Angioimmunoblastic T-cell lymphoma pathophysiology: Difference between revisions

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Clonal [[T-cell receptor]] gene rearrangements are detected in 75% of cases<ref name="fell1">[http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=pubmed&cmd=Retrieve&dopt=AbstractPlus&list_uids=2849301&query_hl=34&itool=pubmed_ExternalLink]
Clonal [[T-cell receptor]] gene rearrangements are detected in 75% of cases<ref name="fell1">[http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=pubmed&cmd=Retrieve&dopt=AbstractPlus&list_uids=2849301&query_hl=34&itool=pubmed_ExternalLink]
Feller AC, Griesser H, Schilling CV, Wacker HH, Dallenbach F, Bartels H, Kuse R, Mak TW, Lennert K. "Clonal gene rearrangement patterns correlate with immunophenotype and clinical parameters in patients with angioimmunoblastic lymphadenopathy." '''Am J Pathol'''. 1988 Dec;133(3):549-56. PMID: 2849301</ref>, and [[immunoglobin]] gene rearrangements are seen in 10% of cases, and these cases are believed to be due to expanded EBV-driven [[B-cell]] populations.<ref name="lip1">[http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=pubmed&cmd=Retrieve&dopt=AbstractPlus&list_uids=3805286&query_hl=36&itool=pubmed_ExternalLink]
Feller AC, Griesser H, Schilling CV, Wacker HH, Dallenbach F, Bartels H, Kuse R, Mak TW, Lennert K. "Clonal gene rearrangement patterns correlate with immunophenotype and clinical parameters in patients with angioimmunoblastic lymphadenopathy." '''Am J Pathol'''. 1988 Dec;133(3):549-56. PMID: 2849301</ref>, and [[immunoglobin]] gene rearrangements are seen in 10% of cases, and these cases are believed to be due to expanded EBV-driven [[B-cell]] populations.<ref name="lip1">[http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=pubmed&cmd=Retrieve&dopt=AbstractPlus&list_uids=3805286&query_hl=36&itool=pubmed_ExternalLink]
Lipford EH, Smith HR, Pittaluga S, Jaffe ES, Steinberg AD, Cossman J. "Clonality of angioimmunoblastic lymphadenopathy and implications for its evolution to malignant lymphoma." '''J Clin Invest'''. 1987 Feb;79(2):637-42. PMID: 3805286</ref>  Similarly, [[EBV]]-related sequences can be detected most cases, usually in [[B-cells]] but occasionally in [[T-cells]].<ref name="wei1"/><ref name="ana1"/>.  [[Trisomy]] 3, trisomy 5, and +X are the most frequent chromosomal abnormalities found in cases.<ref name="kane1">[http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=pubmed&cmd=Retrieve&dopt=AbstractPlus&list_uids=3261178&query_hl=40&itool=pubmed_ExternalLink]
Lipford EH, Smith HR, Pittaluga S, Jaffe ES, Steinberg AD, Cossman J. "Clonality of angioimmunoblastic lymphadenopathy and implications for its evolution to malignant lymphoma." '''J Clin Invest'''. 1987 Feb;79(2):637-42. PMID: 3805286</ref>  The [[Epstein–Barr virus]] (EBV) is observed in the majority of cases,<ref name=who1/> and the virus has been found in the reactive B-cells that comprise part of the polymorphous infiltrate of this disease<ref name=wei1>{{cite journal |author=Weiss LM, Jaffe ES, Liu XF, Chen YY, Shibata D, Medeiros LJ |title=Detection and localization of Epstein-Barr viral genomes in angioimmunoblastic lymphadenopathy and angioimmunoblastic lymphadenopathy-like lymphoma |journal=Blood |volume=79 |issue=7 |pages=1789–95 |date=April 1992 |pmid=1373088 |url=http://www.bloodjournal.org/content/79/7/1789.full}}
</ref> and in the neoplastic T-cells.<ref name=ana1>{{cite journal |author=Anagnostopoulos I, Hummel M, Finn T |title=Heterogeneous Epstein-Barr virus infection patterns in peripheral T-cell lymphoma of angioimmunoblastic lymphadenopathy type |journal=Blood |volume=80 |issue=7 |pages=1804–12 |date=October 1992 |pmid=1327284 |display-authors=etal |url=http://www.bloodjournal.org/content/80/7/1804.full}}
</ref>   [[Trisomy]] 3, trisomy 5, and +X are the most frequent chromosomal abnormalities found in cases.<ref name="kane1">[http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=pubmed&cmd=Retrieve&dopt=AbstractPlus&list_uids=3261178&query_hl=40&itool=pubmed_ExternalLink]
Kaneko Y, Maseki N, Sakurai M, Takayama S, Nanba K, Kikuchi M, Frizzera G. "Characteristic karyotypic pattern in T-cell lymphoproliferative disorders with reactive "angioimmunoblastic lymphadenopathy with dysproteinemia-type" features." '''Blood'''. 1988 Aug;72(2):413-21. PMID: 3261178</ref><ref name="sch1">
Kaneko Y, Maseki N, Sakurai M, Takayama S, Nanba K, Kikuchi M, Frizzera G. "Characteristic karyotypic pattern in T-cell lymphoproliferative disorders with reactive "angioimmunoblastic lymphadenopathy with dysproteinemia-type" features." '''Blood'''. 1988 Aug;72(2):413-21. PMID: 3261178</ref><ref name="sch1">
[http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=pubmed&cmd=Retrieve&dopt=AbstractPlus&list_uids=7919378&query_hl=42&itool=pubmed_ExternalLink]
[http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=pubmed&cmd=Retrieve&dopt=AbstractPlus&list_uids=7919378&query_hl=42&itool=pubmed_ExternalLink]

