Peripheral T cell lymphoma: Difference between revisions

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*On microscopic histopathological analysis, [feature1], [feature2], and [feature3] are characteristic findings of [disease name].
*On microscopic histopathological analysis, [feature1], [feature2], and [feature3] are characteristic findings of [disease name].


==Clinical Features==   
==Clinical Features==
Depending on the subtypes, clinical manifestations may vary however, the majority of patients present with generalized lymphadenopathy with or without extranodal disease <ref name="pmid18626005">{{cite journal| author=Vose J, Armitage J, Weisenburger D, International T-Cell Lymphoma Project| title=International peripheral T-cell and natural killer/T-cell lymphoma study: pathology findings and clinical outcomes. | journal=J Clin Oncol | year= 2008 | volume= 26 | issue= 25 | pages= 4124-30 | pmid=18626005 | doi=10.1200/JCO.2008.16.4558 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=18626005  }}</ref>.  Having nodal disease alone is seen in around 38% of patients, 49% present with both nodal and extranodal disease, while around 13% only present with extranodal disease <ref name="pmid21270441">{{cite journal| author=Weisenburger DD, Savage KJ, Harris NL, Gascoyne RD, Jaffe ES, MacLennan KA et al.| title=Peripheral T-cell lymphoma, not otherwise specified: a report of 340 cases from the International Peripheral T-cell Lymphoma Project. | journal=Blood | year= 2011 | volume= 117 | issue= 12 | pages= 3402-8 | pmid=21270441 | doi=10.1182/blood-2010-09-310342 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21270441  }}</ref>. Hepatomegaly is seen in 17% and splenomegaly in 24% of patients. The bone marrow involvement is seen in 20%.  Some patients present with eosinophilia, pruritus<ref name="pmid2153036">{{cite journal| author=Falini B, Pileri S, De Solas I, Martelli MF, Mason DY, Delsol G et al.| title=Peripheral T-cell lymphoma associated with hemophagocytic syndrome. | journal=Blood | year= 1990 | volume= 75 | issue= 2 | pages= 434-44 | pmid=2153036 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=2153036  }}</ref>].  In 1/4 of cases, thrombocytopenia and anemia are seen. <ref name="pmid212704412">{{cite journal| author=Weisenburger DD, Savage KJ, Harris NL, Gascoyne RD, Jaffe ES, MacLennan KA et al.| title=Peripheral T-cell lymphoma, not otherwise specified: a report of 340 cases from the International Peripheral T-cell Lymphoma Project. | journal=Blood | year= 2011 | volume= 117 | issue= 12 | pages= 3402-8 | pmid=21270441 | doi=10.1182/blood-2010-09-310342 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21270441  }}</ref>
 
Extranodal sites involved are mainly skin and gastrointestinal tract  <ref name="pmid1466400">{{cite journal| author=Chott A, Dragosics B, Radaszkiewicz T| title=Peripheral T-cell lymphomas of the intestine. | journal=Am J Pathol | year= 1992 | volume= 141 | issue= 6 | pages= 1361-71 | pmid=1466400 | doi= | pmc=1886751 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=1466400  }}</ref>. Fever, night sweats and weight loss which are typical systemic B symptoms ,are reported in 35% of cases <ref name="pmid212704413">{{cite journal| author=Weisenburger DD, Savage KJ, Harris NL, Gascoyne RD, Jaffe ES, MacLennan KA et al.| title=Peripheral T-cell lymphoma, not otherwise specified: a report of 340 cases from the International Peripheral T-cell Lymphoma Project. | journal=Blood | year= 2011 | volume= 117 | issue= 12 | pages= 3402-8 | pmid=21270441 | doi=10.1182/blood-2010-09-310342 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21270441  }}</ref>. 50% of patients have increased LDH level and 14% of cases are associated with hypergammaglobulinemia.


