Andy C Hsi1, Sena J Lee2, Ilana S Rosman3, Kenneth R Carson4, Amanda Kelley1, Valerie Viele1, Xiaofan Pang5, Amy Musiek2, András Schaffer6. 1. Washington University Dermatopathology Center, Washington University School of Medicine, St. Louis, Missouri; Department of Pathology & Immunology, Washington University School of Medicine, St. Louis, Missouri. 2. Division of Dermatology, Washington University School of Medicine, St. Louis, Missouri. 3. Washington University Dermatopathology Center, Washington University School of Medicine, St. Louis, Missouri; Department of Pathology & Immunology, Washington University School of Medicine, St. Louis, Missouri; Division of Dermatology, Washington University School of Medicine, St. Louis, Missouri. 4. Division of Medical Oncology, Washington University School of Medicine, St. Louis, Missouri. 5. Department of Biology, Washington University, St. Louis, Missouri. 6. Washington University Dermatopathology Center, Washington University School of Medicine, St. Louis, Missouri; Department of Pathology & Immunology, Washington University School of Medicine, St. Louis, Missouri; Division of Dermatology, Washington University School of Medicine, St. Louis, Missouri. Electronic address: aschaffer@path.wustl.edu.
Abstract
BACKGROUND: Mycosis fungoides (MF) is a neoplasm of skin-homing CD4(+) helper T (TH) lymphocytes with dysregulation of TH1 and TH2 immunity. Diagnosis of MF is challenging, as there is significant morphologic overlap with other dermatologic entities. OBJECTIVE: We investigated diagnostic utility of TH1- and TH2-specific markers, T-bet, and GATA-3, respectively, in MF and its reactive and neoplastic mimics. METHODS: Immunohistochemical staining for CD3/T-bet and CD3/GATA-3 was performed on inflammatory dermatoses (n = 56), MF (n = 37), Sezary syndrome (SS; n = 8), and cutaneous anaplastic large cell lymphoma (C-ALCL; n = 14). RESULTS: Inflammatory dermatoses showed epidermal T cells predominantly expressing GATA-3, except psoriasis, which exhibited a mixed GATA-3/T-bet staining. In contrast, neoplastic T cells in patch stage MF showed markedly increased T-bet positivity with minimal GATA-3 expression. Plaque stage MF had a mixed T-bet/GATA-3 phenotype, whereas tumor stage MF and SS exhibited diffuse GATA-3 expression. C-ALCL lacked significant staining for both markers. LIMITATIONS: Sample size was relatively small. CONCLUSIONS: A predominance of T-bet(+) T cells in the epidermis support patch stage MF over dermatitis. A predominance of GATA-3(+) T cells in the dermis support CD30(+) MF with large cell transformation over C-ALCL. These stains do not allow distinction between dermatitis and cutaneous infiltrates of SS.
BACKGROUND:Mycosis fungoides (MF) is a neoplasm of skin-homing CD4(+) helper T (TH) lymphocytes with dysregulation of TH1 and TH2 immunity. Diagnosis of MF is challenging, as there is significant morphologic overlap with other dermatologic entities. OBJECTIVE: We investigated diagnostic utility of TH1- and TH2-specific markers, T-bet, and GATA-3, respectively, in MF and its reactive and neoplastic mimics. METHODS: Immunohistochemical staining for CD3/T-bet and CD3/GATA-3 was performed on inflammatory dermatoses (n = 56), MF (n = 37), Sezary syndrome (SS; n = 8), and cutaneous anaplastic large cell lymphoma (C-ALCL; n = 14). RESULTS: Inflammatory dermatoses showed epidermal T cells predominantly expressing GATA-3, except psoriasis, which exhibited a mixed GATA-3/T-bet staining. In contrast, neoplastic T cells in patch stage MF showed markedly increased T-bet positivity with minimal GATA-3 expression. Plaque stage MF had a mixed T-bet/GATA-3 phenotype, whereas tumor stage MF and SS exhibited diffuse GATA-3 expression. C-ALCL lacked significant staining for both markers. LIMITATIONS: Sample size was relatively small. CONCLUSIONS: A predominance of T-bet(+) T cells in the epidermis support patch stage MF over dermatitis. A predominance of GATA-3(+) T cells in the dermis support CD30(+) MF with large cell transformation over C-ALCL. These stains do not allow distinction between dermatitis and cutaneous infiltrates of SS.
Authors: Tianjiao Wang; Ye Lu; Avery Polk; Pinki Chowdhury; Carlos Murga-Zamalloa; Hiroshi Fujiwara; Koichiro Suemori; Niklas Beyersdorf; Alexandra C Hristov; Megan S Lim; Nathanael G Bailey; Ryan A Wilcox Journal: Clin Cancer Res Date: 2016-10-25 Impact factor: 12.531
Authors: Thorbjørn Krejsgaard; Lise M Lindahl; Nigel P Mongan; Mariusz A Wasik; Ivan V Litvinov; Lars Iversen; Erik Langhoff; Anders Woetmann; Niels Odum Journal: Semin Immunopathol Date: 2016-10-07 Impact factor: 9.623