A difficult case of angioimmunoblastic T-cell lymphoma to diagnose

Sachsida-Colombo, Elisabetta; Mariano, Lívia Caroline Barbosa; Bastos, Fernanda Queiróz; Rassi, Amanda Bruder; Lage, Luís Alberto de Pádua Covas; Barreto, A. Betariz; Siqueira, Sheila Aparecida Coelho da; Pereira, Juliana

doi:10.1016/j.bjhh.2015.11.002

Cited by 7 publications

(6 citation statements)

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“…If the follicular dendritic cell proliferation and prominent high endothelial venules are not typical enough in conjunction with Epstein-Barr virus (EBV) positive immunoblasts masquerading as ReedSternberg like cells, angioimmunoblastic T cell lymphoma might mimic mixed cellularity classical Hodgkin lymphoma, as evidenced by two cases of the present study. 24,25 Anaplastic large cell lymphoma is regarded as another differential diagnosis of angioimmunoblastic T cell lymphoma, exemplified by a case in the present study due to the fact that both might manifest endothelial proliferation. 26, 27 Peripheral T cell lymphoma is another mimicker of mixed cellularity classical Hodgkin lymphoma because the former often shows Reed-Sternberg like cells, as seen in at least two cases of the present study.…”

Section: Discussionmentioning

confidence: 68%

Flow cytometry of lymph node aspirate can effectively differentiate the reactive lymphadenitis from the nodal non-Hodgkin lymphoma

Dey

Chakravarty

Kamal

2017

Bangabandhu Sheikh Mujib Medical Univ J

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Lymphoma is a common malignancy worldwide affecting both children and adults. In Bangladesh, non-Hodgkin lymphoma (NHL) is relatively common and contributing to 7% of total cancer reported 1 as compared to 4% in USA. 2 Nodal lymphoma is rather prevalent in Bangladesh; for instance, lymphoma constitutes about 6% of all the cases of cervical lymphadenopathy persisting for more than three weeks. 3 Although fine needle aspiration cytology can diagnose almost all the cases of reactive lymphadenitis, only up to about 86% cases of NHL can be correctly identified by cytology alone. 4Fine needle aspiration cytology is accepted in recurrence lymphoma; primary diagnosis and classification of NHLs are usually made by histological examination and till date, considered to be the gold standard. Worldwide, many centers have reported fine needle aspiration cytology show relatively high sensitivity and specificity in the diagnosis of lymphomas when used in conjunction with other ancillary techniques in last 15 years. 5, 6 Despite this, nonHodgkin lymphoma diagnosis of on fine needle aspiration material has remained controversial. 7-9 Even though architectural and morphologic feature continues to be important parameters in World Health Organization's classifycation of hematopoietic and lymphoid tumors, lymphoma diagnosis is now routinely based on combined information from clinical manifestations, histomorphologic features, immunophenotype and genotype. 10, 11, 12 Flow cytometric immunophenotyping offers many advantages in the analysis of fine needle aspiration materials for lymphoma diagnosis. Moreover, it requires small number of cells and is also suitable for cells already in suspension. It is very sensitive immunophenotyping technique, and can detect aberrant cells even 1/10,000 cells. 13 Thus, it almost replaced the classic immunocytochemistry. 14 As in immunocytochemistry only one antigen can be assessed per cell at a time, it is rather time consuming. Large number of specific monoclonal anti-bodies combining four or more fluorochromes can precisely define the cell profile and neoplastic nature of lymphoid cells make FCI is a more sensitive, specific and swift diagnostic tool than is immunocytochemistry. 13, 15-17Indeed FCI evaluates several antigens on one cell (including cytoplasmic antigens), and can | Original | Article | AbstractThe purpose of the present study was to compare the routine cytology, histology, immunohistochemistry and flow cytometry in the diagnosis of nodal lymphoma cases. Thirty five cases of clinically suspected lymphoproliferative disorder were included in this study. After preparation of smears from the fine needle aspirates on the glass slides for cytology, the residual material was processed for flow cytometric immunophenotyping accordingly. Subsequently, histopathology and immunohistochemistry findings of selected cases of lymph node biopsy were correlated to confirm and compare the diagnosis. Flow cytometric immunophenotypes of most of the cases corresponded to the histological and immunohistochem...

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Section: Discussionmentioning

confidence: 68%

Flow cytometry of lymph node aspirate can effectively differentiate the reactive lymphadenitis from the nodal non-Hodgkin lymphoma

Dey

Chakravarty

Kamal

2017

Bangabandhu Sheikh Mujib Medical Univ J

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“…The lymph node is the main site of involvement for AITL and the gold standard for the diagnosis of the disease is excisional lymph node biopsy [ 8 ]. Excisional biopsy is necessary as the architecture of the lymph nodes is effaced in AITL and so helps in morphological diagnosis.…”

Section: Discussionmentioning

confidence: 99%

“…Excisional biopsy is necessary as the architecture of the lymph nodes is effaced in AITL and so helps in morphological diagnosis. A core biopsy is often performed to save time and invasive procedures; however, the sample is usually insufficient to provide an accurate diagnosis as seen in our case [ 8 ]. Our patient underwent a core needle biopsy of the axillary lymph node with no definitive diagnosis reached.…”

Section: Discussionmentioning

confidence: 99%

“…We can argue that her history with SARS-CoV-2 virus infection prior to her initial presenting symptoms in Canada, may have been a trigger for this rare disease [ 10 ]. The most common treatment is chemotherapy using cyclophosphamide, doxorubicin, vincristine prednisone (CHOP) regimen for 21 days, followed by autologous stem cell transplantation [ 7 , 8 , 11 ]. The first-line treatment with anthracycline-based chemotherapy has shown complete remission of AITL in 61% cases, with a 5-year survival rate of 32% [ 1 , 12 ].…”