==Differentiating [disease name] from other Diseases==
==Differentiating [disease name] from other Diseases==
Line 58: Line 61:
   
   
==Epidemiology and Demographics==
==Epidemiology and Demographics==
* The prevalence of [disease name] is approximately [number or range] per 100,000 individuals worldwide.
* The incidence of PTCL is < 1 case per 100 000 people in the United States.<ref name="Morton20062">{{cite journal|last1=Morton|first1=L. M.|title=Lymphoma incidence patterns by WHO subtype in the United States, 1992-2001|journal=Blood|volume=107|issue=1|year=2006|pages=265–276|issn=0006-4971|doi=10.1182/blood-2005-06-2508}}</ref> The most common subtypes are the nodal T-cell lymphomas, with PTCL-NOS (25.9%) followed by AITLs (18.5%) and the ALCLs (12%). NK-/T-cell lymphomas (10.4%), while enteropathy-associated T-cell lymphomas (4.7%), hepatosplenic T-cell lymphomas (1.4%), and panniculitis-like T-cell lymphomas (0.9%) .  
* In [year], the incidence of [disease name] was estimated to be [number or range] cases per 100,000 individuals in [location].
   
   
===Age===
===Age===
Line 68: Line 70:
   
   
===Gender===
===Gender===
*[Disease name] affects men and women equally.
*NK-cell nasal and nasal-type lymphomas is more common in males than in females.<ref name="FossZinzani2011">{{cite journal|last1=Foss|first1=F. M.|last2=Zinzani|first2=P. L.|last3=Vose|first3=J. M.|last4=Gascoyne|first4=R. D.|last5=Rosen|first5=S. T.|last6=Tobinai|first6=K.|title=Peripheral T-cell lymphoma|journal=Blood|volume=117|issue=25|year=2011|pages=6756–6767|issn=0006-4971|doi=10.1182/blood-2010-05-231548}}</ref>
*[Gender 1] are more commonly affected with [disease name] than [gender 2].
* The [gender 1] to [Gender 2] ratio is approximately [number > 1] to 1.
   
   
===Race===
===Race===
*There is no racial predilection for [disease name].
*PTCL-NOS is more common in North America and less common in the European and Asian countries; AITL is more common in Europe than in Asia or North America; ALK+ ALCL is more common in North America; ALK− ALCL is slightly more common in Europe; and the NK-/T-cell lymphomas and ATL are more common in Asia.<ref name="SavageHarris2008">{{cite journal|last1=Savage|first1=K. J.|last2=Harris|first2=N. L.|last3=Vose|first3=J. M.|last4=Ullrich|first4=F.|last5=Jaffe|first5=E. S.|last6=Connors|first6=J. M.|last7=Rimsza|first7=L.|last8=Pileri|first8=S. A.|last9=Chhanabhai|first9=M.|last10=Gascoyne|first10=R. D.|last11=Armitage|first11=J. O.|last12=Weisenburger|first12=D. D.|title=ALK- anaplastic large-cell lymphoma is clinically and immunophenotypically different from both ALK+ ALCL and peripheral T-cell lymphoma, not otherwise specified: report from the International Peripheral T-Cell Lymphoma Project|journal=Blood|volume=111|issue=12|year=2008|pages=5496–5504|issn=0006-4971|doi=10.1182/blood-2008-01-134270}}</ref> The EBV-associated lymphoproliferative, T-cell, and NK-cell neoplasms are seen mainly in Japan, Korea, and Northern China, but also in Native American populations from Central and South America. NK-cell nasal and nasal-type lymphomas is more commonly reported in Asia and Latin America<ref name="FossZinzani20112">{{cite journal|last1=Foss|first1=F. M.|last2=Zinzani|first2=P. L.|last3=Vose|first3=J. M.|last4=Gascoyne|first4=R. D.|last5=Rosen|first5=S. T.|last6=Tobinai|first6=K.|title=Peripheral T-cell lymphoma|journal=Blood|volume=117|issue=25|year=2011|pages=6756–6767|issn=0006-4971|doi=10.1182/blood-2010-05-231548}}</ref>
*[Disease name] usually affects individuals of the [race 1] race.
*[Race 2] individuals are less likely to develop [disease name].
   
   
==Risk Factors==
==Risk Factors==

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Overview

The peripheral T-cell lymphomas (PTCLs) consists of a heterogeneous group of aggressive diseases that constitutes ~10%-15% of non Hodgkin lymphoma. The incidence has been estimated to be <1 case per 100,000 of ppl in United states. [1]The most common type is Peripheral T cell lymphoma, not otherwise specified (PTCL, NOS), followed by Anaplastic large cell lymphoma, primary systemic type (ALCL) , Angioimmunoblastic T cell lymphoma (AITL) and Extranodal NK/T cell lymphoma, nasal type (PTCLs ), which is the rarest type. Although each type presents differently and has special histological features, they all have similar treatment . In addition, all the types have been associated with poor prognosis. [2] The most common presentation is generalized lymphadenopathy with or without extra nodal manifestations. [3]

Historical Perspective

  • [Disease name] was first discovered by [scientist name], a [nationality + occupation], in [year] during/following [event].
  • In [year], [gene] mutations were first identified in the pathogenesis of [disease name].
  • In [year], the first [discovery] was developed by [scientist] to treat/diagnose [disease name].

