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Copyright of Revista Medica del IMSS is the property of Direccion de Prestaciones Medicas - IMSS and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Primary cutaneous anaplastic large cell lymphoma (C-ALCL) is a rare subtype of primary cutaneous lymphoma with a favorable prognosis. Primary cutaneous CD30+ lymphoproliferative disorders, which include C-ALCL and lymphomatoid papulosis, are the second most common group of cutaneous T-cell lymphomas. C-ALCL is comprised of large cells with anaplastic, pleomorphic, or immunoblastic cytomorphology, and indeed, more than 75% of the tumor cells express the CD30 antigen. C-ALCL clinically presents with solitary or localized reddish-brown nodules or tumors, and sometimes indurated papules, and they may be with ulceration covering with dark eschar. Multifocal lesions are seen in 20% of the patients. Extracutaneous dissemination, which mainly involves the regional lymph nodes, occurs in 10% of patients. A 69-year-old man noticed a mild elevated cutaneous lesion containing central ulceration covering with brownish black necrotic tissue on the right lower lip, and the lesion was surgically removed. After the first operation, another skin lesion was developed and the histological examination confirmed the diagnosis, C-ALCL. Eight specimens were excised during the 7-month follow-up period. The patient started the treatment with low-dose oral methotrexate (15 mg/wk) and there was no recurrence for 11 months. [ABSTRACT FROM AUTHOR]

Copyright of Der Hautarzt is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Objective To extend previous observations regarding the prognostic value of analyzing lymph node DNA from patients with cutaneous T-cell lymphoma for the presence of a monoclonal T-cell population by Southern blot vs polymerase chain reaction (PCR) methods. Design Inception cohort study from 1982 to 1998. Recruitment of new patients ended in 1994. Setting A tertiary care referral center in Seattle, Wash. Patients Fifty-five uniformly staged patients with the diagnosis of cutaneous T-cell lymphoma who underwent a lymph node biopsy, 21 with clinically abnormal nodes and 34 with normal nodes. Interventions Lymph nodes were evaluated for T-cell receptor (TCR) γ-chain gene rearrangement by 2 PCR methods: capillary electrophoresis and denaturing gradient gel electrophoresis. The same lymph nodes were evaluated by Southern blot analysis for TCR β-chain gene rearrangement and examined histopathologically on the basis of the National Cancer Institute lymph node classification system. Patients were observed clinically for a mean of 9.5 years. Main Outcome Measures Skin stage, clinical lymph node examination, lymph node histologic examination, Southern blot analysis, and PCR analyses were evaluated as potential prognostic predictors by univariate and multivariate analyses. The statistical association of TCR analysis and clinical outcome was determined among all patients. Hazard ratios (HRs) by Cox proportional hazards regression analysis were used to estimate the risk of a poor clinical outcome. Cumulative survival rates were analyzed by the Kaplan-Meier method. Results A skin stage of T3 (tumors) or T4 (erythroderma) was the most powerful predictor of a poor clinical outcome (HR, 31.3 vs T1; P<.001). Patients with detectable TCR γ-chain gene rearrangement in lymph node DNA by PCR also were more likely to have a poor outcome (HR, 5.1; P<.001), but it was a less powerful predictor than skin stage. Even when the skin stage, presence or absence of lymphadenopathy, and histologic lymph node score were known for the patient, Southern blot analysis still added to prediction of a poor outcome (HR, 9.3; P = .007), whereas PCR provided no statistically significant additional information on outcome. Conclusions Detection of a monoclonal T-cell population by PCR in lymph nodes of patients with cutaneous T-cell lymphoma does not enhance prediction of clinical outcome and probability of survival beyond what can be determined from clinical examination and histologic lymph node scores. Skin stage and the presence or absence of lymphadenopathy remain the most important determinants of clinical outcome. [ABSTRACT FROM AUTHOR]

