Primary cutaneous B-cell lymphoma with abundant reactive gamma/delta T-cells within the skin lesion and peripheral blood.
T-cell/histiocyte-rich diffuse large B-cell lymphoma is characterized by abundant reactive T-cell and histiocyte infiltration within nodal diffuse large B-cell lymphoma, and only limited cases of primary cutaneous T-cell-rich B-cell lymphoma have been documented. These reactive T-cells usually show a T-helper phenotype. Gamma/delta T-cell is a functionally distinct T-cell lineage, which constitutes on average 5% of all T-cells in the peripheral blood. Herein, we report the first documented case of primary cutaneous malignant B-cell lymphoma with abundant reactive gamma/delta(+) T-cells within the skin lesion and peripheral blood. An 80-year-old Japanese male presented with a gradually enlarged knee nodule. Histopathological study revealed diffuse infiltration of lymphoid cells in the dermis and subcutis. Proliferation of large-sized atypical lymphoid cells was observed among medium-sized lymphocytes with convoluted nuclei. Immunohistochemically, these large-sized atypical lymphocytes were CD20(+), and relatively many gamma/delta(+) cell infiltration was also noted. Flowcytometric analysis revealed deviation of lambda+ cells (lambda/kappa 58) and increase of CD3(+) gamma/delta(+) cells (6%). Peripheral blood had CD3(+) gamma/delta(+) cells (28.8%). Rearrangement of immunoglobulin heavy chain, but not of T-cell receptor beta and gamma chains, was observed. Accordingly, an ultimate diagnosis of cutaneous B-cell lymphoma with abundant reactive gamma/delta(+) cells was made. Recent studies have shown reactive gamma/delta(+) T-cell infiltration and/or elevation in the peripheral blood in patients with various types of carcinoma, and that they play a role in the pathogenesis of some carcinomas. Therefore, additional analysis is needed to clarify the role of reactive gamma/delta(+) T-cells in malignant lymphoma.
Department of Clinical Laboratory Medicine and Division of Diagnostic Pathology, Shiga University of Medical Science Shiga, Japan.
Mitsuaki
M
Ishida
Department of Clinical Laboratory Medicine and Division of Diagnostic Pathology, Shiga University of Medical Science Shiga, Japan.
Muneo
M
Iwai
Department of Clinical Laboratory Medicine and Division of Diagnostic Pathology, Shiga University of Medical Science Shiga, Japan.
Keiko
K
Yoshida
Department of Clinical Laboratory Medicine and Division of Diagnostic Pathology, Shiga University of Medical Science Shiga, Japan.
Akiko
A
Kagotani
Department of Clinical Laboratory Medicine and Division of Diagnostic Pathology, Shiga University of Medical Science Shiga, Japan.
Hidetoshi
H
Okabe
D000369:Aged, 80 and over; D006801:Humans; D016393:Lymphoma, B-Cell / Q000097:blood / Q000276:immunology* / Q000473:pathology; D008297:Male; D016692:Receptors, Antigen, T-Cell, gamma-delta / Q000276:immunology*; D012878:Skin Neoplasms / Q000097:blood / Q000276:immunology* / Q000473:pathology; D013601:T-Lymphocytes / Q000276:immunology*
D016692:Receptors, Antigen, T-Cell, gamma-delta
Cutaneous B-cell lymphoma; T-cell-rich B-cell lymphoma; gamma/delta T-cell