Classification

clinical trials.

Classification

In 2008, WHO classified peripheral T cell lymphoma in 4 groups ( cutaneous, nodal, extra nodal and leukemic) based on their clinical manifestations .

In which the majority of aggressive T-cell lymphomas have been included in the nodal, extranodal, and leukemic groups.

The nodal lymphoma consists of 3 entities which include :PTCL, not otherwise specified (NOS) which is the most common subtype accounting for 25.9% of cases, [4] anaplastic large cell lymphoma (ALCL), and angioimmunoblastic T-cell lymphoma (AITL).

Anaplastic large cell lymphoma (ALCS) has two recognized sub groups: ALK+ and ALK- lymphomas. Both subtypes are morphologially and immunophenotypically similar to each other however they are different molecularly. [5]They have similar incidences (6.6% and 5.5% respectively) [6]

Angioimmunoblastic T-cell lymphoma (AITL) comprises 18.5% of cases .[7] One of its variants ,lymphoepithelioid cell variant is consists of CD8 T cells with epithelioid cells in the background which is different than other variants. [8]

Less common entities have been described in extra nodal groups. Tissue tropism has been the characterized distinguishing factor.

First subtype which comprises around 1.4% of PTCL cases [9]and almost always is reported in children and young adults [10]is Hepatosplenic γδ T-cell lymphoma. In this tumor, immature or nonactivated γδ T cells infiltrate bone marrow sinusoides and spleen and Isochromosome 7q chromosomal abnormality is present.

In second subgroup, which is hepatosplenic T-cell lymphoma has often poor prognoses with median survival of below 2 years. Patients usually present with B-symptoms and decreased cell counts. The cells express CD2, CD3 and CD7 markers and lack CD4, CD5 . while CD8 and natural killer cell markers expression are variable .

The third sub-type , Enteropathy-associated T-cell lymphoma (EATL) is more common in populations with high incidence of celiac disease and accounts for 4.7% of cases of T-cell lymphoma. Pain, weight loss, and bowel perforation are the usual clinical presentations. Two morphological variants have been recognized ; pleomorphic and monomorphic. The former group is associated with celiac disease the cells usually express CD3 and CD7 and lack CD56 expression [11]. Conversely, The latter group is often not associated with the celiac disease and express CD56. Gains at chromosome 9q33-q34 has been reported in up to 70% of cases[12].

Furthermore, the intestinal T- and NK-cell lymphomas are part of the nasal-type NK-/T-cell lymphoma[13] which have been reported in Asian countries and are associated with Epstein-Barr virus (EBV) infection .

In addition, The mucocutaneous γδ T-cell lymphomas[14],the nasal type NK-/T-cell lymphomas, and even ALCLs all can present as an intestinal lymphoma[15].

Panniculitis-like T-cell lymphomas constitute only 0.9% of PTCLs which is more common in males. The characteristic clinical presentation is subcutaneous nodules that can become necrotic .The cells express CD3 and CD8 and are CD4- .[16]

The last group,leukemia has 4 subtypes including adult T-cell lymphoma (ATL) associated with human T-lymphotropic virus type I (HTLV-1), T-cell chronic large granular lymphocytic (LGL) leukemia associated with neutropenia , aggressive NK-cell leukemia, and T-cell prolymphocytic leukemia. . NK-cell leukemia and ATL often have a poor outcome.

Other types which have been included in WHO classifications include: hydroa vacciniforme-like lymphoma, NK-cell lymphoma and systemic EBV-positive T-cell lymphoproliferative disease of childhood.

Pathophysiology

  • The pathogenesis of [disease name] is characterized by [feature1], [feature2], and [feature3].
  • The [gene name] gene/Mutation in [gene name] has been associated with the development of [disease name], involving the [molecular pathway] pathway.
  • On gross pathology, [feature1], [feature2], and [feature3] are characteristic findings of [disease name].
  • On microscopic histopathological analysis, [feature1], [feature2], and [feature3] are characteristic findings of [disease name].

