Cutaneous T-cell lymphoma in asians

Abstract

Cutaneous T-cell lymphoma describes a heterogeneous group of neoplasms of skin homing T cells that vary considerably in clinical presentation, histologic appearance, immunophenotype, and prognosis. This paper addresses the cutaneous T-cell lymphoma in Asians with respect to clinical-epidemiologic and histopathological features. Compared with Western countries, Asia usually has higher rates of cutaneous T-cell lymphomas such as extranodal NK/T-cell lymphoma, hydroa vacciniforme-like lymphoma, subcutaneous panniculitis T-cell lymphoma, and adult T-cell leukemia/lymphoma and lower rates of cutaneous B-cell lymphomas. Among many variants of mycosis fungoides, hypopigmented lesions, pityriasis lichenoides-like lesions, and ichthyosiform lesions are more prevalent in Asia than in the West. Adult T-cell leukemia/lymphoma is endemic in southwestern Japan especially in the Kyushu island. The clinicopathologic characteristics of cutaneous lymphoma vary according to geography, and this may be ascribed to genetic and environmental etiologic factors.

Figure 1

(a) Hypopigmented mycosis fungoides. Various sized, hypopigmented, scaly macules, and patches on the trunk. (b) Numerous atypical mononuclear cells (arrow) surrounded by clear halos are scattered through the epidermis are seen (H&E, ×200). (c) A collection of atypical hyperchromatic lymphocytes (arrow) without spongiosis is seen (H&E, ×400).

Figure 2

(a) Pityriasis lichenoides-like mycosis fungoides. Brown red scaling papules and macules, and some erythematous lesions with a hemorrhagic crust may be seen. (b) There is marked disproportionate epidermotropism (H&E, ×100). (c) There are slight focal epidermotropism, Pautrier's microabscess, and coarse collagen bundles (H&E, ×200).

Figure 3

(a) Ichthyosiform mycosis fungoides. Ichthyosiform eruption located on lower extremities. (b) There are compact orthokeratosis with underlying thinned granular layer and slight focal epidermotropism (H&E, ×100). (c) Pautrier's microabscess (arrow) composed of atypical hyperchromatic lymphocytes are seen (H&E, ×100).

Figure 4

(a) Extranodal NK/T-cell lymphoma presenting as violaceous nodules on the leg. (b) Neoplastic lobular lymphoid infiltrate in the dermis and subcutis (H&E, ×20). (c) Prominent angiodestruction and extensive necrosis with diffuse infiltration of various cells (H&E, ×200). (d) Positivity of neoplastic cells for cytoplasmic CD3 and (e) CD 56.

Figure 5

(a) Multiple tender purplish indurated patches on the both forearm and lower extremities. (b) A dense lymphoid infiltrate located in the subcutaneous tissue (H&E, ×40). (c) A focal rimming of adipocytes by atypical lymphocytes, karyorrhexis, and phagocytic macrophages in the subcutaneous tissue (H&E, ×100). ((d), (e), (f), (g)) Immunohistochemical staining showed (d) CD3 (+), (e) CD8 (+), (f) βF1 (+), and (g) T-cell intracellular antigen-1 (+) (H&E, ×200).