Diagnostic and prognostic significance of Sezary cells in peripheral blood smears from patients with cutaneous T cell lymphoma

Abstract

Blood smears stained with Wright-Giemsa were obtained from 124 patients with pathologically confirmed cutaneous T cell lymphoma (CTCL), 70 patients with various other cutaneous disorders, and ten healthy adult volunteers. These were examined in a blinded fashion for atypical lymphocytes with cerebriform nuclei (CLs), which were characterized further according to cell diameter. CLs, comprising up to 15% of lymphocytes in smears, were observed in 20% of the patients with benign dermatitis. CLs, comprising up to 89% of lymphocytes in smears, were found in 22%, 30%, 50%, and 96% of patients with patch, plaque, tumor, and erythrodermic CTCL, respectively. Large-diameter CLs (15 to 20 micron) were observed only in smears from patients with CTCL. Total CL counts above 15 per 100 lymphocytes and/or the presence of large CLs occurred in 33 of 49 (67%) patients with erythrodermic disease and in only two patients with other skin manifestations. Blood smears obtained at the time of cytogenetic studies indicated that a total CL count above 15% was the smear criterion that correlated best with the demonstration of a chromosomally abnormal malignant clone in the blood. The presence of large CLs per se, although also predictive of a malignant clone, was less useful. Multivariate survival analysis showed that the duration of disease before the blood smear and the proportion of large CLs within the total CL population were the covariates that correlated most significantly with survival. We speculate that the reduced survival of patients with increased proportions of large CLs in smears reflects the presence of polyploid malignant lymphocytes in the blood.

Prognostic factors in Sezary syndrome: a study of 28 patients

“…Moreover, Bernengo et al 2 found no correlation between the overall level of Sézary cells and survival, but determined that large circulating Sézary cells (exceeding 15 lm in diameter) constituted a prognostic factor (P < 0AE001). Schechter et al 16 and Vonderheid et al 17 had previously reported similar findings for large Sézary cells, which are much more specific and easily identifiable than small ones that can be confused with circulating lymphocytes.…”

Analysis of β, γ, and δ T-Cell receptor genes in mycosis fungoides and sezary syndrome

“…In MF no DRB were detected with Immunoglobulin heavy and light chain gene probes. In two patients with Sezary syndrome (7,9) analysis of peripheral blood DNA revealed a rearrangement of the Ig heavy chain but germ line K and X light chains (Fig. 5).…”

“…YCOSIS FUNGOIDES (MF) and Sezary syndrome are M distinct clinicopathologic entities which form part of the spectrum of cutaneous T-cell lymphomas (CTCL). ' MF is a primary cutaneous lymphoma whereas Sezary syndrome is characterized by a pruritic infiltrated erythroderma, lymphadenopathy, and the presence of atypical No. 7 TCR GENE ANALYSIS IN CTCL Whittaker et al 1573 implications.…”

Diagnosing erythrodermic cutaneous T-cell lymphoma

“…The presence of large Sézary cells (> 14 µm) is seen only with malignant disease, so a diagnosis of E‐CTCL can be made with certainty 26 . For the small and medium‐sized variants, additional data are required to distinguish neoplastic from reactive lymphocytes.…”