Clinical Features

Depending on the subtypes, clinical manifestations may vary however, the majority of patients present with generalized lymphadenopathy with or without extranodal disease [17]. Having nodal disease alone is seen in around 38% of patients, 49% present with both nodal and extranodal disease, while around 13% only present with extranodal disease [18]. Hepatomegaly is seen in 17% and splenomegaly in 24% of patients. The bone marrow involvement is seen in 20%. Some patients present with eosinophilia, pruritus[19]]. In 1/4 of cases, thrombocytopenia and anemia are seen. [20]

Extranodal sites involved are mainly skin and gastrointestinal tract [21]. Fever, night sweats and weight loss which are typical systemic B symptoms ,are reported in 35% of cases [22]. 50% of patients have increased LDH level and 14% of cases are associated with hypergammaglobulinemia.

Differentiating [disease name] from other Diseases

  • [Disease name] must be differentiated from other diseases that cause [clinical feature 1], [clinical feature 2], and [clinical feature 3], such as:
  • [Differential dx1]
  • [Differential dx2]
  • [Differential dx3]

Epidemiology and Demographics

  • The incidence of PTCL is < 1 case per 100 000 people in the United States.[23] The most common subtypes are the nodal T-cell lymphomas, with PTCL-NOS (25.9%) followed by AITLs (18.5%) and the ALCLs (12%). NK-/T-cell lymphomas (10.4%), while enteropathy-associated T-cell lymphomas (4.7%), hepatosplenic T-cell lymphomas (1.4%), and panniculitis-like T-cell lymphomas (0.9%) .

Age

  • Patients of all age groups may develop [disease name].
  • [Disease name] is more commonly observed among patients aged [age range] years old.
  • [Disease name] is more commonly observed among [elderly patients/young patients/children].

Gender

  • NK-cell nasal and nasal-type lymphomas is more common in males than in females.[24]

Race

  • PTCL-NOS is more common in North America and less common in the European and Asian countries; AITL is more common in Europe than in Asia or North America; ALK+ ALCL is more common in North America; ALK− ALCL is slightly more common in Europe; and the NK-/T-cell lymphomas and ATL are more common in Asia.[25] The EBV-associated lymphoproliferative, T-cell, and NK-cell neoplasms are seen mainly in Japan, Korea, and Northern China, but also in Native American populations from Central and South America. NK-cell nasal and nasal-type lymphomas is more commonly reported in Asia and Latin America[26]

Risk Factors

  • Common risk factors in the development of [disease name] are [risk factor 1], [risk factor 2], [risk factor 3], and [risk factor 4].

Natural History, Complications and Prognosis

  • The majority of patients with [disease name] remain asymptomatic for [duration/years].
  • Early clinical features include [manifestation 1], [manifestation 2], and [manifestation 3].
  • If left untreated, [#%] of patients with [disease name] may progress to develop [manifestation 1], [manifestation 2], and [manifestation 3].
  • Common complications of [disease name] include [complication 1], [complication 2], and [complication 3].
  • Prognosis is generally [excellent/good/poor], and the [1/5/10­year mortality/survival rate] of patients with [disease name] is approximately [#%].

Diagnosis

Diagnostic Criteria

  • The diagnosis of [disease name] is made when at least [number] of the following [number] diagnostic criteria are met:
  • [criterion 1]
  • [criterion 2]
  • [criterion 3]
  • [criterion 4]

Symptoms

  • [Disease name] is usually asymptomatic.
  • Symptoms of [disease name] may include the following:
  • [symptom 1]
  • [symptom 2]
  • [symptom 3]
  • [symptom 4]
  • [symptom 5]
  • [symptom 6]

Physical Examination

  • Patients with [disease name] usually appear [general appearance].
  • Physical examination may be remarkable for:
  • [finding 1]
  • [finding 2]
  • [finding 3]
  • [finding 4]
  • [finding 5]
  • [finding 6]

Laboratory Findings

  • There are no specific laboratory findings associated with [disease name].
  • A [positive/negative] [test name] is diagnostic of [disease name].
  • An [elevated/reduced] concentration of [serum/blood/urinary/CSF/other] [lab test] is diagnostic of [disease name].
  • Other laboratory findings consistent with the diagnosis of [disease name] include [abnormal test 1], [abnormal test 2], and [abnormal test 3].

