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J Cutan Pathol. 2019 Aug 12. doi: 10.1111/cup.13564. [Epub ahead of print]

A histo-immunopathologic and prognostic study of erythrodermic cutaneous T-cell lymphoma.

Author information

1
Sydney Kimmel Comprehensive Cancer Center, Johns Hopkins Medical Institutes, Baltimore, Maryland.
2
Dermatopathologist, Dermpath Diagnostics, Institute for Dermatopathology, Newtown Square, Pennsylvania.
3
Department of Dermatology, The Warren Alpert Medical School of Brown University, Providence, Rhode Island.
4
Mid-Atlantic Permanente Medical Group, Falls Church, Virginia.
5
Department of Dermatology, Boston University and Roger Williams Medical Center, Providence, Rhode Island.

Abstract

BACKGROUND:

Sézary syndrome (SS) and erythrodermic mycosis fungoides (E-MF) represent two expressions of erythrodermic cutaneous T-cell lymphoma (E-CTCL).

METHODS:

Histopathologic features were compared on skin specimens from 41 patients with SS and 70 patients with E-MF. Immunopathologic findings were compared on 42 SS and 79 E-MF specimens.

RESULTS:

Specimens of SS usually showed band-like dermal infiltrates with intermediate-sized lymphoid cells and few plasma cells; on the other hand E-MF more often had a perivascular infiltrative pattern, predominance of small/mixed lymphoid cells and eosinophils. SS also had lower numbers of CD8+ cells and higher numbers of CD62L+ cells compared to E-MF. For E-MF patients, the presence of large Pautrier collections, infiltrates with intermediate-sized cells, increased number of mitotic figures and ≥50% CD62L+ cells in the dermal infiltrate correlated with a relatively poor disease-specific survival. However, only the presence of mitotic figures retained prognostic significance with clinical stage as a covariate.

CONCLUSIONS:

Clinical stage provides the most important prognostic information for patients with E-CTCL. However, mitotic activity for E-MF and CD8+ cells <20% for SS have additional value. We hypothesize that observed differences in plasma cell and eosinophil numbers may reflect the influence of CD62L+ central memory T-cells in the microenvironment.

KEYWORDS:

CD62L; Sézary syndrome; cutaneous T-cell lymphoma; mycosis fungoides; prognosis

PMID:
31403211
DOI:
10.1111/cup.13564

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