Objective To determine if a therapeutic regimen of twice-weekly applications of mechlorethamine hydrochloride and betamethasone dipropionate cream is effective in the treatment of early-stage mycosis fungoides while increasing cutaneous tolerance. Design Prospective nonrandomized study conducted from November 1999 to November 2002. Setting Eleven university or hospital dermatology departments in France. Patients Sixty-four consecutive patients with newly diagnosed early-stage mycosis fungoides (stage IA, n = 33; stage IB, n = 26; stage IIA, n = 5). Interventions Patients were treated with twice-weekly applications of a 0.02% aqueous solution of mechlorethamine followed by an application of betamethasone cream during a 6-month period. Main Outcome Measures The primary end point was the rate of complete response during the treatment. Secondary end points were mean delay to achieve complete response, rate of severe cutaneous reactions of intolerance, and rate of relapse after achieving complete response. Results Thirty-seven patients (58%) had a complete response after a mean ± SD treatment duration of 3.6 ± 2.5 months: 20 (61%) of 33 patients with stage IA disease, 15 (58%) of 26 patients with stage IB disease, and 2 (40%) of 5 patients with stage IIA disease. Eighteen patients (28%) developed severe cutaneous reactions of intolerance that necessitated treatment discontinuation. Relapse was observed in 17 patients (46%) after a mean ± SD time of 7.7 ± 6.5 months. Conclusions A regimen of twice-weekly applications of mechlorethamine and betamethasone cream is an effective treatment for early-stage mycosis fungoides. The decreased frequency of applications provides an advantage to the patient by being easy to use with limited adverse effects. [ABSTRACT FROM AUTHOR]

Focuses on the diagnosis of subcutaneous panniculitic t-cell lymphoma (SPTCL). Examination of heavy infiltrates of monomorphous atypical lymphoid cells; Association of SPTCL with multiple necrotic erythematous nodules; Efficacy of fludeoxyglucose F 18 positron emission tomography in the assessment of tumor burden and treatment response.

Presents a case study of a 30-year-old man with a spontaneous onset of a skin ulcer on his leg and multiple deep-seated necrotic nodules on his extremities. Medical history of the patient; Symptomatology of the disease; Treatment of the disease; Etiology of the disease.

Reports on the case of a 48-year-old Iranian man with a history of hypercholesterolemia and panic attacks who acutely developed hand pruritus and an abdominal rash that was unresponsive to antihistamines. Therapeutic challenge of adult T-cell leukemia/lymphoma; Association with HTLV-1; Oral dose of bexarotene and a subcutaneous low dose of interferon alfa-2b; Marked resolution of the diffuse skin eruption after 30 days.

Background Erythroderma is a diffuse, inflammatory skin reaction that, in rare instances, is associated with hematologic maligancies such as cutaneous T-cell lymphoma (erythrodermic mycosis fungoides) or T-cell leukemia (Sézary syndrome or adult T-cell leukemia/lymphoma). Observations We screened 30 patients with erythroderma (20 patients with erythroderma of known etiology and 10 patients with idiopathic erythroderma) for the presence of circulating monoclonal T-lymphocyte populations using T-cell receptor (TCR)–γ gene–specific polymerase chain reaction and automated capillary DNA electrophoresis. Moreover, the phenotypic analysis of peripheral blood CD4+ lymphocytes was performed using the following surface markers: CD3, CD7, CD8, CD25, CD26, CD27, CD28, CD29, CD30, CD45RO, CD45RA, CD56, CD134, HLA-DR, TCRαβ, TCRγδ, and cutaneous lymphocyte antigen (CLA). In 5 patients with idiopathic erythroderma we detected T-cell clones in peripheral blood (in 1 case, associated with the presence of the same clone in the skin) and a 2-fold increase in the proportion of CD3+CD4+CD7-CD26- cells. Cell depletion studies indicated that the monoclonal T cells were present within the CD4+CD7- cell population. Clinically, all patients had chronic, recalcitrant erythroderma but none developed any hematological malignancy during their lifetimes or fulfilled the criteria for cutaneous lymphoma or Sézary syndrome. Conclusions A proportion of patients with chronic erythroderma present with the monoclonal expansion of CD4+CD7-CD26- lymphocytes in their blood. This condition represents a probably benign T-cell dyscrasia, or one of very low malignancy. Alongside monoclonal gammapathy of undetermined significance (MGUS) and monoclonal (B-cell) lymphocytosis of undetermined significance (MLUS), we propose using monoclonal T-cell dyscrasia of undetermined significance (MTUS) to underline a conceptual similarity between this disorder and the more common types of lymphocytic dyscrasia. [ABSTRACT FROM AUTHOR]

