis fungoides, Sézary syndrome, or primary cutaneous CD4+ small/medium-sized T-cell lymphoproliferative disorder or cutaneous extensions of systemic peripheral T-cell lymphomas (PTCL) with TFH phenotype. What does this study add? This is the first large original series of patients with a diagnosis of primary cutaneous PTCL with a TFH phenotype (pcTFH-PTCL) to be molecularly characterized. pcTFH-PTCL may be a standalone group of cutaneous lymphomas with clinicopathological and molecular characteristics that overlap with those of systemic TFH lymphomas, such as angioimmunoblastic T-cell lymphoma, and does not belong to known diagnostic groups of cutaneous lymphoma. This has an impact on the treatment and follow-up of patients; the clinical behaviour needs to be better clarified in further studies to tailor patient management.
Collapse
Affiliation(s)
- Luojun Wang
- Department of Pathology, Assistance Publique - Hôpitaux de Paris, Henri-Mondor Hospital, 94010, Créteil, France.,INSERM U955 Institut Mondor de Recherche Biomédicale (IMRB), Paris Est Créteil University, 94010, Créteil, France
| | - Delphine Rocas
- Department of Pathology, Lyon Sud, Pierre-Bénite Hospital, 69495, Lyon, France
| | - Stéphane Dalle
- Department of Dermatology, Lyon Sud, Pierre-Bénite Hospital, 69495, Lyon, France
| | - Nouhoum Sako
- INSERM U955 Institut Mondor de Recherche Biomédicale (IMRB), Paris Est Créteil University, 94010, Créteil, France
| | - Laura Pelletier
- INSERM U955 Institut Mondor de Recherche Biomédicale (IMRB), Paris Est Créteil University, 94010, Créteil, France
| | - Nadine Martin
- INSERM U955 Institut Mondor de Recherche Biomédicale (IMRB), Paris Est Créteil University, 94010, Créteil, France
| | - Aurélie Dupuy
- INSERM U955 Institut Mondor de Recherche Biomédicale (IMRB), Paris Est Créteil University, 94010, Créteil, France
| | - Nadia Tazi
- Department of Pathology, Assistance Publique - Hôpitaux de Paris, Henri-Mondor Hospital, 94010, Créteil, France
| | - Brigitte Balme
- Department of Pathology, Lyon Sud, Pierre-Bénite Hospital, 69495, Lyon, France
| | - Béatrice Vergier
- Department of Pathology, CHU de Bordeaux, Haut-Lévêque Hospital, 33600, Pessac, France.,INSERM, U1312, Université de Bordeaux, 33000, Bordeaux, France
| | - Marie Beylot-Barry
- INSERM, U1312, Université de Bordeaux, 33000, Bordeaux, France.,Department of Dermatology, CHU de Bordeaux, Saint-André Hospital, 33000, Bordeaux, France
| | - Agnès Carlotti
- Department of Pathology, Assistance Publique - Hôpitaux de Paris, Cochin Hospital, 75014, Paris, France
| | - Martine Bagot
- Department of Dermatology, Assistance Publique - Hôpitaux de Paris, Saint-Louis Hospital, 75010, Université Paris Cité, Paris, France
| | - Maxime Battistella
- Department of Pathology, Assistance Publique - Hôpitaux de Paris, Saint-Louis Hospital, 75010, Université Paris Cité, Paris, France
| | - Guillaume Chaby
- Department of Dermatology, CHU d'Amiens-Picardie, Hôpital Sud, 80054, Amiens, France
| | - Saskia Ingen-Housz-Oro
- Department of Dermatology, Assistance Publique - Hôpitaux de Paris, Henri-Mondor Hospital, 94010, Créteil, France
| | - Philippe Gaulard
- Department of Pathology, Assistance Publique - Hôpitaux de Paris, Henri-Mondor Hospital, 94010, Créteil, France.,INSERM U955 Institut Mondor de Recherche Biomédicale (IMRB), Paris Est Créteil University, 94010, Créteil, France
| | - Nicolas Ortonne
- Department of Pathology, Assistance Publique - Hôpitaux de Paris, Henri-Mondor Hospital, 94010, Créteil, France.,INSERM U955 Institut Mondor de Recherche Biomédicale (IMRB), Paris Est Créteil University, 94010, Créteil, France
| |
Collapse
