title: Immunophenotypic shift of CD4 and CD8 antigen expression in primary cutaneous T-cell lymphomas: a clinicopathologic study of three cases.
abstract: Primary cutaneous T-cell lymphomas (CTCL) comprise a heterogeneous group of neoplasms with diverse clinical behavior. Mycosis fungoides (MF) is the most common type of CTCL. Immunophenotypical shift during progression of the disease is a rare event and its significance is unknown. We present three primary CTCL cases that showed an immunophenotypical shift and poor prognosis. Conventional hematoxylin/eosin and immunohistochemical-stained sections were examined in all the cases. Molecular analysis for rearrangement of the T-cell receptor (TCR) gene was performed in two cases. One case was classified as MF, while the other two lacked epidermotropism, and were considered primary cutaneous peripheral T-cell lymphoma (PTCL), NOS. Two cases were CD3+/CD4+ and one case was CD3+/CD8+ at diagnosis. The first two patients suffered many relapses and eventually, new CTCL lesions with a CD3+/CD8+ phenotype were observed. Both cases revealed identical clonal TCR rearrangements on the initial and late lesions, supporting the interpretation of a single clonal proliferation with different phenotypes. The third case progressed with skin recurrences and pulmonary lesions with a predominant CD3+/CD4+/CD8- phenotype. All cases manifested poor prognosis and two patients died of lymphoma. Immunophenotypical shift between CD4 and CD8 in CTCL seems to be a rare phenomenon that may be associated with disease progression.
authors.affiliation: National Cancer Institute, National Institutes of Health, Bethesda, MD, USA.
authors.forename: Phyu Phyu
authors.initials: PP
authors.lastname: Aung
authors.forename: Fina
authors.initials: F
authors.lastname: Climent
authors.forename: Tariq
authors.initials: T
authors.lastname: Muzzafar
authors.forename: Jonathan L
authors.initials: JL
authors.lastname: Curry
authors.forename: Keyur P
authors.initials: KP
authors.lastname: Patel
authors.forename: Octavio
authors.initials: O
authors.lastname: Servitje
authors.forename: Victor G
authors.initials: VG
authors.lastname: Prieto
authors.forename: Madeleine
authors.initials: M
authors.lastname: Duvic
authors.forename: Elaine S
authors.initials: ES
authors.lastname: Jaffe
authors.forename: Carlos A
authors.initials: CA
authors.lastname: Torres-Cabala
mesh_terms: D000328:Adult; D000368:Aged; D015704:CD4 Antigens / Q000276:immunology*; D016827:CD8 Antigens / Q000276:immunology*; D018450:Disease Progression; D005260:Female; D006801:Humans; D016130:Immunophenotyping; D016410:Lymphoma, T-Cell, Cutaneous / Q000235:genetics / Q000276:immunology / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D011948:Receptors, Antigen, T-Cell / Q000235:genetics / Q000276:immunology; D012867:Skin / Q000276:immunology / Q000473:pathology*; D012878:Skin Neoplasms / Q000235:genetics / Q000276:immunology / Q000473:pathology*
chemical_list: D015704:CD4 Antigens; D016827:CD8 Antigens; D011948:Receptors, Antigen, T-Cell
keywords: T-cell receptor gene rearrangement (PCR technique); cutaneous T-cell lymphoma (CTCL); immunohistochemistry; immunophenotype; mycosis fungoides (MF)