Background Mycosis fungoides (MF) is the most common type of cutaneous T-cell lymphoma (CTCL). Patients with limited patch and/or plaque disease have a normal life expectancy. Neutrophilic dermatosis (ND) may be associated with various hematologic disorders. However, its association with CTCL is exceptional and has been reported only twice with leukemic forms of CTCL. Observations Three patients with MF developed ND resistant to conventional therapies and responsible for an impaired quality of life due to constitutional symptoms and painful cutaneous lesions. All patients underwent an aggressive treatment course despite their varying initial clinical stages of MF, and all experienced a fatal outcome less than 18 months after the onset of ND. Conclusions The association of MF with ND is exceptional and carries a poor prognosis, but the pathophysiologic nature of this association remains unclear. It may involve neutrophil chemoattractant cytokine production by tumor cells. A triggering role of interferon alfa is also possible. [ABSTRACT FROM AUTHOR]

Objectives To provide an update on the molecular procedures used increasingly in the study and diagnosis of a variety of dermatologic malignancies and inflammatory disorders and to explore the potential use of these techniques in clinical dermatology. Herein, we review assays such as G-banding, fluorescence in situ hybridization, comparative genomic hybridization, and spectral karyotyping in conjunction with the polymerase chain reaction and DNA microarrays. Data Sources PubMed was searched for published articles on molecular diagnosis and dermatologic diseases. Study Selection All English-language studies were selected if they provided useful methodologic information or highlighted the usefulness of molecular techniques. Data Extraction Only methodologic and qualitative information was extracted. Data Synthesis The information was synthesized into 2 sections: one describing the principles of different molecular diagnostic techniques, and the other highlighting the contributions of molecular diagnostic techniques to the understanding and diagnosis of several dermatologic diseases. Conclusions A basic understanding of the principles of molecular diagnostic techniques is crucial for the practicing dermatologist to benefit from the increasing number of molecular diagnostic articles appearing in the literature and potentially to apply these methods in clinical practice. [ABSTRACT FROM AUTHOR]

Objective To investigate the prognostic value of initial characteristics including blood eosinophilia in patients with primary cutaneous T-cell lymphoma. Design A retrospective inception cohort, patients included from date of diagnosis (1982-1998). Setting Two dermatology departments of a university hospital. Patients A total of 104 patients with cutaneous T-cell lymphoma, including patients with mycosis fungoides (n = 69), Sézary syndrome (n = 13), and nonepidermotropic cutaneous lymphoma (n = 22). The following variables were recorded: age, sex, diagnosis according to the European Organization for Research and Treatment of Cancer (EORTC) classification, type of skin involvement at the time of diagnosis, initial eosinophil absolute count, lactate dehydrogenase value, date of disease progression, and cause and date of death or date of last contact. Main Outcome Measures Time from diagnosis to disease progression and to disease-specific death. Results The median follow-up was 43 months (range, 7-197 months). Estimated rates of disease progression and disease-specific death for 3 years were 19.5% (95% confidence interval [CI],11.3%-27.6%) and 9.9% (95% CI, 2.8%-13.6%), respectively. Univariable analysis of initial variables possibly influencing disease progression revealed significant prognostic value for diagnosis according to EORTC classification (hazard ratio [HR], 2.77; 95% CI, 1.04-7.41; P = .04), type of skin involvement (HR, 2.70; 95% CI, 1.00-7.25; P = .04), raised blood eosinophil absolute count (HR, 7.33; 95% CI, 2.84-18.91; P<.001), and raised serum level of lactate dehydrogenase (HR, 3.72; 95% CI, 1.58-8.78; P = .001).Concerning disease-specific death, significant prognostic indicators were diagnosis according to the EORTC classification (HR, 6.62; 95% CI, 1.68-26.12; P = .007) and a raised blood eosinophil absolute count (HR, 10.57; 95% CI, 2.28-49.0; P<.001). In multivariable analysis, only blood eosinophilia was associated with disease progression and disease-specific death. Conclusion These results strongly suggest that blood eosinophilia at baseline is a prognostic factor in patients with primary cutaneous T-cell lymphoma. [ABSTRACT FROM AUTHOR]

Explores the available evidence that suggests neoplastic stem cells in cutaneous lymphomas. Properties of neoplastic stem cells; Origin of neoplastic stem cells; Evidence for precursor cell transformation in cutaneous lymphoma; Evidence against the existence of lichen sclerosus.

