Cutaneous angioimmunoblastic T-cell lymphoma: Epstein-Barr virus positivity and its effects on clinicopathologic features

Lee, Woojin; Won, Kwang Hee; Choi, Jae Won; Won, Chong Hyun; Chang, Sung Eun; Choi, Jee Ho; Lee, Mi Woo

doi:10.1016/j.jaad.2018.08.053

Cited by 10 publications

(9 citation statements)

References 36 publications

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“…In addition to lymph node involvement, it often involves extranodal sites, such as spleen, bone marrow, lungs, and skin . Cutaneous involvement is present approximately in half of AITL patients, most commonly as a maculopapular (typically, a non‐specific morbilliform or exanthematous) eruption . Other manifestations include urticarial or purpuric eruptions, papulovesicular lesions, nodular lesions, erythematosquamous plaques, and ulcerated lesions .…”

Section: Introductionmentioning

confidence: 99%

“…5,13 Cutaneous involvement is present approximately in half of AITL patients, most commonly as a maculopapular (typically, a non-specific morbilliform or exanthematous) eruption. 5,[14][15][16][17] Other manifestations include urticarial or purpuric eruptions, papulovesicular lesions, nodular lesions, erythematosquamous plaques, and ulcerated lesions. 15 Because of such varying dermatological manifestations, cutaneous biopsy is often performed in AITL patients to differentiate true AITL involvement from inflammatory conditions.…”

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confidence: 99%

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Cutaneous lesions of angioimmunoblastic T‐cell lymphoma: Clinical, pathological, and immunophenotypic features

et al. 2019

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Background Angioimmunoblastic T‐cell lymphoma (AITL) is a systemic peripheral T‐cell lymphoma with a follicular helper T‐cell (TFH) immunophenotype that frequently involves the skin. However, the histopathology of cutaneous involvement by AITL has not been fully established. Methods We reviewed the clinicopathological features of 19 patients seen at our institution with AITL involving the skin. Pan‐T‐cell and TFH marker expression was evaluated by immunohistochemistry. Epstein‐Barr virus (EBV) was detected using in situ hybridization (ISH) for Epstein‐Barr virus‐encoded small RNA (EBER). T‐cell receptor (TCR) gene rearrangement was evaluated by PCR. Results AITL affected both trunk and extremities in 15/19 cases (79%). Perivascular infiltration by small and/or medium‐sized lymphocytes was seen in 18/19 (95%). Granulomatous inflammation was identified in 4/19 (21%). Aberrant loss of CD2, CD5, or CD7 was identified in 1/18 (6%), 2/18 (11%), or 7/19 (37%) cases, respectively. Seventeen of eighteen evaluable cases (95%) expressed 2 to 3 TFH markers: PD‐1 in 19/19 (100%), BCL6 in 94% (17/18), and CD10 in 37% (7/19). EBV‐positive cells were detected in 3/18 (17%) with varying density. Clonal TCR gene rearrangement was identified in 9/11 (82%). Conclusions Cutaneous involvement by AITL shows relatively non‐specific histopathological features. However, an immunohistochemical panel including TFH markers and EBER ISH is useful in differential diagnosis.

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Section: Introductionmentioning

confidence: 99%

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confidence: 99%

Cutaneous lesions of angioimmunoblastic T‐cell lymphoma: Clinical, pathological, and immunophenotypic features

et al. 2019

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“…In general, there are three main categories of skin findings in AITL macular, papular, plaque-like-nodular lesions [15], or mixed features of those above [18]. In a recent retrospective analysis, 48.8% of AITL patients had skin involvement, most frequently in the form of a non-specific rash (57.1%), followed by papular (23.8%), erythrodermic (16.7%), nodular (9.5%) and petechial/ purpuric (7.1%) efflorescents [17]. The presented patient had a combination of papules, indurated plaques, and haemorrhagic lesions (Fig.…”

Section: Discussionmentioning

confidence: 99%

“…Cutaneous manifestations are the most common extranodal expressions in AITL patients occurring in up to 50% of cases [15] and not infrequently are the presenting complaint (up to 70% of patients) [16]. The skin involvement by AITL is polymorphic and often non-specific, commonly consisting of maculopapular eruption that may mimic drug reaction or viral exanthema [6,16,17]. In general, there are three main categories of skin findings in AITL macular, papular, plaque-like-nodular lesions [15], or mixed features of those above [18].…”

Section: Discussionmentioning

confidence: 99%

Fever, rash, and eosinophilia – early signs of angioimmunoblastic T-cell lymphoma

Wawrzycki

Prystupa

Szumiło

et al. 2021

Ann Agric Environ Med.

