Case and Research Letters
Primary Cutaneous CD4+ Small/Medium-Sized T-Cell Lymphoma With Spontaneous Regression After Biopsy
Linfoma primario cutáneo T CD4 positivo de linfocitos de pequeño y mediano tamaño con regresión espontánea tras la biopsia
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"apellidos" => "Rodríguez-Prieto" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "S0001731015002185" "doi" => "10.1016/j.ad.2015.02.014" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "es" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0001731015002185?idApp=UINPBA000044" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1578219015002516?idApp=UINPBA000044" "url" => "/15782190/0000010600000009/v1_201511040157/S1578219015002516/v1_201511040157/en/main.assets" ] "en" => array:15 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Case and Research Letters</span>" "titulo" => "Primary Cutaneous CD4+ Small/Medium-Sized T-Cell Lymphoma With Spontaneous Regression After Biopsy" "tieneTextoCompleto" => true "saludo" => "<span class="elsevierStyleItalic">To the Editor:</span>" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "767" "paginaFinal" => "768" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "D. González Fernández, F. Valdés Pineda, S. Gómez Díez, B. Vivanco Allende" "autores" => array:4 [ 0 => array:4 [ "nombre" => "D." "apellidos" => "González Fernández" "email" => array:1 [ 0 => "danigf81@gmail.com" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 1 => array:3 [ "nombre" => "F." "apellidos" => "Valdés Pineda" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 2 => array:3 [ "nombre" => "S." "apellidos" => "Gómez Díez" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 3 => array:3 [ "nombre" => "B." "apellidos" => "Vivanco Allende" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] ] "afiliaciones" => array:2 [ 0 => array:3 [ "entidad" => "Servicio de Dermatología, Hospital Universitario Central de Asturias, Oviedo, Spain" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Servicio de Anatomía Patológica, Hospital Universitario Central de Asturias, Oviedo, Spain" "etiqueta" => "b" "identificador" => "aff0010" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Linfoma primario cutáneo T CD4 positivo de linfocitos de pequeño y mediano tamaño con regresión espontánea tras la biopsia" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 677 "Ancho" => 900 "Tamanyo" => 116958 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">A single nodular lesion of 2.5<span class="elsevierStyleHsp" style=""></span>cm diameter on the nasal ala.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Primary cutaneous CD4+ small/medium-sized T-cell lymphoma (PCSM-TCL) is a rare provisional entity included in the 2005 cutaneous lymphoma classification of the World Health Organization/European Organisation for Research and Treatment of Cancer (WHO/EORTC) in the group of primary cutaneous T-cell lymphomas.<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">1</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">Our patient was a 44-year-old man with no past history of interest. He was seen for a nodular lesion that had appeared on the left nasal ala 3 weeks earlier and had grown progressively. At the time of consultation, this well-defined, indurated nodular lesion measured 2.5<span class="elsevierStyleHsp" style=""></span>cm in diameter and there were no changes in the overlying skin (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>). No other cutaneous lesions were observed and there were no palpable lymph nodes or organomegaly.</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0015" class="elsevierStylePara elsevierViewall">An incisional biopsy revealed a dense, diffuse lymphocytic infiltrate in the dermis. The lymphocyte population was formed of small-sized lymphocytes associated with another population of medium-sized lymphocytes, both populations showing pleomorphism. No discernible germinal centers were found. Epidermotropism was minimal and there was slight infiltration of the follicular epithelium. Immunohistochemistry revealed a lymphocyte population formed predominantly of T cells that expressed CD3 and CD5. The CD4/CD8 ratio was greater than 2 (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>). Analysis of T-cell receptor rearrangement revealed a monoclonal T-cell population.</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0020" class="elsevierStylePara elsevierViewall">Blood tests including complete blood count, routine biochemistry, and lactate dehydrogenase were normal, as was cervical-thoracic-abdominal computed tomography, excluding the involvement of other organs. Based on these findings we made a diagnosis of PCSM-TCL.