Clinical and pathological spectrum of CD8‐positive cutaneous T‐cell lymphomas

Abstract

CD8+ T-cell lymphomas presenting in the skin are rare. We describe the clinical and histological features of 18 patients with CD8+ cutaneous T-cell tumors, which have been divided into four groups. Seven patients had precedent long histories of rashes, which progressively spread in a presentation similar to that of CD4+ mycosis fungoides (MF). Three patients had long-standing localized plaques consistent with a pagetoid reticulosis (PR) pattern. Two patients presented with erythroderma and had peripheral blood involvement consistent with a Sezary syndrome (SS) pattern and had rapidly progressive clinical courses. Six patients presented with cutaneous nodules of varying sizes and had variable outcomes, with two having rapidly progressive disease, two with indolent recurrences and a further two with complete responses to treatment. Histologically, 12 of the 18 cases showed an epidermotropic tumor infiltrate that was most marked in the three PR cases. Prominent periadnexal infiltration was seen in 11 cases. Similar to CD4+ MF, the skin-homing antigen, (cutaneous lymphocyte antigen: CLA), was strongly expressed in 13 of 16 tested cases. Expression of the cytotoxic granule protein granzyme B was noted in a majority of tumor cells in only three of 16 tested cases. We conclude that approximately half of CD8+ cutaneous T-cell lymphomas clinically and histologically resemble CD4+ MF/SS, whereas presentation as discrete nodular lesions are more common in CD8+ tumors as compared to those that express CD4.

Mycosis fungoides with a CD56+ immunophenotype

“…Other series have suggested that cytotoxic, CD8 1 MF follows a course similar to that seen in MF with the classic mature helper T-cell immunophenotype 2,13,14 or a similar course with more rapid disease progression. 15,16 Despite the aggressive nature of other cytotoxic cutaneous lymphomas, our cohort of young patients (in addition to the 3 in the literature) appear to be behaving in a similar manner to that predicted for MF expressing a normal immunophenotype (or the cytotoxic, CD8 1 MF variant). We are, therefore, guardedly optimistic regarding our patients' long-term prognosis.…”

Outcome in 34 patients with juvenile‐onset mycosis fungoides

“…23 CD8-positive MF has been reported to be more aggressive than CD4-positive disease, but this may reflect a failure to distinguish CD8-positive MF from other types of primary CTCLs. 6,[23][24][25] In a previous study, we found that CD8-positive CTCL patients with juvenile-onset MF appeared to behave in a similar manner to patients with CD4-positive juvenile-onset MF. 22 It has been reported that CD8-positive MF follows a more aggressive course if the neoplastic cells are CD2-negative and CD7-positive.…”

CD4/CD8 double-negative epidermotropic cutaneous T-cell lymphoma: An immunohistochemical variant of mycosis fungoides

“…2 A minority of patients have an unusual immunohistochemical profile consisting of a CD4 ÿ , CD8 1 mature T-cell phenotype. [3][4][5][6][7][8] Although partial loss of one or more T-celleassociated antigens is a common finding in tumor-stage MF, [9][10][11][12] an aberrant phenotype, and specifically, loss of both CD4 and CD8 antigens, has hardly been reported in early-stage MF. 11,[13][14][15][16][17] Several reports have described CD4/CD8 double-negative (DN) CTCLs that were not MF, which were characterized by an aggressive clinical course and, usually, g/d TCR expression.…”