CUTANEOUS MANIFESTATIONS OF ANGIOIMMUNOBLASTIC T-CELL LYMPHOMA

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Abstract


Background: Angioimmunoblast T-cell lymphoma (AITL) is a rare T-cell lymphoproliferative disease that is accompanied by generalized lymphadenopathy, hepatosplenomegaly, intoxication symptoms and extranodal lesions. The extranodal manifestations of the disease frequently involve various skin changes. One of the first such manifestations is maculopapular rashes observed in about half of AITL patients and usually preceding the appearance of lymphadenopathy. Other forms of skin lesions accompany the disease considerably less frequently.

Aim: To characterize the range of skin changes in patients suffering from AITL, to establish a correspondence between the nature of skin changes and their histological picture.

Materials and methods: 54 AITL patients were being treated at the National Research Centre for Hematology from 2000 to 2017, with the male/female ratio being 30/24. The median age was 61 (29–81) years.

Results: Changes in the skin were observed in 24 (44.4 %) of 54 AITL patients, out of whom 18 (75 %) and 6 (25 %) were male and female patients, respectively. Maculopapular rash was observed in 22 (91.7 %) out of 24 patients. The morphological and molecular investigations of skin biopsy specimens exhibiting maculopapular rash demonstrated nonspecific reactive changes. Patients with maculopapular rash demonstrated an increase in the level of total (polyclonal) IgE. Specific skin lesions detected in 8 (14.8 %) cases were represented by a ‘livedo reticularis’, focal skin hyperpigmentation, erythroderma, left eyelid tumour and tumour in 3, 2, 1, 1 and 1 cases, respectively.

Conclusion: Maculopapular rash frequently observed in AITL patients is a reactive process not associated with a specific skin lesion. Specific skin lesions in AITL are much less common and can be represented by various forms. In some AITL cases, skin changes of the reactive and tumour nature can be simultaneously observed. 


About the authors

N. G. Chernova

National Research Center for Hematology, Ministry of Healthcare of the Russian Federation

Author for correspondence.
Email: ngchernova@mail.ru

Russian Federation

Cand. Sci. (Medicine), researcher,

Novy Zykovsky proezd, 4, Moscow, 125167

M. N. Sinitsyna

National Research Center for Hematology, Ministry of Healthcare of the Russian Federation

Email: msini@mail.ru

Russian Federation

researcher,

Novy Zykovsky proezd, 4, Moscow, 125167

Yu. V. Sidorova

National Research Center for Hematology, Ministry of Healthcare of the Russian Federation

Email: iouliavl@rambler.ru

Russian Federation

Cand. Sci. (Medicine), Senior Researcher of Medical Science, researcher,

Novy Zykovsky proezd, 4, Moscow, 125167

N. P. Soboleva

National Research Center for Hematology, Ministry of Healthcare of the Russian Federation

Email: nsoboleva@list.ru

Russian Federation

Clinical Laboratory Scientist,

Novy Zykovsky proezd, 4, Moscow, 125167

A. B. Sudarikov

National Research Center for Hematology, Ministry of Healthcare of the Russian Federation

Email: kovrigina.alla@gmail.com

Russian Federation

Dr. Sci. (Biology), Head of Laboratory,

Novy Zykovsky proezd, 4, Moscow, 125167

A. M. Kovrigina

National Research Center for Hematology, Ministry of Healthcare of the Russian Federation

Email: dusha@blood.ru

Russian Federation

Dr. Sci. (Biology), Head of Laboratory,

Novy Zykovsky proezd, 4, Moscow, 125167

V. N. Dvirnyk

National Research Center for Hematology, Ministry of Healthcare of the Russian Federation

Email: vdvirnyk@mail.ru

Russian Federation

Cand. Sci. (Medicine), Dr. Sci. (Biology), Head of Laboratory,

Novy Zykovsky proezd, 4, Moscow, 125167

E. E. Zvonkov

National Research Center for Hematology, Ministry of Healthcare of the Russian Federation