</p><p id="par0025" class="elsevierStylePara elsevierViewall">Since the first follow-up visit, 10 days after the biopsy, the lesion was seen to regress and it had completely disappeared after 3 months (<a class="elsevierStyleCrossRef" href="#fig0015">Fig. 3</a>). In view of the good clinical course, we decided to maintain a wait-and-see approach with frequent follow-up visits. After a year the patient remained asymptomatic and no new lesions had appeared.</p><elsevierMultimedia ident="fig0015"></elsevierMultimedia><p id="par0030" class="elsevierStylePara elsevierViewall">PCSM-TCL is included as a provisional entity in the group of primary cutaneous T-cell lymphomas, both in the 2005 WHO/EORTC classification of cutaneous lymphomas and in the latest (2008) classification of tumors of hematopoietic and lymphoid tissue.<a class="elsevierStyleCrossRefs" href="#bib0055"><span class="elsevierStyleSup">1,2</span></a> It is a rare disease that accounts for approximately 2% to 3% of primary cutaneous lymphomas.<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">1</span></a> It affects men and women equally, and the mean age at the time of diagnosis is 50-60 years, though it can arise at any age—published cases range from 3 to 90 years of age.<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">3</span></a> Clinical presentation is usually as a solitary, asymptomatic, rapidly growing plaque or mass of up to 3<span class="elsevierStyleHsp" style=""></span>cm diameter; lesions most commonly arise on the face or neck, or on the upper part of the trunk. The surface is typically smooth and may have an erythematous or violaceous appearance.<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">3</span></a> There are 2 other forms of presentation with a poorer prognosis, one as an aggressive tumor and the other as multiple lesions with abundant eosinophils observed in the skin biopsy.<a class="elsevierStyleCrossRefs" href="#bib0070"><span class="elsevierStyleSup">4,5</span></a> The histology of the lesions contrasts with the benign course of PCSM-TCL. Dense, nodular or diffuse infiltrates of atypical, pleomorphic small- and medium-sized lymphocytes are found in the superficial and deep dermis and tend to infiltrate the subcutaneous cellular tissue. Although large pleomorphic cells may be observed, by definition these make up less than 30% of the infiltrate. An inflammatory infiltrate of reactive CD8+ T cells is usually present, as well as a variable number of B cells, plasma cells, macrophages, and eosinophils.<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">6</span></a> It is not uncommon to find focal areas of epidermotropism and invasion of adnexal structures. The atypical cells show the following immunohistochemical profile: CD3+, CD4+, CD8–, and CD30–. The proliferation index is less than 30%, and molecular analysis reveals monoclonal rearrangement of the T-cell receptor gene, either of the gamma chain or of the beta chain, in 60% of cases.<a class="elsevierStyleCrossRefs" href="#bib0055"><span class="elsevierStyleSup">1–3</span></a> In the differential diagnosis, there are no clear criteria to differentiate PCSM-TCL from benign lymphoid diseases, and the nuclear pleomorphism, immunohistochemistry, and detection of clonality are therefore used to orient the diagnosis to PCSM-TCL.<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">3</span></a> Five-year survival is over 90% when presentation is with a single lesion with typical characteristics. This prognosis worsens when presentation is multifocal, and overall 5-year survival is of 60% to 80%.<a class="elsevierStyleCrossRefs" href="#bib0055"><span class="elsevierStyleSup">1–3</span></a> Poor prognostic factors include CD2–, rapidly growing tumors over 5<span class="elsevierStyleHsp" style=""></span>cm in diameter, the presence of a limited number of accompanying CD8+ T<span class="elsevierStyleHsp" style=""></span>cells and a high ki-67 index.<a class="elsevierStyleCrossRefs" href="#bib0065"><span class="elsevierStyleSup">3,7</span></a> To date, 3 other cases of spontaneous regression after biopsy have been reported.<a class="elsevierStyleCrossRefs" href="#bib0085"><span class="elsevierStyleSup">7–9</span></a> The therapeutic options described in the consensus statement on the treatment of cutaneous lymphomas<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">10</span></a> suggest non-aggressive management for patients with primary or recurrent, single or multiple localized nodular forms, varying from follow-up of the patient to topical or intralesional corticosteroids or even surgery or radiation therapy. Treatment for aggressive forms must be individualized according to the characteristics of the patient.</p></span>" "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: González Fernández D, Valdés Pineda F, Gómez Díez S, Vivanco Allende B. Linfoma primario cutáneo T CD4 positivo de linfocitos de pequeño y mediano tamaño con regresión espontánea tras la biopsia. Actas Dermosifiliogr. 