Imaging Findings

  • There are no [imaging study] findings associated with [disease name].
  • [Imaging study 1] is the imaging modality of choice for [disease name].
  • On [imaging study 1], [disease name] is characterized by [finding 1], [finding 2], and [finding 3].
  • [Imaging study 2] may demonstrate [finding 1], [finding 2], and [finding 3].

Other Diagnostic Studies

  • [Disease name] may also be diagnosed using [diagnostic study name].
  • Findings on [diagnostic study name] include [finding 1], [finding 2], and [finding 3].

Treatment

Medical Therapy

  • There is no treatment for [disease name]; the mainstay of therapy is supportive care.
  • The mainstay of therapy for [disease name] is [medical therapy 1] and [medical therapy 2].
  • [Medical therapy 1] acts by [mechanism of action 1].
  • Response to [medical therapy 1] can be monitored with [test/physical finding/imaging] every [frequency/duration].

Surgery

  • Surgery is the mainstay of therapy for [disease name].
  • [Surgical procedure] in conjunction with [chemotherapy/radiation] is the most common approach to the treatment of [disease name].
  • [Surgical procedure] can only be performed for patients with [disease stage] [disease name].

Prevention

  • There are no primary preventive measures available for [disease name].
  • Effective measures for the primary prevention of [disease name] include [measure1], [measure2], and [measure3].
  • Once diagnosed and successfully treated, patients with [disease name] are followed-up every [duration]. Follow-up testing includes [test 1], [test 2], and [test 3].

