Long‐term follow‐up and management of small and medium‐sized CD4+ T cell lymphoma and CD8+ lymphoid proliferations of acral sites: a multicenter experience. (5th October 2016)

• Record Type: Journal Article
• Authors: Virmani, Pooja; Jawed, Sarah; Myskowski, Patricia L.; Horwitz, Steven; Skripnik Lucas, Anna; Moskowitz, Alison; Pulitzer, Melissa; Zain, Jasmine; Rosen, Steven T.; Querfeld, Christiane
• Is Part Of: International journal of dermatology. Volume 55:Number 11(2016)
• Page Start: 1248
• Page End: 1254
• Publication Date: 2016-10-05
• Subjects: cutaneous lymphoma -- cutaneous T cell lymphoma; Dermatology -- Periodicals; 616.5
• DOI: 10.1111/ijd.13340
• Languages: English
• ISSNs: 0011-9059

Abstract

Abstract: Background: Primary cutaneous CD4 + small–medium pleomorphic T cell lymphoma (SMPTCL) is a low‐grade cutaneous T cell lymphoma. Its clinical and histopathologic features are comparable with those of CD8 + lymphoid proliferations (LPs) of the ear and acral sites. Objectives: We performed a retrospective analysis of patients with CD4 + SMPTCL or CD8 + LP to elucidate the clinical course, prognosis, and outcomes. Methods: Demographic, clinical, and treatment data were reviewed. Histopathologic data based on architectural, cytomorphologic, and immunohistochemical features were assessed. Immunohistochemical staining for T and B cell markers was evaluated. Results: A total of 25 patients including 22 with CD4 + SMPTCL and three with CD8 + LP were identified. All patients presented with a single lesion, predominantly on the head, neck, or upper trunk (84%). No patients showed extracutaneous disease at any evaluation. The most common histopathologic changes showed a dense nodular infiltrate of small cells with hyperchromatic nuclei without significant follicular or adnexal involvement. Patients were treated with excision (48%), local radiation (28%), or topical or intralesional steroids (24%). All patients achieved complete resolution of disease. Five patients demonstrated cutaneous relapse at new sites. Conclusions: The CD4 + SMPTCL/CD8 + LP subgroup usually presents with solitary lesions and demonstrates an indolent clinical course. Typical presentation, classic histopathology, widespread expression of follicular T helper cell markers, and loss of a T cell antigen are diagnostic features of CD4 + SMPTCL, whereas monomorphous CD8 + infiltrate without follicular T helper cell markers is consistent with CD8 + LP. Local skin‐directed therapy is appropriate in these patients.