Relapsed angioimmunoblastic T-cell lymphoma with acquired expression of CD20: a case report and review of the literature
Tóm tắt
Angioimmunoblastic T-cell lymphoma is one of the most common types of peripheral T-cell lymphomas, usually presenting at an older age with an aggressive clinical course. Its characteristic morphological presentation and follicular helper T-cell phenotype help to distinguish it from other T-cell lymphomas. We recently encountered the unique case of a 63-year old patient with relapsed tumour-cell rich angioimmunoblastic T-cell lymphoma, presenting with a “classical” phenotype and, in addition, an acquired, strong, aberrant expression of CD20. “Lineage infidelity” of phenotypic markers is a well-documented phenomenon in lymphomas and leukemias, a circumstance currently still poorly understood and with the potential to bring about erroneous interpretations, causing diagnostic havoc. This case represents one of the few documented angioimmunoblastic T-cell lymphomas with strong CD20 expression. Of interest, CD20 expression was only detected in the recurrent lymphoma and not upon initial diagnosis. The clinical importance of this finding lies in the potential for treatment with an anti-CD20 antibody, for instance Rituximab, in addition to standard chemotherapy protocols for angioimmunoblastic T-cell lymphoma. Diagnostic work-up of lymphomas to determine their lineage should therefore consider morphology, pheno- as well as genotypic characteristics, where appropriate, and in particular signs of progression and change in marker profile in relapsed cases e.g. acquisition of “non-lineage” markers such as CD20 in T-cell lymphoma.
Tài liệu tham khảo
Rudiger T, Weisenburger DD, Anderson JR, Armitage JO, Diebold J, MacLennan KA, Nathwani BN, Ullrich F, Müller-Hermelink HK: Peripheral T-cell lymphoma (excluding anaplastic large cell lymphoma): Results from the Non-Hodgkin’s Lymphoma Classification Project. Ann Oncol. 2002, 13: 140-149. 10.1093/annonc/mdf033.
Mourad N, Mounier N, Brière J, Raffoux E, Delmer A, Feller A, Meijer CJ, Emile JF, Bouabdallah R, Bosly A, Diebold J, Haioun C, Coiffier B, Gisselbrecht C, Gaulard P: Clinical, biologic, and pathologic features in 157 patients with angioimmunoblastic T-cell lymphoma treated within the Groupe d’Étude des Lymphomes de l’Adulte (GELA) trials. Blood. 2008, 111: 4463-4470. 10.1182/blood-2007-08-105759.
de Leval L, Rickman DS, Thielen C, Reynies A, Huang YL, Delsol G, Lamant L, Leroy K, Brière J, Molina T, Berger F, Gisselbrecht C, Xerri L, Gaulard P: The gene expression profile of nodal peripheral T-cell lymphoma demonstrates a molecular link between angioimmunoblastic T-cell lymphoma (AITL) and follicular helper T (FHT) cells. Blood. 2007, 109: 4952-4963. 10.1182/blood-2006-10-055145.
Vinuesa CG, Tangye SG, Moser B, Mackay CR: Follicular B helper T cells in antibody responses and autoimmunity. Nat Rev Immunol. 2005, 5: 853-865. 10.1038/nri1714.
Rahemtullah A, Longtine JA, Harris NL, Dorn M, Zembowicz A, Quintanilla-Fend L, Preffer FI, Ferry JA: CD20+ T-cell lymphoma: clinicopathologic analysis of 9 cases and a review of the literature. Am J Surg Pathol. 2008, 32: 1593-1607. 10.1097/PAS.0b013e31817d7452.
Meier VS, Rufle A, Gudat F: Simultaneous evaluation of T- and B-cell clonality, t(11;14) and t(14;18), in a single reaction by a four-color multiplex polymerase chain reaction assay and automated high-resolution fragment analysis: a method for the rapid molecular diagnosis of lymphoproliferative disorders applicable to fresh frozen and formalin-fixed, paraffin-embedded tissues, blood, and bone marrow aspirates. Am J Pathol. 2001, 159: 2031-43. 10.1016/S0002-9440(10)63055-6.
