非特殊类型外周T细胞淋巴瘤84例临床病理特征分析

目的探讨非特殊类型外周T细胞淋巴瘤(peripheral T-cell lymphoma-non otherwise specified,PTCL-NOS)临床病理特征。方法对确诊PTCL-NOS 84例的临床病理资料进行回顾性分析。结果 84例中53例获随访,平均随访24.7个月。病变位于淋巴结69例,结外15例;61例依据Ann Arbor分期系统进行分期,其中Ⅰ期3例,Ⅱ期27例,Ⅲ期15例,Ⅳ期16例。免疫组织化学染色蛋白表达T细胞抗体CD3 88.0%,CD4 60.2%,CD5 59.3%,CD2 25.6%,CD7 55.4%,CD8 55.4%;细胞毒相关抗体TIA-1 60.5%,粒酶B 18.1%,穿孔素7.2%;候选相关基因Bcl-10 89.2%,nm23 85.4%,TOPⅡA 73.2%。结论PTCL-NOS主要发生在淋巴结,T细胞抗体CD3、CD4、CD5、CD7、CD8表达依次递减,CD2表达较低;细胞毒相关抗体TIA-1表达较高,PTCL-NOS可能与细胞毒分子有相关性;候选相关基因Bcl-10、nm23和TOPⅡA可能有潜在靶向治疗意义。     

Mycosis Fungoides and Its Relationship to Atopy,Serum Total IgE,and Eosinophil Counts

IntroductionA recent serologic study and reports of increased serum total IgE (IgE-t) and eosinophil counts have suggested that the prevalence of atopy is more common in patients with mycosis fungoides (MF) than previously recognized.Patients and MethodsPatients with clinicopathologic features that were diagnostic and/or consistent with MF and/or the presence or absence of an atopic disorder (eg, allergic rhinitis, asthma, eczematous dermatitis), which was determined by patient history, eosinophil counts, and serum IgE-t obtained at evaluation, were selected from a patient registry. The MF population was divided into those with atypical and typical clinical presentations. We performed matching of controls using age, sex, and race from the 2005 to 2006 National Health Education Survey.ResultsA history of allergic rhinitis was recorded for 186 of 728 patients (25.5%) with typical MF and 71 of 229 patients (31%) with atypical MF. However, the prevalence of asthma and eczema was low. The IgE-t and eosinophil counts were higher for patients with typical MF than for controls and for patients with atopic diathesis than for patients without atopy. The IgE-t and eosinophil counts were higher for the patients with advanced-stage MF compared with those for the patients with less-advanced disease for both atopic and nonatopic cohorts. In the Cox model with age and clinical stage as covariates, a history of atopy, increased IgE-t, and blood eosinophilia (> 500 cells/mm3) did not correlate with overall survival.ConclusionThe findings from the present study did not reveal a significant association of atopy in patients with MF. However, atopy is a factor in the increased IgE-t and eosinophil counts observed in MF. Another factor is related to the disease stage, including possibly the influence of cytokines secreted by T-helper type 2-polarized neoplastic cells.     

Follicular mucinosis - Case report

Follicular mucinosis, also known as alopecia mucinosa, is a cutaneous mucinosis histologically characterized by accumulation of dermal type mucin in the pilosebaceous follicle and sebaceous glands. It presents in two forms, a primary or idiopathic form and a secondary form associated with various benign or malignant processes. Among the malignant processes, the main association is with mycosis fungoides. The frequent overlap of clinical, histopathological, immunohistochemical and molecular biology characteristics makes the correct classification of these conditions difficult, therefore a long follow-up of all cases is recommended. We report the case of an adolescent with disseminated lesions and discuss the difficulty of early identification of secondary follicular mucinosis associated with cutaneous lymphoma.     

