The value of molecular diagnostics in primary cutaneous B-cell lymphomas in the context of clinical findings, histology, and immunohistochemistry Moritz.

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Presentation transcript:

The value of molecular diagnostics in primary cutaneous B-cell lymphomas in the context of clinical findings, histology, and immunohistochemistry Moritz Felcht, MD, Nina Booken, MD, Philipp Stroebel, MD, Sergij Goerdt, MD, Claus-Detlev Klemke, MD Journal of the American Academy of Dermatology Volume 64, Issue 1, Pages 135-143.e4 (January 2011) DOI: 10.1016/j.jaad.2009.12.062 Copyright © 2010 American Academy of Dermatology, Inc. Terms and Conditions

Fig 1 TNM stages of different primary cutaneous B-cell lymphomas (PCBCLs) at time of diagnosis. Patients with PCBCL with indolent behavior were more often staged T1a,b than patients with primary cutaneous diffuse large B-cell lymphoma, leg type (PCLBCL, LT), who were more commonly staged T2a,b. PCFCL, Primary cutaneous follicle center lymphoma; PCMZL, primary cutaneous marginal zone B-cell lymphoma. Journal of the American Academy of Dermatology 2011 64, 135-143.e4DOI: (10.1016/j.jaad.2009.12.062) Copyright © 2010 American Academy of Dermatology, Inc. Terms and Conditions

Fig 2 Different clinical pictures of TNM stages. A, Multiple erythematous nodules on upper aspect of back and left shoulder (patient 10, primary cutaneous marginal zone B-cell lymphoma). She was staged T2cN0M0 (regional skin involvement: multiple lesions limited to one body region or two contiguous body regions: all disease encompassing >30-cm-diameter circular area). B, Erythematous nodule on right lower aspect of back recurred after patient received surgical excision without radiotherapy (patient 1, primary cutaneous follicle center lymphoma). She was staged T2bN0M0 because tumor had primarily been found on upper aspect of back as well (regional skin involvement: multiple lesions limited to one body region or two contiguous body regions: all disease-encompassing >15 and <30-cm-diameter circular area). C, Erythematous nodule on erythematous, well-demarked plaque on right lower leg (patient 17). Patient was also staged T2bN0M0 because she had more than one lesion (regional skin involvement: multiple lesions limited to one body region or two contiguous body regions: all disease encompassing >15 and <30-cm-diameter circular area). Journal of the American Academy of Dermatology 2011 64, 135-143.e4DOI: (10.1016/j.jaad.2009.12.062) Copyright © 2010 American Academy of Dermatology, Inc. Terms and Conditions

Fig 3 Immunophenotypic features of primary cutaneous B-cell lymphoma. A, Intrafollicular primary cutaneous follicle center lymphoma (PCFCL) tumor cells stain bcl-6+, perifollicular cells are bcl-6– (patient 3, PCFCL with follicular growth pattern). B, Primary cutaneous marginal zone B-cell lymphoma (PCMZL) cells in marginal zone strongly express bcl-2+; in germinal center remnants are bcl-2– (patient 10, PCMZL). C, Primary cutaneous diffuse large B-cell lymphoma, leg type (PCLBCL, LT) cells show strong expression of bcl-2+, in grenz zone no cells express bcl-2 (patient 17, PCLBCL, LT). D, PCLBCL, LT. Most of tumor cells are MUM-1+ (patient 15, PCLBCL, LT). Journal of the American Academy of Dermatology 2011 64, 135-143.e4DOI: (10.1016/j.jaad.2009.12.062) Copyright © 2010 American Academy of Dermatology, Inc. Terms and Conditions

Fig 4 Examples of molecular analyses with BIOMED-2 Concerted Action BMH4 CT98-3936 protocol for IgH. A, Repeated analyses of same DNA show polyclonal (pc) pattern in skin specimen of patient 11 (primary cutaneous marginal zone B-cell lymphoma [PCMZL]). B, Repeated analyses of same DNA show two different monoclonal (mc)-like spikes (110 and 81 base pair [bp]) in skin specimen of patient 3 (primary cutaneous follicle center lymphoma [PCFCL]). Analyses are interpreted as pseudo-mc (pmc). C, Repeated analyses of same DNA show mc spikes at 345 bp (c and cc) on two occasions. Analyses could be confirmed with blood specimens (ccc and cccc). Analyses are interpreted as mc B-cell infiltrate in skin and blood (patient 14, primary cutaneous diffuse large B-cell lymphoma, leg type [PCLBCL, LT]). D, Repeated analyses of same DNA show mc spike at 334 bp (d and dd). Analyses could be confirmed with lymph node (LN) specimens (ddd and dddd). Analyses are interpreted as mc B-cell infiltrate in skin and LN (patient 15, PCLBCL, LT). ∗Pseudomonoclonality. Journal of the American Academy of Dermatology 2011 64, 135-143.e4DOI: (10.1016/j.jaad.2009.12.062) Copyright © 2010 American Academy of Dermatology, Inc. Terms and Conditions

Fig 5 Examples of molecular analyses with BIOMED-2 Concerted Action BMH4 CT98-3936 protocol for Igκ. Repeated analyses of same DNA show monoclonal (mc) spike at 150 base pair in patient with primary cutaneous B-cell lymphoma with indolent behavior (patient 11, primary cutaneous marginal zone B-cell lymphoma [PCMZL]). Journal of the American Academy of Dermatology 2011 64, 135-143.e4DOI: (10.1016/j.jaad.2009.12.062) Copyright © 2010 American Academy of Dermatology, Inc. Terms and Conditions