Cutaneous involvement by angioimmunoblastic T‐cell lymphoma: a unique histologic presentation, mimicking an infectious etiology

Jayaraman, Anu G; Advani, Ranjana H.; Kim, Youn H.; Tsai, Eunice Y.; Köhler, Sabine

doi:10.1111/j.1600-0560.2006.00489.x

Cited by 30 publications

(24 citation statements)

References 13 publications

(30 reference statements)

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“…Dermatologists should be aware of AITL and include skin lesions of AITL among the differential diagnoses of fever of unknown origin with generalized skin rash [13][14][15] . As the skin lesions closely mimic a benign condition and the skin biopsies of skin lesions of AITL are not malignant, clonality testing with clinical suspicion is crucial for early and accurate diagnosis and can prevent mistreatment or confusion of treatment policy.…”

Section: Discussionmentioning

confidence: 99%

Angioimmunoblastic T Cell Lymphomas: Frequent Cutaneous Skin Lesions and Absence of Human Herpes Viruses

et al. 2009

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Section: Discussionmentioning

confidence: 99%

Angioimmunoblastic T Cell Lymphomas: Frequent Cutaneous Skin Lesions and Absence of Human Herpes Viruses

et al. 2009

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“…5 The broad spectrum of reported clinical and histopathological findings in this setting [6][7][8][9][10][11][12][13][14] makes the diagnosis elusive and a systematic approach to its recognition is currently lacking. 5 The broad spectrum of reported clinical and histopathological findings in this setting [6][7][8][9][10][11][12][13][14] makes the diagnosis elusive and a systematic approach to its recognition is currently lacking.…”

Section: Introductionmentioning

confidence: 99%

Cutaneous Manifestations of Angioimmunoblastic T-Cell Lymphoma

Botros

Cerroni

Shawwa

et al. 2015

The American Journal of Dermatopathology

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Angioimmunoblastic T-cell lymphoma (AITL), an uncommon variant of peripheral T-cell lymphoma, affects the skin in approximately 50% of cases. Its protean clinical and histopathological cutaneous manifestations pose a challenge in diagnosis, particularly when these precede the diagnosis of AITL on a lymph node biopsy. In this retrospective study, we compared 11 cases of AITL with cutaneous manifestations (mean age 67 years; male:female ratio 1:0.8; 24 skin biopsies) with 20 control cases of inflammatory and non-AITL lymphomatous diseases (mean age 52 years; male:female ratio 1:1.5; 26 skin biopsies). Clinical, histopathological, immunohistochemical, and molecular data were documented. New insights into the clinical evolution of cutaneous involvement by AITL (C-AITL), from early macular, through papular to nodular stages, were observed. Microscopically, a parallel increment in the density of the dermal infiltrate and in the detection of lymphocyte cytological atypia was noted over time. Identification and quantification of follicular T-helper cells (Tfh), the neoplastic lineage, by immunohistochemistry helped to separate cases of C-AITL from inflammatory controls, offering promise as a useful diagnostic adjunct. The presence of T-cell clonality did not have discriminatory value between the 2 groups. Our work suggests that the early maculopapular phase of C-AITL eludes identification on pathological grounds alone and that features such as cytological atypia and high endothelial venules lack diagnostic specificity. In the context of (1) a rash that simulates a drug/viral exanthem or an acute manifestation of a connective tissue disorder, but proves recalcitrant, (2) constitutional abnormalities and/or lymphadenopathy that persist, and (3) a Tfh cell-rich perivascular dermatitis, the diagnosis of early C-AITL can be suspected, but not confirmed, without the benefit of a lymph node biopsy. The later nodular phase of C-AITL occurring in a similar constitutional background, can usually be discerned as lymphomatous, clinically and pathologically. Here a Tfh cell-rich infiltrate is a clue to the specific diagnosis, but confirmation by a nodal evaluation remains mandatory. Despite the difficulty in establishing a diagnosis of C-AITL in its early stages, and speculation that the initial eruptions might be reactive in nature, our sequential data support the concept that these are lymphomatous ab initio. To address the diagnostic challenge presented by this disease, meaningful integration of clinical and pathological data is imperative.

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“…EBV‐positive cells are rarely demonstrated (Martel et al , 2000; Brown et al , 2001). A florid epithelioid or granulomatous reaction has been described in occasional cases, which may mimic sarcoidosis or an infectious process (Scarabello et al , 2002; Suarez‐Vilela & Izquierdo‐Garcia, 2003; Pujol et al , 2005; Jayaraman et al , 2006).…”

mentioning

confidence: 99%

Advances in the understanding and management of angioimmunoblastic T‐cell lymphoma

2010

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Summary Angioimmunoblastic T‐cell lymphoma (AITL) is a distinct peripheral T‐cell lymphoma (PTCL) entity with peculiar clinical and pathological features. The recent identification of follicular helper T (TFH) cell as the cell of origin of this neoplasm represents a major step in our understanding of the pathobiological characteristics of the disease and should, in the future, clarify the diagnostic criteria for AITL and help to delineate its spectrum, especially from PTCL, not otherwise specified (PTCL, NOS). Deciphering the pathogenesis of the disease is needed to identify targets for new therapies that are expected to improve the poor outcome of AITL patients, when treated with conventional chemotherapy regimens. In this respect, efforts will be needed to evaluate promising innovative therapies in prospective clinical trials.

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Cutaneous involvement by angioimmunoblastic T‐cell lymphoma: a unique histologic presentation, mimicking an infectious etiology

Cited by 30 publications

References 13 publications

Angioimmunoblastic T Cell Lymphomas: Frequent Cutaneous Skin Lesions and Absence of Human Herpes Viruses

Angioimmunoblastic T Cell Lymphomas: Frequent Cutaneous Skin Lesions and Absence of Human Herpes Viruses

Cutaneous Manifestations of Angioimmunoblastic T-Cell Lymphoma

Advances in the understanding and management of angioimmunoblastic T‐cell lymphoma

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