|
3
|
Lu J, Kang X, Wang Z, Zhao G, Jiang B. The activity level of follicular helper T cells in the peripheral blood of osteosarcoma patients is associated with poor prognosis. Bioengineered 2022; 13:3751-3759. [PMID: 35081874 PMCID: PMC8974108 DOI: 10.1080/21655979.2022.2031387] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Osteosarcoma (OS) is solid tumors with high malignancy and incidence starting in the bones. OS pathogenesis has been proved to be closely associated with immune imbalance, and follicular helper T cells (Tfh) significantly affect host humoral immune homeostasis. However, there are few reports on the effect of Tfh cell activation on the prognosis of OS patients. Hence, this investigation on the changes in the proportion of peripheral blood Tfh cells in OS patients, and the relationship between their activity level and OS prognosis. We collected peripheral blood from patients with OS, benign bone tumor (BT group) and healthy subjects (Healthy group), respectively. The number of CD4+CXCR5+ Tfh cell in peripheral blood was measured by flow cytometry and correlation analysis between its activity and OS clinicopathological characteristics was carried out. The data showed that in comparison with the BT and Healthy groups, higher proportion and activation level of peripheral blood CD4+CXCR5+ Tfh cells in CD4+ T cells were found in the OS group. In OS patients, increases of the proportion and activity level of Tfh cells were associated with poorly differentiated OS and tumor metastasis. Additionally, Kaplan-Meier and Cox regression analysis showed a longer overall survival in patients with low proportion of peripheral blood CD4+CXCR5+ Tfh cells in CD4+ T cells, and their activation level may be a prognostic factor in OS patients. In conclusion, peripheral blood CD4+CXCR5+ Tfh cell activation in OS patients was associated with a poor prognosis. This study provided ideas for improving the clinical treatment of OS patients.
Collapse
Affiliation(s)
- Jianshu Lu
- Department of Orthopaedics, Dongying People's Hospital, Dongying, China
| | - Xiuqin Kang
- Department of Orthopaedics, Dongying People's Hospital, Dongying, China
| | - Zhitao Wang
- Department of Orthopaedics, Dongying People's Hospital, Dongying, China
| | - Gang Zhao
- Department of Orthopaedics, Dongying People's Hospital, Dongying, China
| | - Baoen Jiang
- Department of Orthopaedics, Dongying People's Hospital, Dongying, China
| |
Collapse
|
4
|
Abstract
There are a number of rare T-cell lymphoma subtypes that may be encountered in clinical practice. In recent years, improved immunohistochemical techniques and molecular tumor profiling have permitted refinement of some of the diagnostic categories in this group, as well as the recognition of distinct conditions not previously well elucidated. In this chapter, we cover the diagnostic and clinical features of some of the more common of these conditions, including subcutaneous panniculitis-like T-cell lymphoma, cutaneous gamma-delta T-cell lymphoma, enteropathy-associated T-cell lymphoma, monomorphic epitheliotropic intestinal T-cell lymphoma, primary cutaneous CD8-positive aggressive epidermotropic cytotoxic T-cell lymphoma, CD4-positive small/medium T-cell lymphoproliferative disorder, and acral CD8-positive T-cell lymphoma. Given the rarity of these conditions, optimal treatments approaches are not always well established, not least as data from large-scale clinical trials are lacking. In this chapter, we aim to provide a summation of current thinking around best treatment, as well as highlighting some controversies in the management of these diagnoses.