Use of antiplatelet agents in sepsis: A glimpse into the future

As mechanisms of sepsis pathophysiology have been elucidated with time, sepsis may be considered nowadays, as an uncontrolled inflammatory and pro-coagulant response to a pathogen. In this cascade of events, platelets play a key role, via interaction with endothelial cells and modulation of both innate and adaptive immune system. In that manner, inhibition of platelet function could represent a useful tool for attenuating inflammatory response and improving outcomes. Data on current antiplatelet agents, including acetylsalicylic acid, P2Y12 inhibitors and GPIIb/IIIa antagonists, in animal models are promising. Clinical data in patients hospitalized for pneumonia, at risk for acute lung injury, and/or critically ill revealed an association between antiplatelet therapy and reduction in both short-term mortality and prevalence of acute lung injury, as well as, the need for intensive care unit admission, without a concomitant increased bleeding risk. In need of innovative approach in the treatment of sepsis, further prospective, interventional, randomized trials are pivotal to establish potential use of antiplatelet agents in this context.     

Hypopigmented mycosis fungoides: a review of its clinical features and pathophysiology

Several distinct clinical forms of mycosis fungoides have been described. Hypopigmented mycosis fungoides should be regarded as a subtype of mycosis fungoides, insofar as it presents some peculiar characteristics that contrast with the clinical features of the classical form. Most patients with hypopigmented mycosis fungoides are younger than patients typically diagnosed with classical mycosis fungoides. In addition to typical dark-skinned individuals impairment, hypopigmented mycosis fungoides has also been described in Asian patients. The prognosis for hypopigmented mycosis fungoides is much better than for classical mycosis fungoides: hypopigmented mycosis fungoides is diagnosed when there are only patches of affected skin, and lesions usually will not progress beyond terminal stages, although they can persist for many years. Diagnosis should involve clinicopathologic correlation: skin biopsy analysis often reveals intense epidermotropism, characterized by haloed, large, and atypical CD8+ lymphocytes with convoluted nuclei, in contrast to mild to moderate dermal lymphocytic infiltrate. These CD8+ cells, which participate in T helper 1-mediated immune responses, prevent evolution to mycosis fungoides plaques and tumors and could be considered the main cause of the inhibition of melanogenesis. Therefore, hypopigmentation could be considered a marker of good prognosis for mycosis fungoides.     

共刺激受体:肿瘤免疫疗法的潜在靶点

免疫细胞表面的共刺激受体对免疫细胞的活化、增殖及效应功能的发挥具有重要作用。在肿瘤中,共刺激受体经特异性激动性单克隆抗体激活后能增强免疫细胞的效应功能,促进对肿瘤细胞的杀伤,抑制肿瘤的生长,可作为抗肿瘤免疫疗法的靶点。本文就几种共刺激受体在生理条件下、肿瘤免疫及抗肿瘤免疫治疗中的作用进行了综述。     

Cyclosporin a and tacrolimus (FK506) differentially alter T-cell receptor expression in vivo

Cyclosporin A (CSA) and tacrolimus (FK506) are two common immunosuppressive agents used post blood and marrow transplantation. Despite similarity in their accepted modes of action, we observed polarized effects of CSA and FK506 on the in vivo human T cell repertoire. To determine the possible mechanism for this difference, the effects of CSA and FK506 on cell viability, cell proliferation, interleukin-2 production, and calcineurin inhibition were determined in vitro. Our data suggest that a secondary mechanism of action exists for the different T-cell repertoire induced by exposure to CSA and FK506.     

Topical immunotherapy changes the composition of the peribulbar infiltrate in alopecia areata

Summary It has previously been shown that, in patients with untreated progressive alopecia areata (AA), the peribulbar T4/T8 ratio is about 4:1. In the present study, the immunohistochemical findings obtained in untreated AA patients were compared to those obtained in patients who had received topical immunotherapy with diphencyprone. The untreated group consisted of 5 patients with progressive AA and 5 patients with inactive AA. The treated group consisted of 5 patients with a good response to diphencyprone and 5 patients with little or no hair regrowth after treatment. In untreated patients with progressive AA, the mean peribulbar T4/T8 ratio was 4:1, whereas in untreated patients with stable AA, the ratio was 2:1. In the treated patients with a good response to diphencyprone, the mean T4/T8 ratio was 1:1, while in the patients with poor or no response to treatment, the ratio was 0.7. In conclusion, topical immunotherapy considerably alters the peribulbar T4/T8 ratio in AA. The results are consistent with, but do not prove, the concept of topical immunomodulation.