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This review covers the diagnosis and management of natural killer and peripheral T-cell lymphomas (PTCL). Problems with PTCL include their rarity, representing usually 10-15% of non-Hodgkin's lymphomas in the Western Hemisphere, morphologic heterogeneity, and lack of immunophenotypic markers for clonality. Additionally, their clinical behavior is variable and may not correlate with morphology.Dr. Kinney gives a general overview of the diagnosis of PTCL and NK cell neoplasms. Emphasis will be placed on extranodal T cell and natural killer (NK) cell lymphomas such as hepatosplenic lymphoma, subcutaneous panniculitis-like lymphoma and nasal/nasal type T/NK-cell lymphoma. The use of ALK gene regulation in the classification of anaplastic large cell lymphoma is also reviewed.Dr. Loughran describes current understanding of the pathogenesis of large granular lymphocyte (LGL) leukemia. The discussion focuses on LGL leukemia as an instructive model of dysregulated apoptosis causing both malignant and autoimmune disease. Current management options and mechanisms of therapeutic response are also described.Dr. Greer addresses whether PTCL should be treated differently from the more common diffuse large B cell lymphomas. He discusses the therapeutic options for anaplastic large cell lymphoma (ALCL), from a conservative approach for primary cutaneous ALCL to combination chemotherapy for the highly chemosensitive ALCL expressing anaplastic lymphoma kinase. He reviews therapy options for the extranodal subtypes of PTCL by drawing from series in adults, pediatrics, dermatology, and the Far East.

Early diagnosis of invasive pulmonary aspergillosis is problematic in some patient groups due to the lack of rapid, sensitive, specific, and reliable diagnostic tests. Fungal burden and therapeutic efficacy were assessed by survival, quantitative culture (CFU counts), galactomannan enzyme immunoassay (GM-EIA), and quantitative PCR (qPCR) in a new guinea pig model of invasive pulmonary aspergillosis using an aerosol challenge. At 1 day postinfection, qPCR determined that the pulmonary fungal burden was 2 log 10 higher than that determined by CFU counting and increased significantly (P < 0.03) over time. In contrast, the tissue burden assessed by CFU counting did not rise over the course of the study. Therapy with the antifungal drug voriconazole produced statistically significant decreases in pulmonary fungal burden, as detected by CFU counting (P < 0.02), qPCR, and GM-EIA (both P < 0.0002). Daily assessment of the progression of fungal infection in serum was performed by qPCR and GM-EIA. GM-EIA demonstrated a statistically significant reduction in the fungal load on days 6 and 7 in voriconazole-treated animals compared to time-matched controls (P < 0.02). Confirmation of fungal tissue burden by two or more methods should provide a more precise account of the burden, allowing improved assessment of diagnostic and therapeutic strategies in invasive pulmonary aspergillosis.

MicroRNA (miRNA) deregulation contributes to cancer pathogenesis. However, analysis of miRNAs in diffuse large B-cell lymphoma (DLBCL) has been hindered by a focus on cell lines, limited number of miRNAs examined, and lack of copy number data. To address these restrictions, we investigated genomewide miRNA expression and copy number data in 86 DLBCLs. Permutation analysis showed that 63 miRNAs were recurrently disrupted in DLBCL, including highly expressed oncomirs not previously linked to chromosomal abnormalities. Further, using training and validation tumor groups, we defined a collection of miRNAs that robustly segregates DLBCLs into 3 subsets, which are independent of the cell-of-origin classification, extent of T-cell infiltrate, and tumor site. Instead, these unique miRNA-driven DLBCL subgroups showed markedly different MYC transcriptional activity, which explained the domi-

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Primary cutaneous CD30+ lymphoproliferative disorders (LPDs), including lymphomatoid papulosis (LyP), anaplastic and nonanaplastic CD30+ large- cell lymphoma, and borderline cases, comprise a clinical and histologic spectrum. Primary cutaneous and primary nodal CD30+ anaplastic large- cell lymphomas (ALCLs) are distinct clinical entities that have identical morphologic features but differ in age of onset, immunophenotype, and prognosis. It can be difficult to distinguish primary cutaneous from nodal ALCLs that secondarily involve the skin, which is important because these diseases differ significantly in response to treatment and clinical outcome. The t(2;5) chromosomal translocation is highly associated with primary CD30+ ALCL of nodal origin. The possible occurrence of t(2;5) in primary cutaneous CD30+ LPDs has not been studied extensively, and it remains to be determined if expression of this translocation can be used to distinguish primary cutaneous ALCL from nodal ALCL that secondarily involves the skin. To address these issues, we studied 43 cases of cutaneous and nodal CD30+ LPDs using reverse transcriptase-polymerase chain reaction (RT-PCR) and/or immunohistochemistry. We found no evidence for the t(2; 5) translocation in 14 cases of primary cutaneous CD30+ LPDs, which included 10 cases of LyP, three cases of primary cutaneous CD30+ ALCL, and one borderline case. These findings were in marked contrast to CD30+ ALCL of nodal origin, in which 19 of 29 (66%) cases were positive for t(2;5), including all five cases with secondary skin involvement. Our results support the hypothesis that (1) primary cutaneous CD30+ LPDs (including LyP) and primary nodal ALCL are distinct diseases that differ in clinical behavior and pathogenesis and (2) differential expression of t(2;5) can help to distinguish between primary cutaneous CD30+ LPDs and ALCL of nodal origin.