Medicine:Cutaneous T cell lymphoma

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Cutaneous T cell lymphoma
Cutaneous T-cell lymphoma - very high mag.jpg
Micrograph showing cutaneous T-cell lymphoma. H&E stain.
SpecialtyHematology and oncology

Cutaneous T cell lymphoma (CTCL) is a class of non-Hodgkin lymphoma, which is a type of cancer of the immune system. Unlike most non-Hodgkin lymphomas (which are generally B cell related), CTCL is caused by a mutation of T cells. The cancerous T cells in the body initially migrate to the skin, causing various lesions to appear. These lesions change shape as the disease progresses, typically beginning as what appears to be a rash which can be very itchy and eventually forming plaques and tumors before spreading to other parts of the body.

Signs and symptoms

The presentation depends if it is mycosis fungoides or Sézary syndrome, the most common, though not the only types. Among the symptoms for the aforementioned types are: enlarged lymph nodes, an enlarged liver and spleen, and non-specific dermatitis.[1]

Cause

The cause of CTCL is unknown.[citation needed]

Diagnosis

A point-based algorithm for the diagnosis for early forms of cutaneous T cell lymphoma was proposed by The International Society for Cutaneous Lymphomas in 2005.[2]

Classification

Cutaneous T-cell lymphoma may be divided into the several subtypes.[3]:727–740 Mycosis fungoides is the most common form of CTCL and is responsible for half of all cases.[4] A WHO-EORTC classification has been developed.[5][6][7]


Treatment

Romidepsin

There is no cure for CTCL, but there are a variety of treatment options available and some CTCL patients are able to live normal lives with this cancer, although symptoms can be debilitating and painful, even in earlier stages. FDA approved treatments include the following:[8]

Histone deacetylase (HDAC) inhibitors are shown to have antiproliferative and cytotoxic properties against CTCL.[9]Other (off label) treatments include:

In 2010, the U.S. Food and Drug Administration granted orphan drug designation for naloxone lotion as a treatment for pruritus in cutaneous T-cell lymphoma to a pharmaceutical company called Elorac.[10]

Epidemiology

Of all cancers involving lymphocytes, 2% of cases are cutaneous T cell lymphomas.[11] CTCL is more common in men and in African-American people.[8] The incidence of CTCL in men is 1.6 times higher than in women.[8]

There is some evidence of a relationship with human T-lymphotropic virus (HTLV) with the adult T-cell leukemia/lymphoma subtype.[8] No definitive link between any viral infection or environmental factor has been definitely shown with other CTCL subtypes.[8]

See also

  • Cutaneous B-cell lymphoma
  • List of cutaneous conditions

References

  1. ↑ Cutaneous T-Cell Lymphoma: Practice Essentials, Background, Pathophysiology. 2016-06-02. http://emedicine.medscape.com/article/2139720-overview. 
  2. ↑ Pimpinelli, Nicola; Olsen, Elise A.; Santucci, Marco; Vonderheid, Eric; Haeffner, Andreas C.; Stevens, Seth; Burg, Guenter; Cerroni, Lorenzo et al. (December 2005). "Defining early mycosis fungoides". Journal of the American Academy of Dermatology 53 (6): 1053–1063. doi:10.1016/j.jaad.2005.08.057. PMID 16310068. https://flore.unifi.it/bitstream/2158/311708/1/Defining%20early%20mycosis%20fungoides.pdf. 
  3. ↑ James, William D. et al. (2006). Andrews' Diseases of the Skin: clinical Dermatology. Saunders Elsevier. ISBN 978-0-7216-2921-6. 
  4. ↑ Sidiropoulos, KG; Martinez-Escala, ME; Yelamos, O; Guitart, J; Sidiropoulos, M (December 2015). "Primary cutaneous T-cell lymphomas: a review". Journal of Clinical Pathology 68 (12): 1003–10. doi:10.1136/jclinpath-2015-203133. PMID 26602417. 
  5. ↑ Willemze, R.; Jaffe, ES.; Burg, G.; Cerroni, L.; Berti, E.; Swerdlow, SH.; Ralfkiaer, E.; Chimenti, S. et al. (May 2005). "WHO-EORTC classification for cutaneous lymphomas". Blood 105 (10): 3768–85. doi:10.1182/blood-2004-09-3502. PMID 15692063. 
  6. ↑ Khamaysi, Z.; Ben-Arieh, Y.; Izhak, OB.; Epelbaum, R.; Dann, EJ.; Bergman, R. (Feb 2008). "The applicability of the new WHO-EORTC classification of primary cutaneous lymphomas to a single referral center". Am J Dermatopathol 30 (1): 37–44. doi:10.1097/DAD.0b013e31815f9841. PMID 18212543. 
  7. ↑ "Clinical, Histologic, and Molecular Characteristics of Anaplastic Lymphoma Kinase-positive Primary Cutaneous Anaplastic Large Cell Lymphoma". The American Journal of Surgical Pathology 44 (6): 776–781. June 2020. doi:10.1097/PAS.0000000000001449. PMID 32412717. https://research.rug.nl/en/publications/634ff7f7-9d94-4950-be22-c0f5bb48135a. 
  8. ↑ 8.0 8.1 8.2 8.3 8.4 Devata, S; Wilcox, RA (June 2016). "Cutaneous T-Cell Lymphoma: A Review with a Focus on Targeted Agents". American Journal of Clinical Dermatology 17 (3): 225–37. doi:10.1007/s40257-016-0177-5. PMID 26923912. 
  9. ↑ Beigi, Pooya Khan Mohammad (2017). "Treatment" (in en). Clinician's Guide to Mycosis Fungoides. Springer International Publishing. pp. 23–34. doi:10.1007/978-3-319-47907-1_6. ISBN 9783319479064. 
  10. ↑ Elorac, Inc. Announces Orphan Drug Designation for Novel Topical Treatment for Pruritus in Cutaneous T-cell Lymphoma (CTCL) website
  11. ↑ Turgeon, Mary Louise (2005). Clinical hematology: theory and procedures. Hagerstown, MD: Lippincott Williams & Wilkins. p. 283. ISBN 978-0-7817-5007-3. https://archive.org/details/clinicalhematolo0004turg. "Frequency of lymphoid neoplasms. (Source: Modified from WHO Blue Book on Tumour of Hematopoietic and Lymphoid Tissues. 2001, p. 2001.)" 

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