References

  1. Morton, L. M. (2006). "Lymphoma incidence patterns by WHO subtype in the United States, 1992-2001". Blood. 107 (1): 265–276. doi:10.1182/blood-2005-06-2508. ISSN 0006-4971.
  2. Moskowitz, A. J.; Lunning, M. A.; Horwitz, S. M. (2014). "How I treat the peripheral T-cell lymphomas". Blood. 123 (17): 2636–2644. doi:10.1182/blood-2013-12-516245. ISSN 0006-4971.
  3. . doi:10.1182/blood-2010-09-310342. Check |doi= value (help). Missing or empty |title= (help)
  4. "International Peripheral T-Cell and Natural Killer/T-Cell Lymphoma Study: Pathology Findings and Clinical Outcomes". Journal of Clinical Oncology. 26 (25): 4124–4130. 2008. doi:10.1200/JCO.2008.16.4558. ISSN 0732-183X.
  5. Salaverria, Itziar; Beà, Silvia; Lopez-Guillermo, Armando; Lespinet, Virginia; Pinyol, Magda; Burkhardt, Birgit; Lamant, Laurence; Zettl, Andreas; Horsman, Doug; Gascoyne, Randy; Ott, German; Siebert, Reiner; Delsol, Georges; Campo, Elias (2008). "Genomic profiling reveals different genetic aberrations in systemic ALK-positive and ALK-negative anaplastic large cell lymphomas". British Journal of Haematology. 140 (5): 516–526. doi:10.1111/j.1365-2141.2007.06924.x. ISSN 0007-1048.
  6. "International Peripheral T-Cell and Natural Killer/T-Cell Lymphoma Study: Pathology Findings and Clinical Outcomes". Journal of Clinical Oncology. 26 (25): 4124–4130. 2008. doi:10.1200/JCO.2008.16.4558. ISSN 0732-183X.
  7. "International Peripheral T-Cell and Natural Killer/T-Cell Lymphoma Study: Pathology Findings and Clinical Outcomes". Journal of Clinical Oncology. 26 (25): 4124–4130. 2008. doi:10.1200/JCO.2008.16.4558. ISSN 0732-183X.
  8. Geissinger, Eva; Odenwald, Tobias; Lee, Seung-Sook; Bonzheim, Irina; Roth, Sabine; Reimer, Peter; Wilhelm, Martin; M�ller-Hermelink, Hans Konrad; R�diger, Thomas (2004). "Nodal peripheral T-cell lymphomas and, in particular, their lymphoepithelioid (Lennert?s) variant are often derived from CD8+ cytotoxic T-cells". Virchows Archiv. 445 (4): 334–343. doi:10.1007/s00428-004-1077-2. ISSN 0945-6317. replacement character in |last8= at position 2 (help); replacement character in |last9= at position 2 (help)
  9. "International Peripheral T-Cell and Natural Killer/T-Cell Lymphoma Study: Pathology Findings and Clinical Outcomes". Journal of Clinical Oncology. 26 (25): 4124–4130. 2008. doi:10.1200/JCO.2008.16.4558. ISSN 0732-183X.
  10. Charton-Bain MC, Brousset P, Bouabdallah R, Gaulard P, Merlio JP, Dubus P; et al. (2000). "Variation in the histological pattern of nodal involvement by gamma/delta T-cell lymphoma". Histopathology. 36 (3): 233–9. PMID 10692026.
  11. Zettl, Andreas; deLeeuw, Ron; Haralambieva, Eugenia; Mueller-Hermelink, Hans-Konrad (2007). "Enteropathy-Type T-Cell Lymphoma". American Journal of Clinical Pathology. 127 (5): 701–706. doi:10.1309/NW2BK1DXB0EQG55H. ISSN 0002-9173.
  12. Zettl, Andreas; Ott, German; Makulik, Angela; Katzenberger, Tiemo; Starostik, Petr; Eichler, Thorsten; Puppe, Bernhard; Bentz, Martin; Müller-Hermelink, Hans Konrad; Chott, Andreas (2002). "Chromosomal Gains at 9q Characterize Enteropathy-Type T-Cell Lymphoma". The American Journal of Pathology. 161 (5): 1635–1645. doi:10.1016/S0002-9440(10)64441-0. ISSN 0002-9440.
  13. Au, W.-y.; Weisenburger, D. D.; Intragumtornchai, T.; Nakamura, S.; Kim, W.-S.; Sng, I.; Vose, J.; Armitage, J. O.; Liang, R. (2008). "Clinical differences between nasal and extranasal natural killer/T-cell lymphoma: a study of 136 cases from the International Peripheral T-Cell Lymphoma Project". Blood. 113 (17): 3931–3937. doi:10.1182/blood-2008-10-185256. ISSN 0006-4971.
  14. Shapira, Michael Y.; Caspi, Ofer; Amir, Gail; Zlotogorski, Abraham; Naparstek, Yaakov (2009). "Gastric-Mucocutaneous γδ T Cell Lymphoma: Possible Association with Epstein-Barr Virus ?". Leukemia & Lymphoma. 35 (3–4): 397–401. doi:10.3109/10428199909145745. ISSN 1042-8194.
  15. Kanavaros, P.; Boulland, M. L.; Petit, B.; Arnulf, B. (2009). "Expression of Cytotoxic Proteins in Peripheral T-Cell and Natural Killer-Cell (NK) Lymphomas: Association with Extranodal Site, NK or Tγδ Phenotype, Anaplastic Morphology and CD30 Expression". Leukemia & Lymphoma. 38 (3–4): 317–326. doi:10.3109/10428190009087022. ISSN 1042-8194.
  16. Toro, J. R. (2003). "Gamma-delta T-cell phenotype is associated with significantly decreased survival in cutaneous T-cell lymphoma". Blood. 101 (9): 3407–3412. doi:10.1182/blood-2002-05-1597. ISSN 0006-4971.
  17. Vose J, Armitage J, Weisenburger D, International T-Cell Lymphoma Project (2008). "International peripheral T-cell and natural killer/T-cell lymphoma study: pathology findings and clinical outcomes". J Clin Oncol. 26 (25): 4124–30. doi:10.1200/JCO.2008.16.4558. PMID 18626005.
  18. Weisenburger DD, Savage KJ, Harris NL, Gascoyne RD, Jaffe ES, MacLennan KA; et al. (2011). "Peripheral T-cell lymphoma, not otherwise specified: a report of 340 cases from the International Peripheral T-cell Lymphoma Project". Blood. 117 (12): 3402–8. doi:10.1182/blood-2010-09-310342. PMID 21270441.
  19. Falini B, Pileri S, De Solas I, Martelli MF, Mason DY, Delsol G; et al. (1990). "Peripheral T-cell lymphoma associated with hemophagocytic syndrome". Blood. 75 (2): 434–44. PMID 2153036.
  20. Weisenburger DD, Savage KJ, Harris NL, Gascoyne RD, Jaffe ES, MacLennan KA; et al. (2011). "Peripheral T-cell lymphoma, not otherwise specified: a report of 340 cases from the International Peripheral T-cell Lymphoma Project". Blood. 117 (12): 3402–8. doi:10.1182/blood-2010-09-310342. PMID 21270441.
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