Collapse
Affiliation(s)
- C van der Weyden
- Department of Haematology, Peter MacCallum Cancer Centre, Melbourne, Australia.
| | - C McCormack
- Department of Surgical Oncology, Peter MacCallum Cancer Centre, Melbourne, Australia
- Department of Dermatology, St Vincent's Hospital, Fitzroy, Australia
- Department of Oncology, Sir Peter MacCallum, The University of Melbourne, Parkville, Australia
| | - S Lade
- Department of Oncology, Sir Peter MacCallum, The University of Melbourne, Parkville, Australia
- Department of Anatomical Pathology, Peter MacCallum Cancer Centre, Melbourne, Australia
| | - R W Johnstone
- Department of Oncology, Sir Peter MacCallum, The University of Melbourne, Parkville, Australia
- Research Division, Peter MacCallum Cancer Centre, Melbourne, Australia
| | - H M Prince
- Department of Haematology, Peter MacCallum Cancer Centre, Melbourne, Australia
- Department of Oncology, Sir Peter MacCallum, The University of Melbourne, Parkville, Australia
- Epworth Healthcare, Melbourne, Australia
| |
Collapse
|
5
|
Primary Cutaneous Follicular Helper T-Cell Lymphoma: A Case Series and Review of the Literature. Am J Dermatopathol 2018; 39:374-383. [PMID: 28375859 DOI: 10.1097/dad.0000000000000695] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
Primary cutaneous follicular helper T-cell (Tfh) lymphoma is a recently described variant of peripheral T-cell lymphoma-not otherwise specified. This particular variant, usually presenting as a sudden onset of multiple plaques and nodules, is characterized by tumoral atypical T cells that express an array of Tfh markers, such as inducible T-cell costimulator, Bcl-6, CXCL13, PD-1, and CD10. The authors now present 3 patients whose known clinical skin findings are consistent with PTCL of Tfh origin (PTCL-Tfh). The typically protracted pattern of skin disease manifesting as scaly patches and plaques encountered in mycosis fungoides was not seen in our 3 cases, and there were distinguishing light microscopic and phenotypic features. These cases are similar to the few previous reported cases of PTCL-Tfh, although systemic involvement was not seen. The categorization of additional patients into this PTCL subtype in the medical literature would be needed to further characterize this new entity and may lead to better targeted treatments based on specific T-cell subtypes.
Collapse
|
6
|
Differential NFATc1 Expression in Primary Cutaneous CD4+ Small/Medium-Sized Pleomorphic T-Cell Lymphoma and Other Forms of Cutaneous T-Cell Lymphoma and Pseudolymphoma. Am J Dermatopathol 2017; 39:95-103. [DOI: 10.1097/dad.0000000000000597] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
|
7
|
Primary Cutaneous Follicular Helper T-cell Lymphoma in a Patient With Neurofibromatosis Type 1: Case Report and Review of the Literature. Am J Dermatopathol 2017; 39:134-139. [PMID: 28134730 DOI: 10.1097/dad.0000000000000697] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Patients with neurofibromatosis type 1 (NF-1) have a well-known predisposition for certain types of malignancies, including lymphoproliferative disorders. Cutaneous T-cell lymphoma (CTCL) has been reported in patients with NF-1, although it is considered a rare entity in this subset of patients. Cutaneous follicular helper T-cell lymphoma (CTFHCL) is a recently emerged rare subtype of CTCL with peculiar clinical and histopathological features and represents a diagnostic and therapeutic challenge. Only a few cases of CTFHCL have been reported in the literature. We report a case of CTFHCL in a patient with NF-1 and compare our findings with previously reported cases. We aim to raise awareness among pathologists regarding this rare subtype of CTCL and emphasize characteristic histological features of CTFHCL, which can be confused with B-cell lymphomas and lead to mismanagement.
