title: Primary cutaneous anaplastic large cell lymphoma with fatal leukemic outcome in association with CLA and CCR4-negative conversion.
abstract: A 70-year-old Japanese male presented with a 1-year history of skin tumors, which were diagnosed as primary cutaneous anaplastic large cell lymphoma (ALCL) because of the CD3(low+), CD4(+), CD25(+), CD30(+), CD45RO(+), CD71(+), HLA-DR(+), CD8(-), CD56(-), and NPM/ALK(-) phenotype and monoclonal T-cell receptor-rearranged property of tumor cells as well as the absence of systemic involvement. At this time, the tumor cell was positive for cutaneous lymphocyte-associated antigen (CLA) and TH(2) chemokine receptor CCR4. The eruption had repeatedly appeared and spontaneously regressed or regressed by virtue of several therapeutic modalities, including radiotherapy, interferon-alpha and chemotherapy, until the tumor cell invaded the gastric mucosa and spread to the peripheral blood 5 years later. Upon progression to the fatal leukemic change, the skin lesions inversely disappeared. Flow cytometric monitoring of the phenotype of peripheral blood and skin-infiltrating lymphocytes disclosed that the expression of CLA and CCR4 on the tumor cells was converted from positive to negative in association with the leukemic change. The altered expression of skin-homing receptors might change its clinical behavior.
authors.affiliation: Department of Dermatology at the University of Occupational and Environmental Health, Kitakyushu, Japan. tokura@med.uoeh-u.ac.jp
authors.forename: Yoshiki
authors.initials: Y
authors.lastname: Tokura
authors.forename: Kazunari
authors.initials: K
authors.lastname: Sugita
authors.forename: Hiroaki
authors.initials: H
authors.lastname: Yagi
authors.forename: Takatoshi
authors.initials: T
authors.lastname: Shimauchi
authors.forename: Kenji
authors.initials: K
authors.lastname: Kabashima
authors.forename: Masahiro
authors.initials: M
authors.lastname: Takigawa
mesh_terms: D000368:Aged; D000945:Antigens, Differentiation, T-Lymphocyte; D000951:Antigens, Neoplasm / Q000378:metabolism*; D017809:Fatal Outcome; D006801:Humans; D007150:Immunohistochemistry; D007938:Leukemia / Q000209:etiology* / Q000378:metabolism / Q000473:pathology; D016403:Lymphoma, Large B-Cell, Diffuse / Q000150:complications* / Q000378:metabolism* / Q000473:pathology; D008297:Male; D008562:Membrane Glycoproteins / Q000378:metabolism*; D009361:Neoplasm Invasiveness; D009360:Neoplastic Cells, Circulating / Q000473:pathology; D010641:Phenotype; D054398:Receptors, CCR4; D019707:Receptors, Chemokine / Q000378:metabolism*; D012867:Skin / Q000473:pathology; D012878:Skin Neoplasms
chemical_list: D000945:Antigens, Differentiation, T-Lymphocyte; D000951:Antigens, Neoplasm; C515354:CCR4 protein, human; C063419:CTAGE1 protein, human; D008562:Membrane Glycoproteins; D054398:Receptors, CCR4; D019707:Receptors, Chemokine