Relapsed angioimmunoblastic T-cell lymphoma with acquired expression of CD20: a case report and review of the literature

BMC Clinical Pathology

Alexander Tzankov³  Stephan Dirnhofer³  Fatime Krasniqi²  Yara Banz¹ 

[1] Institute of Pathology, University of Bern, Bern, Switzerland;Department of Oncology, University Hospital Basel, Basel, Switzerland;Institute of Pathology, University Hospital Basel, Schönbeinstrasse 4, 4031, Basel, Switzerland

关键词: Tumour-cell rich;    CD20;    Lineage infidelity;    Angioimmunoblastic T-cell lymphoma;   

Others  :  1084930
DOI  :  10.1186/1472-6890-13-18

 received in 2012-12-11, accepted in 2013-05-29,  发布年份 2013

【 摘 要 】

Background

Angioimmunoblastic T-cell lymphoma is one of the most common types of peripheral T-cell lymphomas, usually presenting at an older age with an aggressive clinical course. Its characteristic morphological presentation and follicular helper T-cell phenotype help to distinguish it from other T-cell lymphomas.

Case presentation

We recently encountered the unique case of a 63-year old patient with relapsed tumour-cell rich angioimmunoblastic T-cell lymphoma, presenting with a “classical” phenotype and, in addition, an acquired, strong, aberrant expression of CD20.

“Lineage infidelity” of phenotypic markers is a well-documented phenomenon in lymphomas and leukemias, a circumstance currently still poorly understood and with the potential to bring about erroneous interpretations, causing diagnostic havoc. This case represents one of the few documented angioimmunoblastic T-cell lymphomas with strong CD20 expression. Of interest, CD20 expression was only detected in the recurrent lymphoma and not upon initial diagnosis. The clinical importance of this finding lies in the potential for treatment with an anti-CD20 antibody, for instance Rituximab, in addition to standard chemotherapy protocols for angioimmunoblastic T-cell lymphoma.

Conclusion

Diagnostic work-up of lymphomas to determine their lineage should therefore consider morphology, pheno- as well as genotypic characteristics, where appropriate, and in particular signs of progression and change in marker profile in relapsed cases e.g. acquisition of “non-lineage” markers such as CD20 in T-cell lymphoma.