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Angioimmunoblastic T-cell lymphoma (AITL) is an uncommon lymphoma of elderly adults with a poor prognosis. AITL patients show systemic symptoms, lymphadenopathy, and not infrequently, skin rash with various dysimmune phenomena rashes. The case is presented of a 68-year-old male with skin rash, lymphadenopathy and hypereosinophilia who, after investigations, was diagnosed with AITL. Despite the treatment used, the patient's condition gradually deteriorated and died due to heart and kidney failure. The diagnosis of AITL is often established only after several weeks or months because of transient physical findings, non-specific symptoms, and a broad range of serologic or radiologic abnormalities. Some patients with AITL experience non-specific dermatitis and eosinophilia. The presented case should raise awareness of the presentations of AITL which is important for physicians to reach an accurate diagnosis.

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“…EBV appears to play a role in AITL pathogenesis and histological development [2,4], either through EBVinfected B immunoblasts found at early AITL stages adjacent to neoplastic T cells [5][6][7] or infection of both cells types [8]. For this reason, EBV serostatus and viral loads serve as important prognostic factors [9,10], especially among young patients [11]. EBV DNA load in peripheral blood is routinely monitored by polymerase chain reaction (PCR) in patients after allo-SCT to allow for pre-emptive treatment strategies [12].…”

Section: Introductionmentioning

confidence: 99%

Reconstitution of T cell immunity against EBV in the immunocompromised host by adoptive transfer of peptide-stimulated T cells after allogeneic stem cell transplantation

Cobo

Ritter

Gary

et al. 2021

Preprint

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Reconstitution of T cell repertoire after allogeneic stem cell transplantation is a long and often incomplete process. As a result, reactivation of Epstein-Barr virus (EBV) is a frequent complication that may be treated by adoptive transfer of donor-derived EBV-specific T cells. We generated donor-derived EBV-specific T cells by peptide stimulation and adoptively transferred them to a patient with angioimmunoblastic T-cell lymphoma (AITL), who had developed persisting high titers of EBV concomitant to relapse after transplantation. T cell receptor beta (TCRβ) deep sequencing showed that the T cell repertoire of the patient early after transplantation (day 60) was strongly reduced and only very low numbers of EBV-specific T cells were detectable. Manufacturing and in vitro expansion of donor-derived EBV-specific T cells resulted in enrichment of EBV epitope-specific, HLA-restricted T cells. Monitoring after adoptive transfer revealed that the dominant TCR sequences from peptide-stimulated T cells persisted long-term and established an EBV-specific TCR clonotype repertoire in the host, with many of the EBV-specific TCRs present in the donor. This reconstituted repertoire was associated with immunological control of EBV and with lack of further AITL relapse.Author summaryA characteristic feature of all herpesviruses is their persistence in the host’s body after primary infection. Hence, the host’s immune system is confronted with the problem to control these viruses life-long. Well-known representative of the herpesvirus group are the classic Herpes-Simplex Virus (HSV-1) and Varicella Zoster Virus (VZV, causing chicken pox); a less known representative is Epstein Barr Virus (EBV, causing mononucleosis). When the immune system is severely compromised, for example after stem cell transplantation from a foreign (allogeneic) donor, these viruses can reappear, as they are already in the host’s body. Especially EBV cause life-threatening complications after stem cell transplantation and only reinforcement of the host’s immune system can reestablish viral control. Here we show that ex vivo manufactured EBV-specific T cells can reestablish long-term control of EBV and that these cells persist in the host’s body over months. These results give us a better understanding of viral immune reconstitution post-transplant and of clinically-relevant T cell populations against EBV.

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Cutaneous angioimmunoblastic T-cell lymphoma: Epstein-Barr virus positivity and its effects on clinicopathologic features

Cited by 10 publications

References 36 publications

Cutaneous lesions of angioimmunoblastic T‐cell lymphoma: Clinical, pathological, and immunophenotypic features

Cutaneous lesions of angioimmunoblastic T‐cell lymphoma: Clinical, pathological, and immunophenotypic features

Fever, rash, and eosinophilia – early signs of angioimmunoblastic T-cell lymphoma

Reconstitution of T cell immunity against EBV in the immunocompromised host by adoptive transfer of peptide-stimulated T cells after allogeneic stem cell transplantation

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