Collapse
|
8
|
Extranodal Marginal Zone Lymphoma-like Presentations of Angioimmunoblastic T-Cell Lymphoma: A T-Cell Lymphoma Masquerading as a B-Cell Lymphoproliferative Disorder. Am J Dermatopathol 2016; 37:604-13. [PMID: 25839892 DOI: 10.1097/dad.0000000000000266] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Angioimmunoblastic T-cell lymphoma (AITL) is the second most common type of peripheral T-cell lymphoma worldwide, and in some countries, it is the most common form. Clinically, AITL usually presents with systemic symptoms, diffuse lymphadenopathy, hepatosplenomegaly, and common laboratory abnormalities such as hypergammaglobulinemia. Rashes are seen in 50%-80% of patients. AITL derives from follicular T-helper cells (TFH), that express germinal center markers and produce hyperactivation of B-cells seen in AITL. Although the histological features of AITL in the skin could be similar to pathological findings present in lymph node biopsies, herein, we present 2 cases of AITL with histological and immunophenotypic features that were somewhat suggestive of extranodal marginal zone lymphoma. Caution is urged to exclude the possibility of a systemic T-cell lymphoma such as AITL in cutaneous and lymph node B-cell proliferations.
Collapse
|
9
|
Oka T, Sugaya M, Cury-Martins J, Vasconcelos-Berg R, Suga H, Miyagaki T, Scheinberg P, Fujita H, Izutsu K, Sato S, Sanches JA. Hematopoietic stem cell transplantation for cutaneous T-cell lymphoma: Summary of 11 cases from two facilities in Japan and Brazil. J Dermatol 2015; 43:638-42. [PMID: 26602996 DOI: 10.1111/1346-8138.13199] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2015] [Accepted: 09/28/2015] [Indexed: 11/29/2022]
Abstract
Some patients with cutaneous T-cell lymphoma (CTCL) show a miserable clinical course and the only option that can induce long-term remission for advanced CTCL may be hematopoietic stem cell transplantation (HSCT). So far, studies on HSCT for CTCL patients have been limited. In this study, we summarized 11 cases with CTCL treated with HSCT, including nine cases in Japan and two cases in Brazil. The patients were five cases with mycosis fungoides (MF), two cases with Sézary syndrome (SS), three cases with anaplastic large cell lymphoma, and one case with primary cutaneous peripheral T-cell lymphoma, not otherwise specified (PTL-NOS). Currently, seven out of 11 cases are alive (at 13-108 months after transplantation) and four died at 15 days to 14 months after transplantation. When focusing on the eight patients who received allogeneic HSCT for MF/SS and PTL-NOS, all four patients at 45 years old or under are alive at present. One case showed relapse in the skin. On the other hand, one out of the other four patients at over 45 years old survived. Engraftment failure was seen in one case and all the other three cases experienced relapse. Although this is only a case series with a small number, our study has suggested that we should be careful about age when treating patients with MF/SS by allogeneic HSCT.
Collapse
Affiliation(s)
- Tomonori Oka
- Department of Dermatology, Faculty of Medicine, University of Tokyo, Tokyo, Japan
| | - Makoto Sugaya
- Department of Dermatology, Faculty of Medicine, University of Tokyo, Tokyo, Japan
| | - Jade Cury-Martins
- Department of Dermatology, University of São Paulo Medical School, Sao Paulo, Brazil
| | | | - Hiraku Suga
- Department of Dermatology, Faculty of Medicine, University of Tokyo, Tokyo, Japan
| | - Tomomitsu Miyagaki
