University of Medicine and Pharmacie Tg. MureşInternational Congress for Students, Young Physicians and Pharmacists

Marisiensis 2014

Histological and immunohistochemical

findings in Peripheral T cell Lymphoma

Author: Buzdugan DumitriţaScientific coordinators: Şef lucr. Dr. Ovidiu S. Cotoi,

Conf. Dr. Mihai Turcu

Introduction

Peripheral T cell lymphoma (PTCL) is a type of lymphoproliferation of mature T cells (post thymic stage)

Rare, aggressive, with poor outcome

World Health Organization's classification, dating 2008, includes three subtypes of PTCL :

PTCL – Non otherwise specified

PTCL – Angioimmunoblastic

PTCL – Anaplastic ALK+ and ALK-

I PTCL – NOS (non otherwise specified)

Positive at normal T cell markers but with a down regulation of CD5, CD7

Aberrant expression of CD20, CD79a and CD30

Histologically there are known three variants: Lennert

Follicular T-zone

II PTCL - angioimmunoblastic

Positive at T cell markers: CD2, 3, 5, TCR

CD10, BCL-6, CXCL-13 positive – markers for T helper lymphocytes

important proliferation at endothelial arborization level

III PTCL - anaplastic

ALK +• CD30, 2, 4, 5, 25 positive and partially

positive at CD45 and CD45 RO• There have not been observed

antibodies for Epstein Barr virus

ALK –• CD30, 43 positive• Loss of T cell markers

Material and method

Retrospective descriptive study upon 29 patients diagnosed with PTCL between 2008 and 2013 diagnosed in the County Hospital of Tg. Mureş

Clinical criteria: site of primary tumorDemographic criteria: age and genderImmunohistochemical criteria:

presence of specific markers

Results

Frequency (cases) Average age (years)

18

42.88

11

55.27

Men (62%)Women (38%)

Demographic

Types

2

324

PTCLs

ANGIOIMMUNOBLASTIC

ANAPLASTIC

NOS

Histological: in all PTCLs developed in the lymph nodes their structure was totally modified by the neoplasm

Aberrant expression of CD20: - 20 cases positive, but only in

remanent follicules and in low number

- 7 cases negative - 2 unspecified

Specific markers for vessels proliferation were found positive in the 2 cases of PTCL angioimmunoblastic

Results

2008 2009 2010 2011 2012 20130

2

4

6

8

10

12

Inci-dence ...

Cases

0

5

10

15

2020

2 3

6

13

12

1 1CD3CD30CD45 RO

patients

Immunohistochemistry

Discussions

High incidence in men, fifth decade of life [1]

[5]

PTCL-NOS is the most common type of PTCLs with a 83% incidence (while in other studies it has shown a 25-30% incidence) [2][3]

Imprecise differentiation between PTCL-NOS and PTCL-anaplastic ALK- (both CD30 positive) high importance of genetic studies [4]

Significant decreasing incidence of PTCLs from 2008 to 2013 in this center of study

ConclusionsThe latest update of the WHO classification

has useful criteria for PTCL diagnostic

The information obtained in this study is in accordance with that from the specialized literature: high frequency in middle aged male with T cell markers expression maintained – CD3

Further studies about immunofenotyping must be correlated with genetic studies for a better treatment outcome

Limitations of the study:

Retrospective designRestricted to a single center’s

patientsSmall number of cases

Questions ?

ReferencesBettina Bisig, Aurelien de Reynies, Christophe Bonnet, et al:

CD30-positive peripheral T-cell lymphomas share molecular and phenotypic features. The Hematology Journal, 98: 1250-1258, 2013

Brenton T. Tan, Roger A. Warnke, Daniel A. Arber: The frequency of B- and T-Cell Gene Rearrangements and Epstein-Barr Virus in T-Cell Lymphomas. The Journal of Molecular Diagnostics, 8: 466-475, 2006

Harry L. Ioachim, L. Jeffery Medeiros: Ioachim’s Lymph Node Pathology, 4th edition

Julie M. Vose, Neumann M., Mildred E. Harris: International T-cell and Natural Killer/T-cell Lymphoma Study: Pathology findings and Clinical Outcomes. Journal of Clinical Oncology, 26:4124-4130, 2008 [1]

Laurence de Leval, Philippe Gaulard: CD30+ lymphoproliferative disorders. The Hematology Journal, 35 :1627-1630, 2010 [4]

Mihai Turcu, Angela Borda, Vasile Bud: Diagnosticul microscopic al leziunilor nodulului limfatic, ed. Mureş 1999

Philip Went, Claudio Agostinelli, Andrea Gallamini, et al. : Marker Expression in Peripheral T-cell Lymphoma: A proposed Clinical-Pathologic Prognostic Score. Journal of Clinical Oncology, 24: 2472-2479, 2006 [2]

Pier Paolo Piccaluga, Claudio Agostinelli, Anna Gazzola, et al.: Prognostic Markers in Peripheral T-cell Lymphoma. Current Hematologic Malignancy Reports, 5:222-228, 2010 [3]

Steven H. Swerdlow, Elias Campo, Nancy Lee Haris, et al: WHO Classification of Tumors of Haematopoietic and Lymphoid Tissues, 4th edition. International Agency for Research on Cancer, Lyon, 2008 [5]

Thank you for your attention !