Background The most common cutaneous T-cell lymphomas (CTCLs) are mycosis fungoides and Sézary syndrome.Aim To determine whether blood stage and other prognostic variables affect overall survival (OS) in CTCL.
MethodsWe studied retrospectively 1197 CTCL patients seen at the M.D. Anderson Cancer Center since 1987.
ResultsWe identified 124 (10.3%) patients with erythrodermic CTCL (E-CTCL), 63% of whom had positive gene rearrangements in skin and 19 of whom had no evidence of hematologic involvement. The median age at diagnosis was 63 years (range, 26-90 years); the male to female ratio was 1.3 : 1. OS curves were estimated by the Kaplan-Meier method and compared using log-rank tests. The median OS in all 124 E-CTCL patients was 5.1 years (range, 0.4-18.6 years) regardless of the cause of death or blood involvement. Patients were stratified by the H0-H4 staging system with manual or flow cytometric determination of Sézary cell counts (Russell-Jones R, Whittaker SJ. Sézary syndrome: diagnostic criteria and therapeutic options. Semin Cutan Med Surg 2000; 19 : 100 -108). The median OS was 7.6 years for H0-H2 ( < 1000 Sézary cells/L) ( n = 23), 5.4 years for H3 ( ≥ 1000 to ≤ 10,000 Sézary cells/L) ( n = 79), and 2.4 years for H4 ( ≥ 10,000 Sézary cells/L) ( n = 22) ( P = 0.011). Treatment with systemic steroids, age, serum lactate dehydrogenase, and white blood cell count ≥ 20,000 μ L were significant prognostic factors, but large cell transformation, T-cell receptor gene rearrangement, tumor-node-metastasis stage, treatments, and CD4 : CD8 ratio were not. In multivariate analysis, advanced age and elevated lactate dehydrogenase were the strongest predictors of a poor prognosis.Conclusions Serum LDH and age were the strongest predictive factors for OS in E-CTCL.
Many articles have been published on improving the appearance of scars; however, there are no definitive management protocols. Our objective was to review the literature on laser therapy for various types of scars. There are multiple laser modalities that have been studied with certain features that may be indicated for specific scar types. Suggestions are given for further studies.
Carcinoid tumors are the most common type of neuroendocrine tumors with an incidence of 1.5 per 100 000 of the population. Skin manifestations of carcinoid tumors include those associated with the carcinoid syndrome and sequelae from metastatic disease. Carcinoid tumors in the breast, which were first described in 1977, are rare and may present either as primary or metastatic lesions. The existence of primary breast carcinoid tumors is controversial, however, and, if they do exist, would account for <1% of primary breast cancers. We report the case of a 76-year-old woman who presented to the M.D. Anderson Cancer Center with a long-standing history of a breast lump. Core biopsy of the mass and left axillary lymph node aspiration revealed neuroendocrine tumor of the breast, which stained positive for synaptophysin and chromogranin. Subsequently, the patient developed a left-sided pleural effusion, and a further work-up revealed metastases to the lung parenchyma and pleural space. Three years after her diagnosis, she complained of a persistent, erythematous thickening of skin over the surface of her left inferior breast, which had been present for 1 year. On examination, multiple erythematous grouped nodules arranged in an oval pattern were present. A punch biopsy from one of the nodules revealed invasive low-grade carcinoma with neuroendocrine features similar to those in her prior breast core biopsy. The tumor was seen to be infiltrating the dermis. This is a unique case of a neuroendocrine tumor of the breast with cutaneous spread. The number of reported cases of neuroendocrine tumors with cutaneous involvement remains small.
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