Yokose N, Ogata K, Sugisaki Y, Mori S, Yamada T, An E, Dan K: CD20-positive T cell leukemia/lymphoma: case report and review of the literature. Ann Hematol. 2001, 80: 372-375. 10.1007/s002770100297.
Tachibana T, Tomita N, Furuya M, Yamanaka S, Takeuchi K, Nakamura N, Fujita H, Ishigatsubo Y: Aberrant CD20 expression in angioimmunoblastic T-cell lymphoma. Intern Med. 2011, 50: 495-499. 10.2169/internalmedicine.50.4386.
Foukas PG, Kefala M, Papageorgiou S, Tsirigotis P, Panayiotidis P, Korkolopoulou P, Spathis A, Dervenoulas J, Patsouris E, Karakitsos P, Panayiotides IG: CD20 expression in angioimmunoblastic T cell lymphoma. Leuk Lymphoma. 2012, 53: 345-347. 10.3109/10428194.2011.602768.
Blakolmer K, Vesely M, Kummer JA, Jurecka W, Mannhalter C, Chott A: Immunoreactivity of B-cell markers (CD79a, L26) in rare cases of extranodal cytotoxic peripheral T- (NK/T-) cell lymphomas. Mod Pathol. 2001, 13: 766-772.
Kaleem Z, White G, Zutter MM: Aberrant expression of T-cell-associated antigens on B-cell non-Hodgkin lymphomas. Am J Clin Pathol. 2001, 115: 396-403. 10.1309/V8YG-8PP4-B4TE-9X6J.
Went P, Agostinelli C, Gallamini A: Marker expression in peripheral T-cell lymphoma: a proposed clinical-pathologic prognostic score. J Clin Oncol. 2006, 24: 2472-2479. 10.1200/JCO.2005.03.6327.
Tzankov AS, Went PT, Münst S, Papadopoulos T, Jundt G, Dirnhofer SR: Rare expression of BSAP (PAX-5) in mature T-cell lymphomas. Mod Pathol. 2007, 20: 632-637. 10.1038/modpathol.3800778.
Murayama Y, Mukai R, Sata T, Matsunaga S, Noguchi A, Yoshikawa Y: Transient expression of CD20 antigen (pan B cell marker) in activated lymph node T cells. Microbiol Immunol. 1996, 40: 467-471.
Joly E, Hudrisier D: What is trogocytosis and what is its purpose?. Nat Immunol. 2003, 4: 815-10.1038/ni0903-815.
Hwang I, Huang JF, Kishimoto H, Brunmark A, Peterson PA, Jackson MR, Surh CD, Cai Z, Sprent J: T cells can use either T cell receptor or CD28 receptors to absorb and internalize cell surface molecules derived from antigen-presenting cells. J Exp Med. 2000, 191: 1137-1148. 10.1084/jem.191.7.1137.
Maloney DG: Anti-CD20 antibody therapy for B-cell lymphomas. New Engl J Med. 2012, 366: 2008-2016. 10.1056/NEJMct1114348.
Alizadeh AA, Advani RH: Evaluation and management of angioimmunoblastic T-cell lymphoma: a review of current approaches and future strategies. Clin Adv Hematol Oncol. 2008, 6: 899-909.
Delfau-Larue MH, de Leval L, Joly B, Plonquet A, Challine D, Parrens M, Delmer A, Salles G, Morschhauser F, Delarue R, Brice P, Bouabdallah R, Casasnovas O, Tilly H, Gaulard P, Haioun C: Targeting intratumoral B-cells with Rituximab in addition to CHOP in angioimmunoblastic T-cell lymphoma. A clinicobiological study of the GELA. Haematol. 2012, 97: 1594-602. 10.3324/haematol.2011.061507.
Karin M: Nuclear factor-kappaB in cancer development and progression. Nature. 2006, 441: 431-436. 10.1038/nature04870.
The pre-publication history for this paper can be accessed here:http://www.biomedcentral.com/1472-6890/13/18/prepub