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• W2894717321 abstract "To the Editor: Peripheral T-cell lymphoma, not otherwise specified (PTCL-NOS) is the rarest subtype of primary cutaneous lymphoma, accounting for approximately 2% of cutaneous lymphomas; therefore, clinicopathologic features of this subtype are not well established.1Willemze R. Jaffe E.S. Burg G. et al.WHO-EORTC classification for cutaneous lymphomas.Blood. 2005; 105: 3768-3785Crossref PubMed Scopus (3224) Google Scholar, 2Bekkenk M.W. Vermeer M.H. Jansen P.M. et al.Peripheral T-cell lymphomas unspecified presenting in the skin: analysis of prognostic factors in a group of 82 patients.Blood. 2003; 102: 2213-2219Crossref PubMed Scopus (200) Google Scholar It is important to differentiate cases of systemic PTCL-NOS from primary cutaneous PTCL-NOS because the prognosis varies depending on the primary tumor site.3Tolkachjov S.N. Weenig R.H. Comfere N.I. Cutaneous peripheral T-cell lymphoma, not otherwise specified: a single-center prognostic analysis.J Am Acad Dermatol. 2016; 75: 992-999Abstract Full Text Full Text PDF PubMed Scopus (24) Google Scholar, 4Su C. Nguyen K.A. Bai H.X. et al.Disease site as a determinant of survival outcome in patients with primary cutaneous peripheral T-cell lymphoma, unspecified: an analysis of 4057 cases from the US National Cancer Database.Leuk Lymphoma. 2018; 59: 2105-2112Google Scholar We analyzed the clinicopathologic characteristics according to the primary tumor site by comparing primary with secondary cutaneous PTCL-NOS. Primary cutaneous PTCL-NOS (group A) was defined as involving only the skin at the initial staging with no evidence of extracutaneous disease at that time or as cutaneous lesions preceding systemic involvement by >6 months. The initial staging workup included a complete blood cell count, serum lactate dehydrogenase level, obtaining a bone marrow biopsy specimen, and computed tomography. A total of 53 cases of cutaneous PTCL-NOS were identified in the medical database at Asan Medical Center (Table I). The age of patients in secondary cutaneous PTCL-NOS (group B) was significantly higher than in primary cutaneous PTCL-NOS (group A) (P = .024). Advanced stage, International Prognostic Index (IPI) score >2, and an elevated serum lactate dehydrogenase level were significantly more common in group B than in group A. On follow-up, the frequency of lymph node (P < .001) and visceral involvement other than the site at diagnosis (P = .003) was significantly more common in group B than in group A (Table I).Table IClinical and pathologic features of cutaneous peripheral T-cell lymphoma, not otherwise specified, according to the primary tumor siteFeaturePrimary cutaneous PTCL-NOS (n = 25), n (%)Secondary cutaneous PTCL-NOS (n = 28), n (%)P valueSex.707 Male13 (52)16 (57) Female12 (48)12 (43)Age (year) Range28–7546–90 Mean47.660.1.024∗Statistically significant. >6012 (48)21 (75)Cutaneous involvement Localized16 (64)8 (29).010∗Statistically significant. Extensive†The extent of a cutaneous lesion was classified as localized when skin lesions were restricted to 1 anatomic site or extensive when several noncontiguous anatomic sites were involved.9 (36)20 (72) Multiple12 (48)23 (82) Single13 (52)5 (18).009∗Statistically significant.Location of skin lesions Legs7 (28)7 (25).805 Arms7 (28)11 (39).386 Trunk12 (48)16 (57).506 Head and neck14 (56)8 (29).043∗Statistically significant.Clinical features of skin lesions Nodules16 (64)9 (32).020∗Statistically significant. Papules6 (24)5 (18).582 Maculopatches5 (20)13 (46).043∗Statistically significant. Cellulitis-like swelling1 (4)2 (7)1Ann Arbor Stage at diagnosis<.001∗Statistically significant. Low (1-2)25 (100)6 (21) High (3-4)0 (0)22 (79)LN involvement during follow-up7 (28)25 (89)<.001∗Statistically significant.BM involvement during follow-up5 (20)9 (32).317Visceral involvement other than primary site during follow-up5 (20)19 (68).003∗Statistically significant.IPI score<.001∗Statistically significant. 