Landa N G, Zelickson B D, Peters M S, Muller S A, Pittelkow M R
Department of Dermatology, Mayo Clinic, Rochester, MN 55905.
J Am Acad Dermatol. 1993 Dec;29(6):945-53. doi: 10.1016/0190-9622(93)70272-u.
Diagnosis of cutaneous lymphoma in the absence of systemic lymphoma may be difficult. Reactive lymphoid lesions can mimic lymphoma clinically and histologically and have been designated pseudolymphomas.
Our purpose was to analyze lymphoid gene rearrangements in cutaneous lymphoproliferative lesions and to correlate these findings with the histologic, immunophenotypic, and clinical profile.
We examined 21 cases of lymphoproliferative lesions that developed in skin and performed molecular rearrangement analysis of T-cell receptor and immunoglobulin genes. We examined identical tissues by histologic and immunophenotypic criteria and conducted follow-up clinical evaluation of all patients.
Clonal rearrangements of immunoglobulin (seven cases) or T-cell receptor (two cases) gene were detected in 9 of 21 patients. No specific histologic or immunophenotypic feature was consistently associated with a clonal lymphoid gene rearrangement. Systemic lymphoma developed in one patient in whom a clonal rearrangement within the immunoglobulin gene was identified.
Gene rearrangement analysis may be helpful in differentiating primary cutaneous lymphoma from pseudolymphoma. The chronic clinical course of patients with clonal lymphoid gene rearrangements supports a lack of correlation between clonality and biologic aggressiveness.
在无系统性淋巴瘤的情况下，皮肤淋巴瘤的诊断可能具有挑战性。反应性淋巴样病变在临床和组织学上可模仿淋巴瘤，被称为假性淋巴瘤。
我们的目的是分析皮肤淋巴增殖性病变中的淋巴样基因重排，并将这些发现与组织学、免疫表型和临床特征相关联。
我们检查了21例发生于皮肤的淋巴增殖性病变，并对T细胞受体和免疫球蛋白基因进行了分子重排分析。我们根据组织学和免疫表型标准检查了相同的组织，并对所有患者进行了随访临床评估。
21例患者中有9例检测到免疫球蛋白（7例）或T细胞受体（2例）基因的克隆性重排。没有特定的组织学或免疫表型特征与克隆性淋巴样基因重排始终相关。在1例鉴定出免疫球蛋白基因内克隆性重排的患者中发生了系统性淋巴瘤。
基因重排分析可能有助于区分原发性皮肤淋巴瘤和假性淋巴瘤。克隆性淋巴样基因重排患者的慢性临床病程支持克隆性与生物学侵袭性之间缺乏相关性。
