The Fingerland Department of Pathology, Charles University Faculty of Medicine and University Hospital Hradec Králové, Sokolská 581, Hradec Králové, 500 03, Czech Republic.
Department of Clinical Biochemistry and Diagnostics, Charles University Faculty of Medicine and University Hospital Hradec Králové, Sokolská 581, Hradec Králové, 500 03, Czech Republic.
Pathol Res Pract. 2020 Dec;216(12):153279. doi: 10.1016/j.prp.2020.153279. Epub 2020 Nov 4.
Cutaneous T-cell lymphoid infiltrate can represent reactive lesion or a malignant T-cell lymphoma. However, clinical and histopathological appearance can overlap in both groups with a risk of misdiagnosis. Aberrant expression of T-cell markers is not always applicable and T-cell receptor (TCR) gene rearrangement is not always accessible and diagnosis in borderline cases can be challenging.
Several types of TCR antibodies are currently available with limited knowledge of their expression in different cutaneous lymphoid infiltrates. Aim of the study is a comparison of expression of TCR antibodies in benign and malignant lymphoid infiltrates and their utility in borderline cases.
Representative cases of reactive and malignant lymphoproliferations were collected. Separate group of lesions with borderline morphology was selected for comparison. Immunohistochemical expression of TCR-V-betaF1 (TCRBF1), TCR-C-beta1 (TCRJOVI.1), TCR gamma/delta (TCRGD) and TCR delta (TCRD) was performed in all cases. TCR gene rearrangement evaluation was performed in all cases using PCR BIOMED-2 assay.
Benign lymphoid infiltrates were all negative in TCRD and TCRGD. Expression of TCRJOVI.1 was seen in 3/10 cases and TCRBF1 in one. T-cell lymphomas were positive for TCRBF1 and TCRGD in 60% and 30% of cases respectively. TCR gene rearrangement was confirmed in 90% of lymphoma cases. All benign lesions were polyclonal. Morphologically borderline lesions showed expression of TCRBF1 in 6/10 cases and TCR gene rearrangement in 4/10 cases. Re-evaluation of the cases and clinical correlation led to the change of the diagnosis and confirmation of T-cell lymphoma in 4/10 cases.
Expression of TCRBF1 and TCR-gene rearrangement was significantly associated with malignant infiltrates. TCRBF1 positivity in borderline cutaneous lymphoproliferations can raise the suspicion of malignancy but confirmation by TCR gene rearrangement and careful clinical correlation is still advisable.
皮肤 T 细胞淋巴浸润既可以是反应性病变，也可以是恶性 T 细胞淋巴瘤。然而，两组疾病的临床表现和组织病理学表现可能重叠，存在误诊的风险。T 细胞标志物的异常表达并不总是适用，T 细胞受体（TCR）基因重排也并不总是可行的，边界病例的诊断具有挑战性。
目前有几种类型的 TCR 抗体可用，但对它们在不同皮肤淋巴浸润中的表达知之甚少。本研究旨在比较良性和恶性淋巴增生性浸润中 TCR 抗体的表达及其在边界病例中的应用。
收集了具有代表性的反应性和恶性淋巴增生性病变病例。选择具有边界形态的单独病变组进行比较。所有病例均进行 TCR-V-betaF1（TCRBF1）、TCR-C-beta1（TCRJOVI.1）、TCR gamma/delta（TCRGD）和 TCR delta（TCRD）的免疫组织化学表达。所有病例均采用 PCR BIOMED-2 检测进行 TCR 基因重排评估。
良性淋巴浸润均为 TCRD 和 TCRGD 阴性。TCRJOVI.1 在 3/10 例中表达，TCRBF1 在 1/10 例中表达。T 细胞淋巴瘤中，TCRBF1 和 TCRGD 的阳性率分别为 60%和 30%。90%的淋巴瘤病例均证实 TCR 基因重排。所有良性病变均为多克隆。形态学边界病变中有 6/10 例表达 TCRBF1，有 4/10 例 TCR 基因重排。对这些病例进行重新评估并结合临床相关性，导致其中 4/10 例的诊断发生改变，证实为 T 细胞淋巴瘤。
TCRBF1 表达和 TCR 基因重排与恶性浸润显著相关。边界性皮肤淋巴增生中 TCRBF1 的阳性表达可能提示恶性，但仍建议通过 TCR 基因重排和仔细的临床相关性来确认。
