Erem, Anna Sarah

ABSTRACTBackgroundPrimary cutaneous anaplastic large cell lymphoma (pcALCL) and lymphomatoid papulosis (LyP) are indolent CD30‐positive lymphoproliferative disorders that rarely express TCR‐γδ. However, primary cutaneous gamma‐delta T‐cell lymphoma (pcGDTCL), characterized by TCR‐γδ expression on neoplastic cells, is a rare, aggressive cutaneous T‐cell lymphoma with a poor prognosis. Accurate differentiation is essential due to distinct clinical behavior and treatment.MethodsWe identified 11 TCR‐γδ‐positive pcALCL cases from internal and consultation files, verified by two cutaneous lymphoma experts, with clinicopathologic data recorded.ResultsThe median age was 68 years (range 38–95). Most cases presented as a single dermal lesion on the upper extremities. All were ALK‐negative, CD30‐positive (> 90% tumor cells), TCR‐βF1‐negative, and diffusely TCR‐γδ‐positive. CD4−/CD8− (54.5%) and CD4+/CD8− (45.5%) immunophenotypes were observed. CD2 (63.6%) and CD3 (54.5%) were the most common T‐cell antigens. Ulceration, inflammation (both 45.5%), and necrosis (36.4%) were frequent. Angiotropism, angiocentricity, and myxoid stroma appeared in one case; epidermotropism in two. Four of ten tested were DUSP22‐rearranged, and TP63 was negative in all eight tested.ConclusionsMost ALK‐negative TCR‐γδ‐positive pcALCL were CD4−/CD8−, followed by CD4+/CD8−. DUSP22 rearrangement occurred in 40% of cases, similar to reports in typical pcALCL. Its prognosis and the role of DUSP22 are yet to be clarified.

Abstract Background The prevalence of multiple primary lung cancers is rising, highlighting the need for tools to distinguish independent primary tumors from metastases. Molecular markers and hisopathologic comparison are useful to aid in this distinction, but they have significant limitations. Case Presentation A 76-year old woman presented with recurrent bronchorrhea, non-productive cough, and dyspnea upon exertion. She was a former smoker (15 pack-year history). Computerized tomography imaging revealed multiple lung masses: 1.9 × 2.3 cm nodule in the right upper lobe, and a 6.5 cm mass in the right lower lobe. Histologic examination of the tumors showed that the right lower lobe mass was an adenosquamous carcinoma with a mucinous adenocarcinoma component. This tumor showed visceral pleural invasion, and direct invasion of one intrapulmonary peribronchial lymph node. The upper lobe lesion was characterized by pure invasive mucinous adenocarcinoma with no squamous component. Abdominal and pelvic imaging was performed to rule out alternative primary sites, and no evidence of disease was identified outside of the chest. A cancer mutation and rearrangement panel on the adenosquamous carcinoma did not reveal any mutations. Conclusions In this interesting case, a patient presented with two lung tumors which had some morphologic similarities, but also some important differences, and no specific genetic mutations were present to establish the relationship between the tumors. Although current tools are useful, this case highlights an example of a case where it remains extremely difficult to determine whether two lung cancers are independent primary tumors or intrapulmonary metastases.