Primary Cutaneous Small/Medium CD4+ T-Cell Lymphomas: A Heterogeneous Group of Tumors With Different Clinicopathologic Features and Outcome

• Published in: Journal of clinical oncology Vol. 26; no. 20; pp. 3364 - 3371
• Main Authors: GARCIA-HERRERA, Adriana, COLOMO, Luis, CAMOS, Mireia, CARRERAS, Joaquin, BALAGUE, Olga, MARTINEZ, Antonio, LOPEZ-GUILLERMO, Armando, ESTRACH, Teresa, CAMPO, Elias
• Format: Journal Article
• Language: English
• Published: Baltimore, MD American Society of Clinical Oncology 10-07-2008; Lippincott Williams & Wilkins
• Subjects: Adult; Aged; Aged, 80 and over; Biological and medical sciences; Biopsy, Needle; CD4 Antigens - analysis; CD56 Antigen - analysis; CD8 Antigens - analysis; Cell Proliferation; Combined Modality Therapy; Diagnosis, Differential; Female; Humans; Immunohistochemistry; Ki-1 Antigen - analysis; Lymphocytes - pathology; Lymphocytes - physiology; Lymphoma, T-Cell, Cutaneous - diagnosis; Lymphoma, T-Cell, Cutaneous - mortality; Lymphoma, T-Cell, Cutaneous - pathology; Lymphoma, T-Cell, Cutaneous - therapy; Male; Medical sciences; Middle Aged; Neoplasm Staging; Probability; Prognosis; Risk Assessment; Sensitivity and Specificity; Skin Neoplasms - diagnosis; Skin Neoplasms - mortality; Skin Neoplasms - pathology; Skin Neoplasms - therapy; Statistics, Nonparametric; Survival Analysis; Tumors; Cancerology; Histopathology; CD4 T lymphocyte; Prognosis; T lymphoma; Primary; Tumor; Skin
• ISSN: 0732-183X; 1527-7755
• DOI: 10.1200/JCO.2008.16.1307

To define the clinical and pathologic characteristics of primary cutaneous small/medium CD4(+) T-cell lymphoma (PCSM-TCL) and identify parameters of prognostic significance.
We have investigated 24 patients with primary cutaneous lymphomas composed of small/medium mature T-cells with a betaF1, CD3, CD4(+) and/or noncytotoxic, CD8(-) and CD30(-) phenotype. The proliferation index and CD8(+) infiltrating cells were quantified with an automated image analysis system.
Sixteen patients presenting with solitary or localized plaques or small nodules (< 3 cm) had an indolent course. Only three patients experienced repeated cutaneous relapses, and none of them died as a result of the disease after 1 to 168 months (median, 17 months) of follow-up. The tumors had a low proliferation (median Ki-67, 9% +/- 5%) and an intense infiltrate of reactive CD8(+) (median, 20% +/- 11.7%). Five patients presenting with rapidly evolving large tumors or nodules (>/= 5 cm) had an aggressive disease and died with extracutaneous dissemination 18 to 36 months after diagnosis (median, 23 months). These tumors had a significantly higher proliferation (median Ki-67, 22% +/- 11.3%; P < .05) and lower number of infiltrating CD8(+) (median, 1% +/- 3%; P < .05) than the previous group. A third group of three patients had a peculiar clinical presentation with multifocal relapsing lesions without extracutaneous dissemination after a long period of follow-up ranging from 41 to 92 months. Histologically, these cases had an intense infiltrate of eosinophils.
PCSM-TCL is a heterogeneous group of tumors with differentiated clinical and pathological characteristics with impact in the outcome of the patients.