Revision as of 15:18, 21 December 2015

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [7]; Associate Editor(s)-in-Chief: Raviteja Guddeti, M.B.B.S. [8] Sowminya Arikapudi, M.B,B.S. [9]

Pathophysiology

Genetics

Clonal T-cell receptor gene rearrangements are detected in 75% of cases[1], and immunoglobin gene rearrangements are seen in 10% of cases, and these cases are believed to be due to expanded EBV-driven B-cell populations.[2] The Epstein–Barr virus (EBV) is observed in the majority of cases,[3] and the virus has been found in the reactive B-cells that comprise part of the polymorphous infiltrate of this disease[4] and in the neoplastic T-cells.[5] Trisomy 3, trisomy 5, and +X are the most frequent chromosomal abnormalities found in cases.[6][7]

Gross Pathology

The normal architecture of a lymph node is partially effaced by a polymorphous infiltrate and residual follicles are commonly seen. The polymorphous infiltrate consists of lymphocytes of moderate size with pale/clear cytoplasm and smaller reactive lymphocytes, eosinophils, histiocytes, plasma cells, and follicular dendritic cells. In addition, blast-like B-cells are occasionally seen. A classic morphological finding is the aborization and proliferation of high endothelial venules.[3] Hyperplastic germinal centers and Reed-Sternberg cells can also be seen.[8][9]

Microscopic Pathology

AILT typically has the phenotype of a mixture of CD4+ and CD8+ T-cells, with a CD4:CD8 ratio greater than unity. Polyclonal plasma cells and CD21+ follicular dendritic cells are also seen.[3] Due to the systemic nature of this disease, neoplastic cells can be found in lymph nodes, liver, spleen, skin, and bone marrow.

Gallery

  • A kidney biopsy showing effacement of the renal structure by diffuse leukocytic infiltrate, represented mostly by elongated cells with marked artifactual changes.<ref name = casereport>Angioimmunoblastic T-cell lymphoma presenting as giant kidneys: a case report

    A kidney biopsy showing effacement of the renal structure by diffuse leukocytic infiltrate, represented mostly by elongated cells with marked artifactual changes.<ref name = casereport>Angioimmunoblastic T-cell lymphoma presenting as giant kidneys: a case report

  • A biopsy of an inguinal lymph node was remarkable for obliteration of the node architecture.[10]

    A biopsy of an inguinal lymph node was remarkable for obliteration of the node architecture.[10]

  • The paracortical area was infiltrated by cells that were positive for CD3 and CD4.[10]

    The paracortical area was infiltrated by cells that were positive for CD3 and CD4.[10]


References

  1. ↑ [1] Feller AC, Griesser H, Schilling CV, Wacker HH, Dallenbach F, Bartels H, Kuse R, Mak TW, Lennert K. "Clonal gene rearrangement patterns correlate with immunophenotype and clinical parameters in patients with angioimmunoblastic lymphadenopathy." Am J Pathol. 1988 Dec;133(3):549-56. PMID: 2849301
  2. ↑ [2] Lipford EH, Smith HR, Pittaluga S, Jaffe ES, Steinberg AD, Cossman J. "Clonality of angioimmunoblastic lymphadenopathy and implications for its evolution to malignant lymphoma." J Clin Invest. 1987 Feb;79(2):637-42. PMID: 3805286
  3. ↑ 3.0 3.1 3.2
  4. ↑ Weiss LM, Jaffe ES, Liu XF, Chen YY, Shibata D, Medeiros LJ (April 1992). "Detection and localization of Epstein-Barr viral genomes in angioimmunoblastic lymphadenopathy and angioimmunoblastic lymphadenopathy-like lymphoma". Blood. 79 (7): 1789–95. PMID 1373088.
  5. ↑ Anagnostopoulos I, Hummel M, Finn T; et al. (October 1992). "Heterogeneous Epstein-Barr virus infection patterns in peripheral T-cell lymphoma of angioimmunoblastic lymphadenopathy type". Blood. 80 (7): 1804–12. PMID 1327284.
  6. ↑ [3] Kaneko Y, Maseki N, Sakurai M, Takayama S, Nanba K, Kikuchi M, Frizzera G. "Characteristic karyotypic pattern in T-cell lymphoproliferative disorders with reactive "angioimmunoblastic lymphadenopathy with dysproteinemia-type" features." Blood. 1988 Aug;72(2):413-21. PMID: 3261178
  7. ↑ [4] Schlegelberger B, Zhang Y, Weber-Matthiesen K, Grote W. "Detection of aberrant clones in nearly all cases of angioimmunoblastic lymphadenopathy with dysproteinemia-type T-cell lymphoma by combined interphase and metaphase cytogenetics." Blood. 1994 Oct 15;84(8):2640-8. PMID: 7919378
  8. ↑ [5] Quintanilla-Martinez L, Fend F, Moguel LR, Spilove L, Beaty MW, Kingma DW, Raffeld M, Jaffe ES. "Peripheral T-cell lymphoma with Reed-Sternberg-like cells of B-cell phenotype and genotype associated with Epstein-Barr virus infection." Am J Surg Pathol. 1999 Oct;23(10):1233-40. PMID: 10524524
  9. ↑ [6] Ree HJ, Kadin ME, Kikuchi M, Ko YH, Go JH, Suzumiya J, Kim DS. "Angioimmunoblastic lymphoma (AILD-type T-cell lymphoma) with hyperplastic germinal centers." Am J Surg Pathol. 1998 Jun;22(6):643-55. PMID: 9630171
  10. ↑ 10.0 10.1 Angioimmunoblastic T-cell lymphoma presenting as giant kidneys: a case report http://www.jmedicalcasereports.com/content/3/1/9258 Accessed on November,25 2015


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