- Department of Dermatology, Faculty of Medicine, University of Tokyo, Tokyo, Japan
| | | | - Hideki Fujita
- Department of Dermatology, Faculty of Medicine, University of Tokyo, Tokyo, Japan
| | - Koji Izutsu
- Department of Hematology, Toranomon Hospital, Tokyo, Japan
| | - Shinichi Sato
- Department of Dermatology, Faculty of Medicine, University of Tokyo, Tokyo, Japan
| | - José A Sanches
- Department of Dermatology, University of São Paulo Medical School, Sao Paulo, Brazil
| |
Collapse
|
10
|
Santonja C, Soto C, Manso R, Requena L, Piris MA, Rodríguez-Pinilla SM. Primary cutaneous follicular helper T-cell lymphoma. J Cutan Pathol 2015; 43:164-70. [DOI: 10.1111/cup.12614] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2015] [Revised: 08/13/2015] [Accepted: 08/16/2015] [Indexed: 11/27/2022]
Affiliation(s)
| | - Carlos Soto
- Hematology Department; Fundación Jiménez Díaz; Madrid Spain
| | - Rebeca Manso
- Pathology Department; Fundación Jiménez Díaz; Madrid Spain
| | - Luis Requena
- Dermatology Department; Fundación Jiménez Díaz; Madrid Spain
| | - Miguel Angel Piris
- Pathology Department; Hospital Universitario Marqués de Valdecilla; Santander Spain
| | | |
Collapse
|
11
|
Expression of T-Follicular Helper Markers in Sequential Biopsies of Progressive Mycosis Fungoides and Other Primary Cutaneous T-Cell Lymphomas. Am J Dermatopathol 2015; 37:115-21. [DOI: 10.1097/dad.0000000000000258] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
|
12
|
Ocampo-Garza J, Herz-Ruelas ME, González-Lopez EE, Mendoza-Oviedo EE, Garza-Chapa JI, Ocampo-Garza SS, Vázquez-Herrera NE, Miranda-Maldonado I, Ocampo-Candiani J. Angioimmunoblastic T-cell lymphoma: a diagnostic challenge. Case Rep Dermatol 2014; 6:291-5. [PMID: 25685133 PMCID: PMC4307011 DOI: 10.1159/000370302] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Angioimmunoblastic T-cell lymphoma (AITL) accounts for 15–20% of all peripheral T-cell lymphomas. It is a rare subtype of CD4 T-cell peripheral lymphoma that affects aged individuals, causing B symptoms, generalized lymphadenopathy and hepatosplenomegaly. Its pathogenesis is still unclear, but in some cases it has been associated with infection, allergic reaction or drug exposure. The majority of patients are diagnosed in an advanced stage and anthracycline based regimen is considered the first-line therapy. Skin involvement is not well characterized, occurring in up to 50% of patients and presenting as nonspecific rash, macules, papules, petechiae, purpura, nodules and urticaria. We present the illustrative case of a 55-year-old woman with an AITL who presented prominent skin findings, arthritis, lymphadenopathy and hypereosinophilia. Skin biopsy reported a T-cell lymphoma and the diagnosis of AITL was confirmed by an axillary lymph node biopsy, which was also positive for Epstein-Barr virus. Chemotherapy with CHOP-21 and thalidomide was given, accomplishing complete remission after six cycles.
Collapse
Affiliation(s)
- Jorge Ocampo-Garza
- Department of Dermatology, University Hospital 'Dr. José Eleuterio González', Universidad Autónoma de Nuevo León, Monterrey, Mexico
| | - Maira Elizabeth Herz-Ruelas
- Department of Dermatology, University Hospital 'Dr. José Eleuterio González', Universidad Autónoma de Nuevo León, Monterrey, Mexico
| | - Elias Eugenio González-Lopez
- Department of Hematology, University Hospital 'Dr. José Eleuterio González', Universidad Autónoma de Nuevo León, Monterrey, Mexico
| | - Eric Eduardo Mendoza-Oviedo
