title: Specificity of IRF4 translocations for primary cutaneous anaplastic large cell lymphoma: a multicenter study of 204 skin biopsies.
abstract: Current pathologic criteria cannot reliably distinguish cutaneous anaplastic large cell lymphoma from other CD30-positive T-cell lymphoproliferative disorders (lymphomatoid papulosis, systemic anaplastic large cell lymphoma with skin involvement, and transformed mycosis fungoides). We previously reported IRF4 (interferon regulatory factor-4) translocations in cutaneous anaplastic large cell lymphomas. Here, we investigated the clinical utility of detecting IRF4 translocations in skin biopsies. We performed fluorescence in situ hybridization (FISH) for IRF4 in 204 biopsies involved by T-cell lymphoproliferative disorders from 182 patients at three institutions. In all, 9 of 45 (20%) cutaneous anaplastic large cell lymphomas and 1 of 32 (3%) cases of lymphomatoid papulosis with informative results demonstrated an IRF4 translocation. Remaining informative cases were negative for a translocation (7 systemic anaplastic large cell lymphomas; 44 cases of mycosis fungoides/Sézary syndrome (13 transformed); 24 peripheral T-cell lymphomas, not otherwise specified; 12 CD4-positive small/medium-sized pleomorphic T-cell lymphomas; 5 extranodal NK/T-cell lymphomas, nasal type; 4 gamma-delta T-cell lymphomas; and 5 other uncommon T-cell lymphoproliferative disorders). Among all cutaneous T-cell lymphoproliferative disorders, FISH for IRF4 had a specificity and positive predictive value for cutaneous anaplastic large cell lymphoma of 99 and 90%, respectively (P=0.00002, Fisher's exact test). Among anaplastic large cell lymphomas, lymphomatoid papulosis, and transformed mycosis fungoides, specificity and positive predictive value were 98 and 90%, respectively (P=0.005). FISH abnormalities other than translocations and IRF4 protein expression were seen in 13 and 65% of cases, respectively, but were nonspecific with regard to T-cell lymphoproliferative disorder subtype. Our findings support the clinical utility of FISH for IRF4 in the differential diagnosis of T-cell lymphoproliferative disorders in skin biopsies, with detection of a translocation favoring cutaneous anaplastic large cell lymphoma. Like all FISH studies, IRF4 testing must be interpreted in the context of morphology, phenotype, and clinical features.
authors.affiliation: Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN 55905, USA.
authors.forename: David A
authors.initials: DA
authors.lastname: Wada
authors.forename: Mark E
authors.initials: ME
authors.lastname: Law
authors.forename: Eric D
authors.initials: ED
authors.lastname: Hsi
authors.forename: David J
authors.initials: DJ
authors.lastname: Dicaudo
authors.forename: Linglei
authors.initials: L
authors.lastname: Ma
authors.forename: Megan S
authors.initials: MS
authors.lastname: Lim
authors.forename: Aieska de
authors.initials: Ad
authors.lastname: Souza
authors.forename: Nneka I
authors.initials: NI
authors.lastname: Comfere
authors.forename: Roger H
authors.initials: RH
authors.lastname: Weenig
authors.forename: William R
authors.initials: WR
authors.lastname: Macon
authors.forename: Lori A
authors.initials: LA
authors.lastname: Erickson
authors.forename: Nazan
authors.initials: N
authors.lastname: Ozsan
authors.forename: Stephen M
authors.initials: SM
authors.lastname: Ansell
authors.forename: Ahmet
authors.initials: A
authors.lastname: Dogan
authors.forename: Andrew L
authors.initials: AL
authors.lastname: Feldman
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D014408:Biomarkers, Tumor / Q000032:analysis / Q000235:genetics*; D001706:Biopsy; D002648:Child; D002675:Child, Preschool; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D007150:Immunohistochemistry; D017404:In Situ Hybridization, Fluorescence; D050835:Interferon Regulatory Factors / Q000235:genetics*; D017728:Lymphoma, Large-Cell, Anaplastic / Q000235:genetics; D054446:Lymphoma, Primary Cutaneous Anaplastic Large Cell / Q000737:chemistry / Q000235:genetics* / Q000473:pathology; D017731:Lymphomatoid Papulosis / Q000235:genetics; D008232:Lymphoproliferative Disorders / Q000235:genetics* / Q000378:metabolism / Q000473:pathology; D008297:Male; D008875:Middle Aged; D009182:Mycosis Fungoides / Q000235:genetics; D011237:Predictive Value of Tests; D012680:Sensitivity and Specificity; D012878:Skin Neoplasms / Q000737:chemistry / Q000235:genetics* / Q000473:pathology; D014178:Translocation, Genetic; D014481:United States; D055815:Young Adult; D000099218:Interferon Regulatory Factor-4
chemical_list: D014408:Biomarkers, Tumor; D050835:Interferon Regulatory Factors; D000099218:Interferon Regulatory Factor-4