Email: dr.zvonkov@gmail.com

Russian Federation

Dr. Sci. (Medicine), Departmental Head,

Novy Zykovsky proezd, 4, Moscow, 125167

References

  1. Swerdlow S. H., Campo E., Harris N. L., Jaffe E. S., Pileri S. A., Stein H., et al. WHO classification of tumors of haematopoietic and lymphoid tissues. Lyon: IARC;2017:407–10.
  2. Vose J., Armitage J., Weisenburger D. International peripheral T-cell and natural killer/T-cell lymphoma study: pathology findings and clinical outcomes. J Clin Oncol. 2008;1;26(25):4124–30. doi: 10.1200/JCO.2008.16.4558
  3. Виноградова Ю. Е., Луценко И. Н., Кременецкая А. М., Капланская И. Б., Самойлова Р. С., Шкловский-Корди Н. Е., Гилязитдинова Е. А., Губкин А. В., Джулакян У. Л., Марголин О. В., Марьин Д. С., Чернова Н. Г., Кравченко С. К. Структура T/NK-клеточных лимфатических опухолей в Гематологическом научном центре РАМН. Проблемы гематологии и переливания крови. 2005;4: 30–34. [Vinogradova Yu. E., Lutsenko I.N., Kremenetskaya A. M., Kaplanskaya I. B., Samoylova R. S., Shklovsky-Cordy N. E., Gilyazitdinova E. A., Gubkin A. V., Djulakyan U. L., Margolin O. V., Maryin D. S., Chernova N. G., Kravchenko S. K. Structure of T/NK-cell lymphatic tumors in the Hematology Research Center of the Russian Academy of Medical Sciences. Problems of hematology and blood transfusion. 2005;4:30–34.]
  4. de Leval L., Gisselbrecht C., Gaulard P. Advances in the understanding and management of angioimmunoblastic T-cell lymphoma. Br J Haematol. 2009;148:673–89. doi: 10.1111/j.1365-2141.2009.08003.x
  5. Чернова Н. Г., Виноградова Ю. Е., Сидорова Ю. В., Капланская И. Б., Гилязитдинова Е. А., Горенкова Л. Г., Марьин Д. С., Кременецкая А. М., Воробьев А. И., Кравченко С. К. Длительные режимы цитостатической терапии ангиоиммунобластной Т-клеточной лимфомы. Клиническая онкогематология. Фундаментальные исследования и клиническая практика. 2014.;7(1):57–62. [Chernova N. G, Vinogradova Yu. E., Sidorova Yu. V., Kaplanskaya I. B., Gilyazitdinova E. A., Gorenkova L. G., Mariin D. S., Kremenetska A. M., Vorobyov A. I., Kravchenko S. K. Long-term regimens of cytostatic therapy of angioimmunoblastic T-cell lymphoma. Clinical oncohematology. Fundamental research and clinical practice. 2014.;7(1):57–62.]
  6. Willenbrock K., Renné C., Gaulard P., Hansmann M. L. In angioimmunoblastic T-cell lymphoma, neoplastic T cells may be a minor cell population. A molecular single-cell and immunohistochemical study. Virchows Arch. 2005 Jan;446(1):15–20.
  7. Weiss L. M., Jaffe E. S., Liu X. F., Chen Y. Y., Shibata D., Medeiros L. J. Detection and localization of Epstein-Barr viral genomes in angioimmunoblastic lymphadenopathy and angioimmunoblastic lymphadenopathy-like lymphoma. Blood. 1992;79:1789–95.
  8. Dupuis J., Boye K., Martin N., Copie-Bergman C., Plonquet A., Fabiani B., Baglin A.C., Haioun C., Delfau-Larue M. H., Gaulard P. Expression of CXCL13 by neoplastic cells in angioimmunoblastic T-cell lymphoma (AITL). A new diagnostic marker providing evidence that AITL derives from follicular helper T-cells. Am. J. Surg. Pathol. 2006;30:490–4.
  9. Attygalle A, Al Jehani R., Diss T. C., Munson P., Liu H., Du M. Q., Isaacson P. G., Dogan A. Neoplastic T cells in angioimmunoblastic T-cell lymphoma express CD10. Blood. 2002;99:627–33.
  10. Yu H., Shahsafaei A., Dorfman D. Germinal-center T-helper cell markers PD-1 and CXCL13 are both expressed by neoplastic cells in angioimmunoblastic T-cell lymphoma. Am J Clin Pathol. 2009 Jan;131(1):33– 41. doi: 10.1309/AJCP62WRKERPXDRT
  11. Cho-Vega J. H., Medeiros L. J., Prieto V. G., Vega F. Leukemia cutis Am J Clin Pathol. 2008 Jan;129(1):130–42. DOI: 10.1309/ WYACYWF6NGM3WBRT
  12. Чернова Н. Г., Синицына М. Н., Двирнык В. Н., Ковригина А. М., Звонков Е. Е., Паровичникова Е. Н. Поражение кожи при остром монобластном лейкозе (клиническое наблюдение). Вестник дерматологии и венерологии. 2017. №1.С 46-50. [Chernova N. G, Sinitsyna M. N., Dvirnyk V. N., Kovrigina A. M., Zvonkov E. E., Parovnikikova Ye. N. Skin lesion with acute monoblast leukemia (clinical observation). Herald of dermatology and venereology. 2017;1:46–50.]
  13. Faaij C. M., Willemze A. J., Revesz T., et al. Chemokine/chemokine receptor interactions in extramedullary leukaemia of the skin in childhood AML: Differential roles for CCR2, CCR5, CXCR4 and CXCR7. Pediatr Blood Cancer. 2010:55; 344–8. doi: 10.1002/pbc.22500