- Department of Pathology, University Hospital 'Dr. José Eleuterio González', Universidad Autónoma de Nuevo León, Monterrey, Mexico
| | - Juana Irma Garza-Chapa
- Department of Dermatology, University Hospital 'Dr. José Eleuterio González', Universidad Autónoma de Nuevo León, Monterrey, Mexico
| | - Sonia Sofía Ocampo-Garza
- Department of Dermatology, University Hospital 'Dr. José Eleuterio González', Universidad Autónoma de Nuevo León, Monterrey, Mexico
| | - Norma Elizabeth Vázquez-Herrera
- Department of Dermatology, University Hospital 'Dr. José Eleuterio González', Universidad Autónoma de Nuevo León, Monterrey, Mexico
| | - Ivett Miranda-Maldonado
- Department of Pathology, University Hospital 'Dr. José Eleuterio González', Universidad Autónoma de Nuevo León, Monterrey, Mexico
| | - Jorge Ocampo-Candiani
- Department of Dermatology, University Hospital 'Dr. José Eleuterio González', Universidad Autónoma de Nuevo León, Monterrey, Mexico
| |
Collapse
|
13
|
Han L, Liu F, Li R, Li Z, Chen X, Zhou Z, Zhang X, Hu T, Zhang Y, Young K, Sun S, Wen J, Zhang M. Role of programmed death ligands in effective T-cell interactions in extranodal natural killer/T-cell lymphoma. Oncol Lett 2014; 8:1461-1469. [PMID: 25202350 PMCID: PMC4156194 DOI: 10.3892/ol.2014.2356] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2013] [Accepted: 04/03/2014] [Indexed: 01/15/2023] Open
Abstract
Extranodal natural killer/T-cell lymphoma (ENKL) is marked by a profound cellular immune deficiency that may influence the capacity of T cells to extract an efficient antitumor immune response. It has been confirmed that the B7-CD28 pathway may promote tumor immune evasion by providing a negative regulatory signal. The current study analyzed the expression of programmed death 1 (PD-1)/programmed death ligand (PD-L) in ENKL cell lines and tissues. The functional studies were performed to analyze the functional activity of PD-L1 interacting with effective T cells in ENKL. PD-L1 and PD-L2 mRNA levels in ENKL cell lines were markedly upregulated compared with those in normal natural killer cells. The proteins constitutively expressed in the 30 ENKL specimens were significantly higher than in the 20 rhinitis specimens. In addition, PD-L1 and PD-L2 expression were found to closely correlate with certain clinical histopathological parameters. Furthermore, the count of PD-1+ tumor-infiltrating T lymphocytes was found to negatively correlate with the expression of PD-L1 and PD-L2. The PD-1 expression in the CD4+ and CD8+ T-cell subsets of 20 ENKL patients prior to therapy were significantly higher than that of the 10 healthy volunteers. In the functional studies, the cytokines (interleukin-2 and interferon-γ) secreted by CD8+ T cells were inhibited by PD-L1 expression in SNK-6 cells and this was restored with the presence of the PD-L1 blocking antibody. However no direct effect of PD-L1 was identified on CD8+ T-cell apoptosis and CD8+ T-cell cytotoxicity, as assessed by the proliferation of SNK-6 cells in the presence or absence of the neutralizing anti-PD-L1 antibody. The results of the current study revealed that PD-Ls and PD-1 are aberrantly expressed in ENKL and, furthermore, PD-L1 expression in SNK-6 cells was found to inhibit the activity of CD8+ T-cell cytokine secretion. This indicated that the PD-Ls may prevent effective antitumor immunity in vivo by interacting with tumor T cells, which provides important evidence to delineate the cellular immune deficiency mechanism in ENKL. Therefore, PD-1/PD-Ls are predicted to become novel targets for ENKL immunotherapy.