Section: Discussionmentioning

confidence: 99%

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A Case of Angioimmunoblastic T-cell Lymphoma Hidden in Plain Sight: A Delay in Diagnosis and Management

et al. 2022

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Angioimmunoblastic T-cell lymphoma (AITL) is an uncommon type of cluster of differentiation (CD)4 T-cell peripheral lymphoma. The varied clinical presentations of AITL present a challenge for accurate diagnosis. We present a case of a 57-year-old female with a history of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection in May 2020, who presented to the hospital in the summer of 2021 with shortness of breath for 3 months. She underwent an extensive workup for lymphadenopathy while in Canada involving multiple core lymph node biopsies, which were inconclusive. Here in our institution, several tests for infectious diseases were unremarkable. Imaging tests revealed bilateral pleural effusion, lymphadenopathies, and rectal thickening. Results from rectal biopsy and excisional cervical lymph node biopsy revealed findings typical of AITL. Due to worsening hypoxia with pleural fluid accumulation, bilateral chest tubes (PleurX catheter) were placed. Steroids and chemotherapy were started. She was discharged in stable condition to follow-up care. An integrated and persistent approach comprising clinical, morphologic, excisional biopsy, immunophenotyping, and molecular tests is essential in reaching a correct diagnosis of AITL. Through our consistent effort to obtain further imaging and tissue biopsies, we came to the diagnosis which allowed her to begin appropriate life-saving treatments.

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“…Even for the most expert hematopathologists, the differentiation between PTCL/NOS and ALK-negative ALCL or AITL is quite problematic [1]. This analysis can be more troublesome particularly if tumor sample is scarce, preventing analysis of the complete architecture of the lymph node that is commonly found in samples obtained by core-biopsy [1,23,24].…”

Section: Discussionmentioning

confidence: 99%

<strong><em>GATA 3</em> Gene Overexpression Is A Biomarker of Adverse Prognosis for Peripheral T-Cell Lymphoma, Not Otherwise Specified and for ALK-Negative Anaplastic Large Cell Lymphoma: An Exploratory Analysis of 80 Latin American Cases of nodal PTCLs</strong>

Lage¹,

Brito²,

Levy³

et al. 2020

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Background: Nodal peripheral T-cell lymphomas (nPTCLs) encompass a heterogeneous group of mature and aggressive lymphoid malignancies, including peripheral T-cell lymphoma, not otherwise specified (PTCL/NOS), angioimmunoblastic T-cell lymphoma (AITL) and anaplastic large cell lymphoma (ALCL) ALK-positive and ALK-negative. Their differential diagnosis and prognosis are an issue in the clinical practice. Accurate biomarkers to refine the different subtypes of nPTCLs and to stratify their prognosis are essential to improve their treatment approach. The aim of this study was to test the prognostic impact of GATA3 gene expression, and its capability to discriminate the different subtypes of nPTCLs. Patients and Methods: From 2000 to 2017, 80 patients with nPTCLs were eligible for GATA3 gene expression analysis that was assessed retrospectively by quantitative real time PCR (qRT-PCR) of neoplastic biopsies in Formalin-Fixed Paraffin-Embedded samples (FFPE). Results: Median age was 49 years old (IqR 34-59), 43/80 (53.7%) were male. Median follow-up was 1.72 years. Of them, 36.3% were classified as PTCL/NOS, 31.2% ALK-negative ALCL, 21.2% ALK-positive ALCL and 11.3% AITL. The majority of cases had advanced stage (III/IV). Two-year estimated overall survival (OS) and progression-free survival (PFS) were 52.2% and 39.5%, respectively. The median GATA3 gene expression level was 0.49% (range 0 – 7.07) in all cohort, it was 0.11% for ALK-positive ALCL, 0.46% for ALK-negative ALCL, 0.86% for PTCL/NOS and 0.67% for AITL. The difference of GATA3 gene expression among distinct variants of nPTCLs was statistically significant (p < 0.001). GATA3 gene expression levels ≥ 0.71% discriminate PTCL/NOS from ALK-negative ALCL and AITL with sensitivity of 62% and specificity of 80.3%. GATA3 gene expression levels ≥ median was associated with poor 2-year OS for PTCL/NOS (46.7% x 21.4%, p=0.04) and for ALK-negative ALCL (85.7% x 54.5%, p=0.04). Conclusion: Despite the relative small and heterogeneous group of patients with nPTCLs, GATA3 gene overexpression may be an important biomarker associated with poor prognosis in PTCL/NOS and ALK-negative ALCL. Moreover it may also discriminate different subtypes of nPTCLs. Further studies with larger series of patients should confirm our findings.

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A difficult case of angioimmunoblastic T-cell lymphoma to diagnose

Cited by 7 publications

References 8 publications

Flow cytometry of lymph node aspirate can effectively differentiate the reactive lymphadenitis from the nodal non-Hodgkin lymphoma

Flow cytometry of lymph node aspirate can effectively differentiate the reactive lymphadenitis from the nodal non-Hodgkin lymphoma

A Case of Angioimmunoblastic T-cell Lymphoma Hidden in Plain Sight: A Delay in Diagnosis and Management

<strong><em>GATA 3</em> Gene Overexpression Is A Biomarker of Adverse Prognosis for Peripheral T-Cell Lymphoma, Not Otherwise Specified and for ALK-Negative Anaplastic Large Cell Lymphoma: An Exploratory Analysis of 80 Latin American Cases of nodal PTCLs</strong>

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