  14. Bernstein J. E., Soltani K., Lorincz A. L. Cutaneous manifestations of angioimmunoblastic lymphadenopathy. J Am Acad Dermatol. 1979;1:227–32.
  15. Ковынев И. Б., Агеева Т. А, Обгольц Ю. Н. Клинические маски периферических Т-клеточных лимфом: ангиоиммунобластная Т-клеточная неходжкинская лимфома. Сибирский научный медицинский журнал. 2011;31(2):108–111. [Kovynev I. B., Ageeva T. A., Obgolts Yu. N. Clinical masks of peripheral T-cell lymphomas: angioimmunoblast T-cell non-Hodgkin’s lymphoma. Siberian Scientific Medical Journal. 2011;31(2):108–111.]
  16. Kang M., Bhatia N., Sauder A., Feurdean M. Angioimmunoblastic T Cell Lymphoma Mimicking Chronic Urticaria. Case Rep Med. 2016;2016:8753235. doi: 10.1155/2016/8753235
  17. Jayaraman A. G., Cassarino D., Advani R., Kim Y. H., Tsai E., Kohler S. Cutaneous involvement by angioimmunoblastic T-cell lymphoma: a unique histologic presentation, mimicking an infectious etiology. J Cutan Pathol. 2006 Sep;33(2):6–11.
  18. Botros N., Cerroni L., Shawwa A., Green P. J., Greer W., Pasternak S., Walsh N. M. Cutaneous manifestations of angioimmunoblastic T-cell lymphoma: clinical and pathological characteristics. Am J Dermatopathol. 2015 Apr;37(4):274-83. doi: 10.1097/DAD.0000000000000144
  19. Martel P., Laroche L., Courville P., Larroche C., Wechsler J., Lenormand B., Delfau M. H., Bodemer C., Bagot M., Joly P. Cutaneous involvement in patients with angioimmunoblastic lymphadenopathy with dysproteinemia: a clinical, immunohistological, and molecular analysis. Archives of Dermatology. 2000;136:881–6.
  20. Dongen J. J., Langerak A. W., Bruggemann M., Evans P. A., Hummel M., Lavender F. L., Delabesse E., Davi F., Schuuring E., Garcia-Sanz R., Krieken J. H., Droese J., Gonzalez D., Bastard C., White H. E., Spaargaren M., Gonzalez M., Parreira A., Smith J. L., Morgan G. J., Kneba M., Macintyre E. A. Design and standardization of PCR primers and protocols for detection of clonal immunoglobulin and T-cell receptor gene recombinations in suspect lymphoproliferations: report of the BIOMED-2 Concerted Action BMH4-CT98-3936. Leukemia. 2003.
  21. Сидорова Ю. В., Чернова Н. Г., Рыжикова Н. В., Смирнова С. Ю., Синицына М. Н., Виноградова Ю. Е., Джулакян У. Л., Ковригина А. М., Звонков Е. Е., Судариков А. Б. Клональные реаранжировки и опухолевые клоны при периферической Т-клеточной лимфоме. Acta Naturae. 2015;7:3(26):130–140. [Sidorova Yu. V., Chernova N. G., Ryzhikova N. V., Smirnova S. Yu., Sinitsyna M. N., Vinogradova Yu. E., Djulakyan U. L., Kovrigina A. M., Zvonkov E. E., Sudarikov A. B. Clonal rearrangements and tumor clones in peripheral T-cell lymphoma. Acta Naturae. 2015;7:3(26):130–140.]
  22. Nakamoto-Matsubara R., Sakata-Yanagimoto M., Enami T., Yoshida K., Yanagimoto S., Shiozawa Y., Nanmoku T., Satomi K., Muto H., Obara N., Kato T., Kurita N., Yokoyama Y., Izutsu K., Ota Y., Sanada M., Shimizu S., Komeno T., Sato Y., Ito T., Kitabayashi I., Takeuchi K., Nakamura N., Ogawa S., Chiba S. Detection of the G17V RHOA mutation in angioimmunoblastic T-cell lymphoma and related lymphomas using quantitative allele-specific PCR. PLoS One. 2014 Oct 13; 9(10):e109714. DOI: 10.1371/ journal.pone.0109714
  23. Воробьев А. И., Воробьев И. А., Грецов Е. М., Кременецкая А. М., Корнева Е. П., Магомедова А. У. Харазишвили Д. В., Худолеева О. А., Чернова Н. Г. Вопросы теоретической гематологии. Терапевтический архив. 2003;75(9):22–29. [Vorobyev A.I, Vorobyev I. A., Gretsov E. M, Kremenetsky A. M., Korneva E. P., Magomedova A. U., Kharazishvili D. V, Khudoleva O. A., Chernova N. G. Questions of theoretical hematology. Therapeutic archive. 2003;75(9):22–29.]
  24. Lee W. J., Won K. H., Won C. H., Chang S. E., Choi J. H., Moon K. C., Park C. S., Huh J., Suh C., Lee M. W. Secondary Cutaneous Diffuse Large B-cell Lymphoma has a Higher International Prognostic Index Score and Worse Prognosis Than Diffuse Large B-cell Lymphoma, Leg Type Acta Derm Venereol. 2016 Feb;96(2):245–50. doi: 10.2340/00015555-2139
  25. Reich A., Wróbel G., Kazanowska B., Maldyk J., Bubala H., Dluzniewska A., Stefaniak J., Stefanska K., Stolarska M. Skin involvement in highly malignant non-Hodgkin lymphomas of childhood and adolescence. Acta Dermatovenerol Alp Pannonica Adriat. 2006 Dec;15(4):158–68.

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