Collapse
Affiliation(s)
- Lijuan Han
- Department of Oncology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan 450000, P.R. China
| | - Feifei Liu
- Department of Sports Medicine, Research Center of Sports Medicine, Xiangya Hospital of Central South University, Changsha, Hunan 410008, P.R. China
| | - Ruping Li
- Department of Oncology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan 450000, P.R. China
| | - Zhaoming Li
- Department of Oncology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan 450000, P.R. China
| | - Xinfeng Chen
- Biotherapy Center, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan 450000, P.R. China
| | - Zhiyuan Zhou
- Department of Oncology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan 450000, P.R. China
| | - Xudong Zhang
- Department of Oncology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan 450000, P.R. China
| | - Tengpeng Hu
- Department of Oncology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan 450000, P.R. China
| | - Yi Zhang
- Biotherapy Center, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan 450000, P.R. China
| | - Ken Young
- Department of Hematopathology, The University of Texas MD Anderson Cancer Center, Houston, TX 77230-1439, USA
| | - Suke Sun
- Institute of Clinical Medicine, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan 450000, P.R. China
| | - Jianguo Wen
- Institute of Clinical Medicine, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan 450000, P.R. China
| | - Mingzhi Zhang
- Department of Oncology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan 450000, P.R. China
| |
Collapse
|
14
|
Takaki M, Inozume T, Matsuzawa T, Ando N, Yamaguchi M, Harada K, Kawamura T, Shibagaki N, Shimada S. Case of primary cutaneous peripheral T-cell lymphoma, not otherwise specified, with characteristics of follicular helper T cells. J Dermatol 2014; 41:529-32. [DOI: 10.1111/1346-8138.12493] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2014] [Accepted: 03/13/2014] [Indexed: 11/30/2022]
Affiliation(s)
- Machiko Takaki
- Department of Dermatology; University of Yamanashi; Chuo Japan
| | - Takashi Inozume
- Department of Dermatology; University of Yamanashi; Chuo Japan
| | | | - Noriko Ando
- Department of Dermatology; University of Yamanashi; Chuo Japan
| | | | - Kazutoshi Harada
- Department of Dermatology; Tokyo Medical University; Tokyo Japan
| | | | | | - Shinji Shimada
- Department of Dermatology; University of Yamanashi; Chuo Japan
| |
Collapse
|
15
|
de Masson A, Beylot-Barry M, Bouaziz JD, Peffault de Latour R, Aubin F, Garciaz S, d'Incan M, Dereure O, Dalle S, Dompmartin A, Suarez F, Battistella M, Vignon-Pennamen MD, Rivet J, Adamski H, Brice P, François S, Lissandre S, Turlure P, Wierzbicka-Hainaut E, Brissot E, Dulery R, Servais S, Ravinet A, Tabrizi R, Ingen-Housz-Oro S, Joly P, Socié G, Bagot M. Allogeneic stem cell transplantation for advanced cutaneous T-cell lymphomas: a study from the French Society of Bone Marrow Transplantation and French Study Group on Cutaneous Lymphomas. Haematologica 2013; 99:527-34. [PMID: 24213148 DOI: 10.3324/haematol.2013.098145] [Citation(s) in RCA: 60] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
The treatment of advanced stage primary cutaneous T-cell lymphomas remains challenging. In particular, large-cell transformation of mycosis fungoides is associated with a median overall survival of two years for all stages taken together. Little is known regarding allogeneic hematopoietic stem cell transplantation in this context. We performed a multicenter retrospective analysis of 37 cases of advanced stage primary cutaneous T-cell lymphomas treated with allogeneic stem cell transplantation, including 20 (54%) transformed mycosis fungoides. Twenty-four patients (65%) had stage IV disease (for mycosis fungoides and Sézary syndrome) or disseminated nodal or visceral involvement (for non-epidermotropic primary cutaneous T-cell lymphomas). After a median follow up of 29 months, 19 patients experienced a relapse, leading to a 2-year cumulative incidence of relapse of 56% (95%CI: 0.38-0.74). Estimated 2-year overall survival was 57% (95%CI: 0.41-0.77) and progression-free survival 31% (95%CI: 0.19-0.53). Six of 19 patients with a post-transplant relapse achieved a subsequent complete remission after salvage therapy, with a median duration of 41 months. A weak residual tumor burden before transplantation was associated with increased progression-free survival (HR=0.3, 95%CI: 0.1-0.8; P=0.01). The use of antithymocyte globulin significantly reduced progression-free survival (HR=2.9, 95%CI: 1.3-6.2; P=0.01) but also transplant-related mortality (HR=10(-7), 95%CI: 4.10(-8)-2.10(-7); P<0.001) in univariate analysis. In multivariate analysis, the use of antithymocyte globulin was the only factor significantly associated with decreased progression-free survival (P=0.04). Allogeneic stem cell transplantation should be considered in advanced stage primary cutaneous T-cell lymphomas, including transformed mycosis fungoides.
Collapse
|