Dermatopathology Update.

Dec 2012

[Article in English, Spanish]

Fernández-Figueras MT, Puig L.

Source

Servicio de Anatomía Patológica, Hospital Universitari Germans Trias i Pujol, Badalona, España; Departamento de Ciencias Morfológicas, Universitat Autònoma de Barcelona, Barcelona, España. Electronic address: maiteffig@gmail.com.

Abstract

This past year has seen a wealth of new developments in dermatopathology that appear to herald the dawning of a new era. Advances in molecular biology and the simplification of techniques have put molecular tests within reach of routine clinical practice and led to a radical change in our approach to lesions such as melanoma; in the future, the genetic characterization of these lesions will be an essential requirement for establishing diagnosis, prognosis, and therapy. 

Technological innovations have also reached dermatology departments: the introduction of ultrasound scans has propitiated the use of fine-needle aspiration cytology, which allows samples to be stained and studied immediately, thereby facilitating diagnosis of superficial and lymph-node lesions, and allowing staging of tumors such as melanoma. Targeted cancer therapies have led to the introduction of more sensitive and specific systems for identifying new targets, have reawakened interest in forgotten diseases such as aggressive basal cell carcinoma, and have led to dermatological reactions that, together with those caused by biologic drugs, we are just beginning to recognize. Consolidated techniques such as immunohistochemistry continue to advance with the addition of new antibodies that contribute considerably to improved diagnosis.

New clinicopathologic diseases have also been described or characterized this year, including 2 new types of melanoma, and progress has been made in our knowledge of other diseases, such as primary cutaneous CD4(+) small/medium-sized pleomorphic T-cell lymphoma. These topics, together with new developments in adnexal tumors, alopecia, and other lesions, will be discussed in this review.

PubMed

Cutaneous peripheral T-cell lymphomas, unspecified/NOS and rare subtypes: a heterogeneous group of challenging cutaneous lymphomas.

Dec 2012

Kempf W, Rozati S, Kerl K, French LE, Dummer R.

Source

Department of Dermatology, University Hospital Zürich, Zürich, Switzerland - werner.kempf@access.unizh.ch.

Abstract

Cutaneous peripheral T-cell lymphoma, unspecified/not otherwise specified (PTL NOS) represents a phenotypically and prognostically heterogenous group of cutaneous T-cell lymphomas (CTCL) that do not fit into any of well defined defined CTCL subtypes. In the WHO-EORTC classification as well as the WHO classification, three entities have been delineated as provisional rare subtypes of PTL based on their characteristic clinico-pathological, immunophenotypic and prognostic features and have been separated out from PTL, NOS: Primary cutaneous CD4-positive small/medium T-cell lymphoma(CD4+ SMTL), primary cutaneous CD8-positive aggressive epidermotropic T-cell lymphoma (CD8+ AECTCL), and primarycutaneous gamma/delta T-cell lymphoma (CGD-TCL). CD4+ SMTL manifests in most patients with a solitary nodule in the head and neck area and nodular infiltrates of CD4+ small to medium-sized lymphocytes with nuclear pleomorphism. The prognosis of this lymphoproliferation is excellent in patients with a solitary lesion, but may be impaired in patients with multifocal disease. Rapidly evolving erosive or necrotic plaques and nodules with an epidermotropic infiltrate of CD8+ atypical lymphocytes are the hallmark of CD8+ AECTCL, which exhibits a poor prognosis. CGD-TCL displays a broad spectrum of clinical and histological manifestations with expression of the T-cell receptor gamma/delta chain as the common denominator and diagnostic marker. As most of other forms of PTL, CGD-TCL carries a poor prognosis. Despite the rarity of PTL NOS, clinicians as well as dermatopathologists and pathologists should be familiar with these rare CTC, especially since most of these lymphomas exhibit an unfavourable prognosis. Immediate intense treatment with multiagent chemotherapy and hematopoietic stem cell transplantation is indicated in patients with PTL NOS. This review focuses on the clinicopathological aspects, the diagnostic criteria and the classification of the rare subtypes of PTL and PTL NOS.

PubMed

Letter: Primary cutaneous marginal zone B cell lymphoma of the face: A challenging diagnosis.

Feb 2012

Oliveira A, Caetano M, Alves R, Lima M, Selores M.

Source

Department of Dermatology, Centro Hospitalar do Porto - Hospital de Santo António, Porto, Portugal.

Abstract

The primary cutaneous marginal zone B cell lymphoma is a small B cell lymphoma, including cells of the marginal zone, lymphoplasmacytic cells, and plasma cells. Clinically it manifests as erythematous or erythematous-violaceous papules, plaques, or nodules, single or multiple, most often located to the extremities. Its course is usually indolent, with a survival at 5 years of approximately 97 percent. The tumor exhibits a tendency towards local recurrence, but spread to locations outside the skin is extremely rare. We present a case report of a man, 80 years of age, with a primary cutaneous marginal B cell lymphoma of the chin, an atypical location.

Dermatology Online Journal