title: Clinicopathologic Spectrum of Gastrointestinal T-cell Lymphoma: Reappraisal Based on T-cell Receptor Immunophenotypes.
abstract: The differential diagnosis of primary gastrointestinal EBV T-cell lymphoma (GITCL) includes enteropathy-associated T-cell lymphoma (EATL), peripheral T-cell lymphoma, not otherwise specified, adult T-cell leukemia/lymphoma, and anaplastic large cell lymphoma. Type II EATL is considered to be a tumor of intraepithelial lymphocytes. However, the evaluation of intraepithelial lymphocytosis by biopsy specimens is challenging, which poses a diagnostic problem between the EATL and peripheral T-cell lymphoma, not otherwise specified. This situation requested us to establish a pragmatic diagnostic approach for the classification of GITCL. We identified 42 cases of GITCL and analyzed clinicopathologic features, especially addressing their T-cell receptor (TCR) phenotype. Nine (21%) of 42 GITCL cases were positive for TCRγ protein expression. Among these TCRγ cases, TCRβ expression or not was detected in 5 and 4, respectively, but resulted in no further clinicopathologic differences. TCRβ positivity without TCRγ expression (βγ) was seen in 9 GITCL patients (21%). Twenty-four patients (57%) were negative for TCRβ and γ expression (βγ). Compared with TCRβγ or βγ type, TCRγ cases were characterized by exclusive involvement of intestinal sites (100% vs. 11%, P<0.001; 100% vs. 58%, P=0.032, respectively), but not of stomach (0% vs. 78%, P=0.002; 0% vs. 38%, P=0.039, respectively). Notably, TCRγ positivity was an independent unfavorable prognostic factor among our GITCL patients (P<0.001). Considering our results, TCRγ GITCL, that is, intestinal γδ T-cell lymphoma, appears to constitute a distinct disease entity.
authors.affiliation: Departments of *Endoscopy ¶Hematology and Cell Therapy, Aichi Cancer Center †Department of Gastroenterology, Nagoya University Graduate School of Medicine §Department of Pathology and Laboratory Medicine, Nagoya University Hospital, Nagoya ‡Department of Gastroenterology, Toyohashi Municipal Hospital, Toyohashi ∥Department of Molecular Diagnosis, Nagano Prefectural Suzaka Hospital, Suzaka, Japan.
authors.forename: Tsutomu
authors.initials: T
authors.lastname: Tanaka
authors.forename: Hideko
authors.initials: H
authors.lastname: Yamamoto
authors.forename: Ahmed Ali
authors.initials: AA
authors.lastname: Elsayed
authors.forename: Akira
authors.initials: A
authors.lastname: Satou
authors.forename: Naoko
authors.initials: N
authors.lastname: Asano
authors.forename: Kei
authors.initials: K
authors.lastname: Kohno
authors.forename: Tomohiro
authors.initials: T
authors.lastname: Kinoshita
authors.forename: Yasumasa
authors.initials: Y
authors.lastname: Niwa
authors.forename: Hidemi
authors.initials: H
authors.lastname: Goto
authors.forename: Shigeo
authors.initials: S
authors.lastname: Nakamura
authors.forename: Seiichi
authors.initials: S
authors.lastname: Kato
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D005434:Flow Cytometry; D005770:Gastrointestinal Neoplasms / Q000276:immunology* / Q000401:mortality / Q000473:pathology*; D006801:Humans; D007150:Immunohistochemistry; D016130:Immunophenotyping; D053208:Kaplan-Meier Estimate; D016399:Lymphoma, T-Cell / Q000276:immunology* / Q000401:mortality / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D016016:Proportional Hazards Models; D011948:Receptors, Antigen, T-Cell / Q000276:immunology*; D055815:Young Adult
chemical_list: D011948:Receptors, Antigen, T-Cell