Originally published as JCO Early Release 10.1200/JCO.2008.16.1307 on June 9 2008

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Primary Cutaneous Small/Medium CD4⁺ T-Cell Lymphomas: A Heterogeneous Group of Tumors With Different Clinicopathologic Features and Outcome

Adriana Garcia-Herrera, Luis Colomo, Mireia Camós, Joaquín Carreras, Olga Balague, Antonio Martinez, Armando Lopéz-Guillermo, Teresa Estrach, Elias Campo

From the Hematopathology Section, Department of Pathology, Department of Hematology, and Dermatology, Hospital Clínic, Institut d'Investigacions Biomediques August Pi i Sunyer, University of Barcelona, Barcelona, Spain

Corresponding author: Elias Campo, MD, Hematopathology Section, Hospital Clínic, Villarroel 170, 08036-Barcelona, Spain; e-mail: ecampo{at}clinic.ub.es

Purpose: To define the clinical and pathologic characteristics of primary cutaneous small/medium CD4⁺ T-cell lymphoma (PCSM-TCL) and identify parameters of prognostic significance.

Patients and Methods: We have investigated 24 patients with primary cutaneous lymphomas composed of small/medium mature T-cells with a βF1, CD3, CD4⁺ and/or noncytotoxic, CD8^– and CD30^– phenotype. The proliferation index and CD8⁺ infiltrating cells were quantified with an automated image analysis system.

Results: Sixteen patients presenting with solitary or localized plaques or small nodules (< 3 cm) had an indolent course. Only three patients experienced repeated cutaneous relapses, and none of them died as a result of the disease after 1 to 168 months (median, 17 months) of follow-up. The tumors had a low proliferation (median Ki-67, 9% ± 5%) and an intense infiltrate of reactive CD8⁺ (median, 20% ± 11.7%). Five patients presenting with rapidly evolving large tumors or nodules ( 5 cm) had an aggressive disease and died with extracutaneous dissemination 18 to 36 months after diagnosis (median, 23 months). These tumors had a significantly higher proliferation (median Ki-67, 22% ± 11.3%; P < .05) and lower number of infiltrating CD8⁺ (median, 1% ± 3%; P < .05) than the previous group. A third group of three patients had a peculiar clinical presentation with multifocal relapsing lesions without extracutaneous dissemination after a long period of follow-up ranging from 41 to 92 months. Histologically, these cases had an intense infiltrate of eosinophils.

Conclusion: PCSM-TCL is a heterogeneous group of tumors with differentiated clinical and pathological characteristics with impact in the outcome of the patients.

published online ahead of print at www.jco.org on June 9, 2008.

Supported by the Spanish Comisión Interministerial de Ciencia y Tecnología SAF05-5855 (E.C.), Instituto de Salud Carlos III, Fondo de Investigación Sanitaria (PI050458-TE and PI070409-ALG), Red Temática de Investigación Cooperativa de Cáncer (RET 20 39), and Instituto de Salud Carlos III (where O.B. is a fellow).

Authors’ disclosures of potential conflicts of interest and author contributions are found at the end of this article.

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