Presents a letter to the editor about the possible role of neoplastic stem cells in the pathogenesis of cutaneous lymphomas.

Presents a reply to a letter to the editor about the possible role of neoplastic stem cells in the pathogenesis of cutaneous lymphomas.

Discusses the concept of preneoplastic conditions of dyscrasias showing clinical, histological, or laboratory findings of undetermined significance. Criteria which are of undetermined significance in cutaneous lymphomas; Factors which drive lymphoid infiltrates from prelymphomatous conditions to full-blown lymphoma.

Post-transplantation cutaneous lymphoproliferative diseases (PTCLD) are rare, with 29 cases have so far been reported in the literature--only 4 cases underwent cardiac transplantation. Herein, we report on, to the best of our knowledge, the first case in the English literature of primary cutaneous CD4-positive small/medium-sized pleomorphic T-cell lymphoma in a cardiac transplant recipient. [ABSTRACT FROM AUTHOR]

The article discusses the potential role for aberrant DNA rearrangements in connection to dyscrasias of unclear origin and lymphoma. The author argues that the activation of the V(D)J recombination, isotype switching, or somatic hypermutation setups, in combination with defective or altered nonhomologous end-joining DNA repair mechanisms, is responsible for the genomic instability in cell populations of dyscrasias of undetermined origin and is critical for subsequent transformation to lymphomas.

Presents a letter to the editor about CD8+ lymphoma in patient with HIV.

The article discusses the treatment of a 22-year-old man suffering from granulomatous slack skin (GSS), which is a rare variant of cutaneous T-cell lymphoma. After being diagnosed with GSS, he was treated with six courses of combined chemotherapy that included cyclophosphamide, vincristine sulfate, and prednisone. This resulted in partial remission of the skin lesions and reduction of the enlarged lymph nodes. There is stability in his disease status in the last two years since treatment.

The article discusses the prognostic value of nodal T-cell receptor gene rearrangement analysis in cutaneous T-cell lymphoma (CTCL). Proper staging in CTCL hardly requires nodal or bone marrow biopsies, but rather a thorough skin and physical examination. Further, defining a circulating T-cell clone may also be helpful in differentiating a dominant CTCL clone from the innocent cytotoxic T-cell clones that are occasionally detected in the peripheral blood of elderly patients.

Reports on the case of drug-induced eosinophilia in a 44-year-old woman who was admitted for a maculo-papular rash with pruritus, facial edema, and fever six weeks after beginning treatment with diclofenac for lombalgias. Enlarged cervical and inguinofemoral lymph nodes; Hepatomegaly; Diffuse crackling noise on chest auscultation; Extensive erythematous eruption; Respiratory distress; Diagnosis of angioimmunoblastic T-cell lymphoma.

The paper details the case of a 47-year-old black woman presented with progressive asymptomatic skin lesions of more than 5 years' duration. Physical examination revealed lax skin masses on her neck and trunk, the upper part of both arms, and the inner area of both thighs. There was a large indurated plaque on her abdomen and ulcerated tumoral lesions on her arms and legs. The lymph nodes were not enlarged. The results of routine laboratory tests and radiography of the chest were all within the normal range. A biopsy specimen was obtained from the right upper arm area.

The biopsy specimen revealed a dense nodular or diffuse cell infiltrate throughout the dermis and subcutaneous tissue. Small lymphocytes predominated, admixed with epithelioid tubercles and giant cells. Single, slightly atypical lymphocytes were seen within the epidermis. Elastolysis was observed on Weigert-van Gieson staining. Immunostaining was positive for leukocyte common antigen, CD3, and CD4. The article discusses the diagnosis of granulomatous slack skin in a 47-year-old woman. The patient underwent further evaluation. Bone marrow aspiration showed no neoplastic infiltrate. The results of a serologic test for human T-lymphotropic virus 1 and a Sézary cell count were negative. Abdominal ultrasound showed a thickening of the abdominal wall where an indurated plaque was present, but no visceral enlargement. There was no evidence of disease spread beyond the skin.

Comments on the study concerning the use of cDNA arrays in investigating the gene expression patterns in peripheral blood mononuclear cells from patients with leukemia forms of cutaneous T cell lymphomas specifically Sezary syndrome (SS). Names of the genes that were highly overexpressed during cDNA arrays; Role of plastin-T in the pathogenesis of SS; Useful applications of cDNA arrays.