University of Medicine and Pharmacie Tg. Mureş International Congress for Students, Young Physicians and Pharmacists Marisiensis 2014 Author: Buzdugan Dumitriţa Scientific coordinators: Conf. Dr. Mihai Turcu, Şef lucr. Dr. Ovidiu S. Cotoi

Introduction Peripheral T cell lymphoma (PTCL) is a type of lymphoproliferation of mature T cells (post thymic stage) Rare, aggressive, with poor outcome World Health Organization's classification, dating 2008, includes three subtypes of PTCL :

PTCL – Non otherwise specified PTCL – Angioimmunoblastic PTCL – Anaplastic ALK+ and ALK-

I PTCL – NOS (non otherwise specified) Positive at normal T cell markers but with a down regulation of CD5, CD7 Aberrant expression of CD20, CD79a and CD30 Histologically there are known three variants: Lennert Follicular T-zone

II PTCL - angioimmunoblastic Positive at T cell markers: CD2, 3, 5, TCR CD10, BCL-6, CXCL-13 positive – markers for T helper lymphocytes important proliferation at endothelial arborization level

III PTCL - anaplastic ALK + CD30, 2, 4, 5, 25 positive and partially positive at CD45 and CD45 RO There have not been observed antibodies for Epstein Barr virus ALK – CD30, 43 positive Loss of T cell markers

Material and method Retrospective descriptive study upon 29 patients diagnosed with PTCL between 2008 and 2013 diagnosed in the County Hospital of Tg. Mureş Clinical criteria: site of primary tumor Demographic criteria: age and gender Immunohistochemical criteria: presence of specific markers

Results  Demographic

  Types

 Histological: in all PTCLs developed in the lymph nodes their structure was totally modified by the neoplasm Results I PTCL developed in the lymph node in which the structure is completely modified, 2x, H.E. Source: Morphopathology Department’s Library of The County Hospital of Tg. Mures

II. Lymph Node 20x, H.E. Source: Morphopathology Department’s Library of County Hospital Tg. Mures III. Lymph Node 20x, H.E. Malignant mitotic cells. Source: Morphopathology Department’s Library of County Hospital Tg. Mures

IV. PTCL developed in the spleen 2x, 10x, 20x H.E. Source: Morphopathology Department’s Library of County Hospital Tg. Mures 4x

V. PTCL developed in the spleen 10x, 20x. H.E. Source: Morphopathology Department’s Library of County Hospital Tg. Mures 20x

 Immunohistochemistry

Discussions High incidence in men, fifth decade of life [1] [5] PTCL-NOS is the most common type of PTCLs with a 83% incidence (while in other studies it has shown a 25-30% incidence) [2][3]

Imprecise differentiation between PTCL- NOS and PTCL-anaplastic ALK- (both CD30 positive)  high importance of genetic studies [4] Significant decreasing incidence of PTCLs from 2008 to 2013 in this center of study

Conclusions The latest update of the WHO classification has useful criteria for PTCL diagnostic The information obtained in this study is in accordance with that from the specialized literature: high frequency in middle aged male with T cell markers expression maintained – CD3 Further studies about immunofenotyping must be correlated with genetic studies for a better treatment outcome

Limitations of the study: Retrospective design Restricted to a single center’s patients Small number of cases

Questions ?

References Bettina Bisig, Aurelien de Reynies, Christophe Bonnet, et al: CD30-positive peripheral T-cell lymphomas share molecular and phenotypic features. The Hematology Journal, 98: , 2013 Brenton T. Tan, Roger A. Warnke, Daniel A. Arber: The frequency of B- and T-Cell Gene Rearrangements and Epstein-Barr Virus in T-Cell Lymphomas. The Journal of Molecular Diagnostics, 8: , 2006 Harry L. Ioachim, L. Jeffery Medeiros: Ioachim’s Lymph Node Pathology, 4 th edition Julie M. Vose, Neumann M., Mildred E. Harris: International T- cell and Natural Killer/T-cell Lymphoma Study: Pathology findings and Clinical Outcomes. Journal of Clinical Oncology, 26: , 2008 [1]

Laurence de Leval, Philippe Gaulard: CD30+ lymphoproliferative disorders. The Hematology Journal, 35 : , 2010 [4] Mihai Turcu, Angela Borda, Vasile Bud: Diagnosticul microscopic al leziunilor nodulului limfatic, ed. Mureş 1999 Philip Went, Claudio Agostinelli, Andrea Gallamini, et al. : Marker Expression in Peripheral T-cell Lymphoma: A proposed Clinical-Pathologic Prognostic Score. Journal of Clinical Oncology, 24: , 2006 [2] Pier Paolo Piccaluga, Claudio Agostinelli, Anna Gazzola, et al.: Prognostic Markers in Peripheral T-cell Lymphoma. Current Hematologic Malignancy Reports, 5: , 2010 [3]

Steven H. Swerdlow, Elias Campo, Nancy Lee Haris, et al: WHO Classification of Tumors of Haematopoietic and Lymphoid Tissues, 4 th edition. International Agency for Research on Cancer, Lyon, 2008 [5]

Thank you for your attention !