2015;106:767–768.</p>" ] ] "multimedia" => array:3 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 677 "Ancho" => 900 "Tamanyo" => 116958 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">A single nodular lesion of 2.5<span class="elsevierStyleHsp" style=""></span>cm diameter on the nasal ala.</p>" ] ] 1 => array:7 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 363 "Ancho" => 1948 "Tamanyo" => 279668 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">A and B, Biopsy showing the dense lymphocytic infiltrate. Hematoxylin-eosin, original magnification ×<span class="elsevierStyleHsp" style=""></span>2 (A) and ×<span class="elsevierStyleHsp" style=""></span>10 (B). C, Detail of the composition of the infiltrate, showing cellular pleomorphism. Hematoxylin–eosin, original magnification ×<span class="elsevierStyleHsp" style=""></span>40. D, Immunohistochemical stain for CD4, original magnification ×<span class="elsevierStyleHsp" style=""></span>2.</p>" ] ] 2 => array:7 [ "identificador" => "fig0015" "etiqueta" => "Figure 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr3.jpeg" "Alto" => 900 "Ancho" => 932 "Tamanyo" => 142556 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Complete regression of the lesion at 3 months.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:10 [ 0 => array:3 [ "identificador" => "bib0055" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "WHO-EORTC classification for cutaneous lymphomas" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "R. 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| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 November | 6 | 10 | 16 |
| 2024 October | 72 | 39 | 111 |
| 2024 September | 78 | 31 | 109 |
| 2024 August | 107 | 66 | 173 |
| 2024 July | 74 | 46 | 120 |
| 2024 June | 74 | 41 | 115 |
| 2024 May | 64 | 33 | 97 |
| 2024 April | 88 | 26 | 114 |
| 2024 March | 85 | 34 | 119 |
| 2024 February | 68 | 27 | 95 |
| 2024 January | 61 | 37 | 98 |
| 2023 December | 49 | 31 | 80 |
| 2023 November | 59 | 27 | 86 |
| 2023 October | 57 | 18 | 75 |
| 2023 September | 74 | 31 | 105 |
| 2023 August | 59 | 17 | 76 |
| 2023 July | 55 | 35 | 90 |
| 2023 June | 56 | 26 | 82 |
| 2023 May | 81 | 30 | 111 |
| 2023 April | 53 | 22 | 75 |
| 2023 March | 52 | 32 | 84 |
| 2023 February | 84 | 22 | 106 |
| 2023 January | 59 | 36 | 95 |
| 2022 December | 75 | 57 | 132 |
| 2022 November | 40 | 31 | 71 |
| 2022 October | 41 | 55 | 96 |
| 2022 September | 33 | 48 | 81 |
| 2022 August | 53 | 36 | 89 |
| 2022 July | 34 | 43 | 77 |
| 2022 June | 38 | 29 | 67 |
| 2022 May | 71 | 35 | 106 |
| 2022 April | 85 | 36 | 121 |
| 2022 March | 101 | 52 | 153 |
| 2022 February | 94 | 28 | 122 |
| 2022 January | 75 | 38 | 113 |
| 2021 December | 51 | 41 | 92 |
| 2021 November | 67 | 50 | 117 |
| 2021 October | 48 | 69 | 117 |
| 2021 September | 53 | 42 | 95 |
| 2021 August | 35 | 47 | 82 |
| 2021 July | 44 | 29 | 73 |
| 2021 June | 47 | 25 | 72 |
| 2021 May | 28 | 31 | 59 |
| 2021 April | 83 | 61 | 144 |
| 2021 March | 88 | 40 | 128 |
| 2021 February | 58 | 36 | 94 |
| 2021 January | 48 | 34 | 82 |
| 2020 December | 51 | 19 | 70 |
| 2020 November | 34 | 27 | 61 |
| 2020 October | 37 | 20 | 57 |
| 2020 September | 47 | 30 | 77 |
| 2020 August | 36 | 15 | 51 |
| 2020 July | 36 | 23 | 59 |
| 2020 June | 38 | 28 | 66 |
| 2020 May | 49 | 29 | 78 |
| 2020 April | 36 | 26 | 62 |
| 2020 March | 41 | 23 | 64 |
| 2020 February | 6 | 2 | 8 |
| 2020 January | 0 | 1 | 1 |
| 2019 December | 4 | 2 | 6 |
| 2019 November | 0 | 5 | 5 |
| 2019 October | 0 | 2 | 2 |
| 2019 September | 4 | 3 | 7 |
| 2019 July | 0 | 9 | 9 |
| 2019 June | 2 | 14 | 16 |
| 2019 May | 0 | 37 | 37 |
| 2019 April | 0 | 5 | 5 |
| 2019 March | 2 | 7 | 9 |
| 2019 January | 6 | 0 | 6 |
| 2018 November | 1 | 0 | 1 |
| 2018 October | 4 | 0 | 4 |
| 2018 September | 3 | 2 | 5 |
| 2018 August | 0 | 1 | 1 |
| 2018 July | 0 | 1 | 1 |
| 2018 June | 0 | 3 | 3 |
| 2018 May | 0 | 10 | 10 |
| 2018 March | 0 | 11 | 11 |
| 2018 February | 26 | 8 | 34 |
| 2018 January | 29 | 7 | 36 |
| 2017 December | 48 | 13 | 61 |
| 2017 November | 37 | 10 | 47 |
| 2017 October | 16 | 10 | 26 |
| 2017 September | 22 | 10 | 32 |
| 2017 August | 25 | 9 | 34 |
| 2017 July | 26 | 20 | 46 |
| 2017 June | 24 | 21 | 45 |
| 2017 May | 25 | 24 | 49 |
| 2017 April | 18 | 9 | 27 |
| 2017 March | 12 | 24 | 36 |
| 2017 February | 19 | 20 | 39 |
| 2017 January | 14 | 12 | 26 |
| 2016 December | 16 | 18 | 34 |
| 2016 November | 20 | 21 | 41 |
| 2016 October | 16 | 20 | 36 |
| 2016 September | 0 | 1 | 1 |
| 2016 August | 1 | 3 | 4 |
| 2016 July | 1 | 2 | 3 |
| 2016 June | 3 | 0 | 3 |
| 2016 May | 1 | 3 | 4 |
| 2016 January | 0 | 1 | 1 |
| 2015 December | 0 | 1 | 1 |
| 2015 November | 0 | 6 | 6 |
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