0-225 (100)12 (43) 3-50 (0)16 (57)Serum LDH Elevated8 (32)24 (86)<.001∗Statistically significant.Histopathologic features Epidermotropism0/23 (0)0 (0) Pattern of dermal infiltrationPerivascular9 (36)18 (64).040∗Statistically significant.Periadnexal6 (24)12 (43).148Nodular12 (48)6 (21).041∗Statistically significant.Diffuse5 (20)6 (21).511 Angiocentricity4 (16)4 (14).862 Panniculitis-like infiltration4 (16)3 (11).694 Size of tumor cellsSmall7 (28)16 (57).033∗Statistically significant.Medium925 (36)6 (21).240Large9 (36)6 (21).240Immunostaining and EBV status CD325 (100)28 (100)1 CD4+/CD8-19 (76)18 (64).354 CD4-/CD8+1 (4)1 (4)1 CD4-/CD8-2 (8)1 (4)1 CD4+/CD8+3 (12)8 (28).183 CD302 (8)5 (18).426 CD561 (4)2 (7)1 Beta F122 (88)27 (96).333 EBV2 (8)2 (7)1BM, Bone marrow; EBV, Epstein–Barr virus; IPI, international prognostic index; LDH, lactic dehydrogenase; LN, lymph node; PTCL-NOS, peripheral T-cell lymphoma, not otherwise specified.∗ Statistically significant.† The extent of a cutaneous lesion was classified as localized when skin lesions were restricted to 1 anatomic site or extensive when several noncontiguous anatomic sites were involved. Open table in a new tab BM, Bone marrow; EBV, Epstein–Barr virus; IPI, international prognostic index; LDH, lactic dehydrogenase; LN, lymph node; PTCL-NOS, peripheral T-cell lymphoma, not otherwise specified. Skin involvement of the head and neck was significantly more common in primary (14/25, 56.0%) than in secondary (8/28, 28.6%) cutaneous PTCL-NOS (Table I; P = .043). The most common morphology observed in group A was cutaneous nodules (Fig 1, A and B; P = .020) and in group B was maculopatches (Fig 1, C and D; P = .043). Thirty-five of 53 patients (66.0%) presented with multiple skin lesions, and the number of lesions was significantly higher in group B than in group A (P = .009). Histopathologic and immunophenotype findings are summarized in Table I. Small tumor cells were significantly more common in group B (P = .033). A nodular infiltration pattern was most common in group A (Fig 1, E; P = .041), but perivascular infiltration was the most common pattern in group B (Fig 1, F; P = .040). There were no significant differences between the immunophenotypic profiles in the 2 groups. The present study demonstrated differences in clinical and pathologic features of primary and secondary cutaneous PTCL-NOS. Patients with secondary cutaneous PTCL-NOS had more extensive disease and a greater number of skin lesions than those with primary cutaneous disease. Cutaneous involvement in systemic PTCL-NOS suggests disease progression, consistent with the higher International Prognostic Index scores and the frequency of lymph node and other visceral involvement in secondary cutaneous PTCL-NOS. Skin lesions in primary cutaneous PTCL-NOS more commonly affected the head and neck area. In conclusion, cutaneous PTCL-NOS had differences in clinicopathologic features depending on the primary tumor site. The present study would be helpful to differentiate cases of systemic PTCL-NOS from primary cutaneous PTCL-NOS." @default.
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• W2894717321 date "2019-06-01" @default.
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• W2894717321 title "Comparative clinicopathologic analysis of cutaneous peripheral T-cell lymphoma, not otherwise specified, according to primary tumor site" @default.
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• W2894717321 doi "https://doi.org/10.1016/j.jaad.2018.09.051" @default.
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