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Cutaneous lymphocyte antigen expression loss and PD1 positivity in early cutaneous lesions of rapidly progressive mycosis fungoides.

Ogunrinade O, Ahn CS, Gergis U, Yassin AH, Magro C - Clin Case Rep (2014)

Bottom Line: It's important to assess cases both clinically and pathologically for factors potentially predictive of an aggressive clinical course.We concluded that the relative immunosuppressive effects of PD1 may contribute to tumor progression while the lack of staining for cutaneous lymphocyte antigen may be an additional factor facilitating distant extracutaneous migration.

View Article: PubMed Central - PubMed

Affiliation: Department of Dermatology, Weill Cornell Medical College New York City, New York, 10065.

ABSTRACT

Key clinical message: It's important to assess cases both clinically and pathologically for factors potentially predictive of an aggressive clinical course. We concluded that the relative immunosuppressive effects of PD1 may contribute to tumor progression while the lack of staining for cutaneous lymphocyte antigen may be an additional factor facilitating distant extracutaneous migration.

No MeSH data available.


Related in: MedlinePlus

(A) In July 2013, the patient underwent a biopsy of one of his many tumor nodules. This low-power image shows an effacing nodular malignant infiltrate dominated by large atypical lymphocytes. (B) This higher magnification shows the pleomorphic infiltrate. The cells are in the 20–30 micron size range and are largely unaccompanied by other significant inflammatory cell elements. (C) The neoplastic cells do not show any significant immunoreactivity for cutaneous lymphocyte antigen.
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fig08: (A) In July 2013, the patient underwent a biopsy of one of his many tumor nodules. This low-power image shows an effacing nodular malignant infiltrate dominated by large atypical lymphocytes. (B) This higher magnification shows the pleomorphic infiltrate. The cells are in the 20–30 micron size range and are largely unaccompanied by other significant inflammatory cell elements. (C) The neoplastic cells do not show any significant immunoreactivity for cutaneous lymphocyte antigen.

Mentions: Subsequent biopsies in February of 2013 and July of 2013 appeared similar showing a massive effacing diffuse and nodular malignant lymphocytic infiltrate (Fig.8A). The cells were in the 20–30 micron size range exhibiting a vesicular chromatin with basophilic to eosinophilic nucleoli (Fig.8B). There were a number of atypical mitoses. A few scattered eosinophils and histiocytes were observed. While the dominant cell populace was a pleomorphic large cell, there were small foci of epidermotropism of smaller hyperchromatic and hyperconvoluted lymphocytes diagnostic of those encountered in MF. The B specimen showed the same fundamental process of a diffuse and nodular malignant large cell infiltrate. These cells were in the 15–20 micron size range; however, there was a smattering of hyperconvoluted cerebriform lymphocytes disposed amidst this malignant large cell infiltrate. The tumor cells were extensively positive for the pan T-cell markers CD3 and CD5 and were of the BetaF1 subset. There was a marked reduction in the expression of CD7. The CD30 preparation showed only a few positive-staining cells. The CD4+ and CD25+ regulatory T-cell component was very minimal and did not occupy more than 10–15% of the infiltrate; there were broad sheets of malignant cells without regulatory T-cell activity. There was significant staining for CD25. 30% to 40% of the infiltrate showed strong cytoplasmic membrane pattern of staining. As with the earlier biopsies, there was marked expression of PD-1 (Fig.9) and a loss of immunoreactivity of the neoplastic cells for CLA (Fig.8C).


Cutaneous lymphocyte antigen expression loss and PD1 positivity in early cutaneous lesions of rapidly progressive mycosis fungoides.

Ogunrinade O, Ahn CS, Gergis U, Yassin AH, Magro C - Clin Case Rep (2014)

(A) In July 2013, the patient underwent a biopsy of one of his many tumor nodules. This low-power image shows an effacing nodular malignant infiltrate dominated by large atypical lymphocytes. (B) This higher magnification shows the pleomorphic infiltrate. The cells are in the 20–30 micron size range and are largely unaccompanied by other significant inflammatory cell elements. (C) The neoplastic cells do not show any significant immunoreactivity for cutaneous lymphocyte antigen.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4302628&req=5

fig08: (A) In July 2013, the patient underwent a biopsy of one of his many tumor nodules. This low-power image shows an effacing nodular malignant infiltrate dominated by large atypical lymphocytes. (B) This higher magnification shows the pleomorphic infiltrate. The cells are in the 20–30 micron size range and are largely unaccompanied by other significant inflammatory cell elements. (C) The neoplastic cells do not show any significant immunoreactivity for cutaneous lymphocyte antigen.
Mentions: Subsequent biopsies in February of 2013 and July of 2013 appeared similar showing a massive effacing diffuse and nodular malignant lymphocytic infiltrate (Fig.8A). The cells were in the 20–30 micron size range exhibiting a vesicular chromatin with basophilic to eosinophilic nucleoli (Fig.8B). There were a number of atypical mitoses. A few scattered eosinophils and histiocytes were observed. While the dominant cell populace was a pleomorphic large cell, there were small foci of epidermotropism of smaller hyperchromatic and hyperconvoluted lymphocytes diagnostic of those encountered in MF. The B specimen showed the same fundamental process of a diffuse and nodular malignant large cell infiltrate. These cells were in the 15–20 micron size range; however, there was a smattering of hyperconvoluted cerebriform lymphocytes disposed amidst this malignant large cell infiltrate. The tumor cells were extensively positive for the pan T-cell markers CD3 and CD5 and were of the BetaF1 subset. There was a marked reduction in the expression of CD7. The CD30 preparation showed only a few positive-staining cells. The CD4+ and CD25+ regulatory T-cell component was very minimal and did not occupy more than 10–15% of the infiltrate; there were broad sheets of malignant cells without regulatory T-cell activity. There was significant staining for CD25. 30% to 40% of the infiltrate showed strong cytoplasmic membrane pattern of staining. As with the earlier biopsies, there was marked expression of PD-1 (Fig.9) and a loss of immunoreactivity of the neoplastic cells for CLA (Fig.8C).

Bottom Line: It's important to assess cases both clinically and pathologically for factors potentially predictive of an aggressive clinical course.We concluded that the relative immunosuppressive effects of PD1 may contribute to tumor progression while the lack of staining for cutaneous lymphocyte antigen may be an additional factor facilitating distant extracutaneous migration.

View Article: PubMed Central - PubMed

Affiliation: Department of Dermatology, Weill Cornell Medical College New York City, New York, 10065.

ABSTRACT

Key clinical message: It's important to assess cases both clinically and pathologically for factors potentially predictive of an aggressive clinical course. We concluded that the relative immunosuppressive effects of PD1 may contribute to tumor progression while the lack of staining for cutaneous lymphocyte antigen may be an additional factor facilitating distant extracutaneous migration.

No MeSH data available.


Related in: MedlinePlus