【 授权许可】

   
2013 Banz et al.; licensee BioMed Central Ltd.

【 图 表 】

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【 参考文献 】

• [1]Rudiger T, Weisenburger DD, Anderson JR, Armitage JO, Diebold J, MacLennan KA, Nathwani BN, Ullrich F, Müller-Hermelink HK: Peripheral T-cell lymphoma (excluding anaplastic large cell lymphoma): Results from the Non-Hodgkin’s Lymphoma Classification Project. Ann Oncol 2002, 13:140-149.
• [2]Mourad N, Mounier N, Brière J, Raffoux E, Delmer A, Feller A, Meijer CJ, Emile JF, Bouabdallah R, Bosly A, Diebold J, Haioun C, Coiffier B, Gisselbrecht C, Gaulard P: Clinical, biologic, and pathologic features in 157 patients with angioimmunoblastic T-cell lymphoma treated within the Groupe d’Étude des Lymphomes de l’Adulte (GELA) trials. Blood 2008, 111:4463-4470.
• [3]de Leval L, Rickman DS, Thielen C, Reynies A, Huang YL, Delsol G, Lamant L, Leroy K, Brière J, Molina T, Berger F, Gisselbrecht C, Xerri L, Gaulard P: The gene expression profile of nodal peripheral T-cell lymphoma demonstrates a molecular link between angioimmunoblastic T-cell lymphoma (AITL) and follicular helper T (FHT) cells. Blood 2007, 109:4952-4963.
• [4]Vinuesa CG, Tangye SG, Moser B, Mackay CR: Follicular B helper T cells in antibody responses and autoimmunity. Nat Rev Immunol 2005, 5:853-865.
• [5]Rahemtullah A, Longtine JA, Harris NL, Dorn M, Zembowicz A, Quintanilla-Fend L, Preffer FI, Ferry JA: CD20+ T-cell lymphoma: clinicopathologic analysis of 9 cases and a review of the literature. Am J Surg Pathol 2008, 32:1593-1607.
• [6]Meier VS, Rufle A, Gudat F: Simultaneous evaluation of T- and B-cell clonality, t(11;14) and t(14;18), in a single reaction by a four-color multiplex polymerase chain reaction assay and automated high-resolution fragment analysis: a method for the rapid molecular diagnosis of lymphoproliferative disorders applicable to fresh frozen and formalin-fixed, paraffin-embedded tissues, blood, and bone marrow aspirates. Am J Pathol 2001, 159:2031-43.
• [7]Yokose N, Ogata K, Sugisaki Y, Mori S, Yamada T, An E, Dan K: CD20-positive T cell leukemia/lymphoma: case report and review of the literature. Ann Hematol 2001, 80:372-375.
• [8]Tachibana T, Tomita N, Furuya M, Yamanaka S, Takeuchi K, Nakamura N, Fujita H, Ishigatsubo Y: Aberrant CD20 expression in angioimmunoblastic T-cell lymphoma. Intern Med 2011, 50:495-499.
• [9]Foukas PG, Kefala M, Papageorgiou S, Tsirigotis P, Panayiotidis P, Korkolopoulou P, Spathis A, Dervenoulas J, Patsouris E, Karakitsos P, Panayiotides IG: CD20 expression in angioimmunoblastic T cell lymphoma. Leuk Lymphoma 2012, 53:345-347.
• [10]Blakolmer K, Vesely M, Kummer JA, Jurecka W, Mannhalter C, Chott A: Immunoreactivity of B-cell markers (CD79a, L26) in rare cases of extranodal cytotoxic peripheral T- (NK/T-) cell lymphomas. Mod Pathol 2001, 13:766-772.
• [11]Kaleem Z, White G, Zutter MM: Aberrant expression of T-cell-associated antigens on B-cell non-Hodgkin lymphomas. Am J Clin Pathol 2001, 115:396-403.
• [12]Went P, Agostinelli C, Gallamini A: Marker expression in peripheral T-cell lymphoma: a proposed clinical-pathologic prognostic score. J Clin Oncol 2006, 24:2472-2479.
• [13]Tzankov AS, Went PT, Münst S, Papadopoulos T, Jundt G, Dirnhofer SR: Rare expression of BSAP (PAX-5) in mature T-cell lymphomas. Mod Pathol 2007, 20:632-637.
• [14]Murayama Y, Mukai R, Sata T, Matsunaga S, Noguchi A, Yoshikawa Y: Transient expression of CD20 antigen (pan B cell marker) in activated lymph node T cells. Microbiol Immunol 1996, 40:467-471.
• [15]Joly E, Hudrisier D: What is trogocytosis and what is its purpose? Nat Immunol 2003, 4:815.
• [16]Hwang I, Huang JF, Kishimoto H, Brunmark A, Peterson PA, Jackson MR, Surh CD, Cai Z, Sprent J: T cells can use either T cell receptor or CD28 receptors to absorb and internalize cell surface molecules derived from antigen-presenting cells. J Exp Med 2000, 191:1137-1148.
• [17]Maloney DG: Anti-CD20 antibody therapy for B-cell lymphomas. New Engl J Med 2012, 366:2008-2016.
• [18]Alizadeh AA, Advani RH: Evaluation and management of angioimmunoblastic T-cell lymphoma: a review of current approaches and future strategies. Clin Adv Hematol Oncol 2008, 6:899-909.
• [19]Delfau-Larue MH, de Leval L, Joly B, Plonquet A, Challine D, Parrens M, Delmer A, Salles G, Morschhauser F, Delarue R, Brice P, Bouabdallah R, Casasnovas O, Tilly H, Gaulard P, Haioun C: Targeting intratumoral B-cells with Rituximab in addition to CHOP in angioimmunoblastic T-cell lymphoma. A clinicobiological study of the GELA. Haematol 2012, 97:1594-602.
• [20]Karin M: Nuclear factor-kappaB in cancer development and progression. Nature 2006, 441:431-436.