scholarly journals AB0757 ON THE ISSUE OF DIFFERENTIAL DIAGNOSIS OF PANNICULITIS

2021 ◽  
Vol 80 (Suppl 1) ◽  
pp. 1406.2-1406
Author(s):  
O. Egorova ◽  
V. Gorodetskiy ◽  
B. Belov ◽  
A. Potapova ◽  
S. Radenska-Lopovok ◽  
...  
Keyword(s):  
T Cell ◽  
Blood Test ◽  
Activity Index ◽  
Subcutaneous Fat ◽  
Cell Receptor ◽  
Immunological Parameters ◽  
Non Hodgkin Lymphoma ◽  
Positron Emission ◽  
Pet Ct ◽  
High Proliferative Activity

Background:Diagnosis of panniculitis (Pn) is associated with significant difficulties due to the variety of etiological factors, which include panniculitis-like T-cell lymphoma (PLTСL) – a rare variant of non-Hodgkin lymphoma.Objectives:to study clinical and laboratory features of PLTСL in rheumatology.Methods:Over 8 years PLTСL was diagnosed in 10 patients (9 women and 1 man, average age 37.2 ± 7.4) who were referred to V.A. Nasonova Research Institute of Rheumatology with a diagnosis of erythema nodosum or panniculitis. In addition to general clinical study, serum concentrations of α-1 antitrypsin, amylase, lipase, ferritin, creatine phosphokinase, immunological parameters (ANF-Hep2, dsDNA, C3 and C4 complements, CRP, ANCA, Scl-70, antibodies to cardiolipins G and M) were determined, and positron emission tomography combined with computed tomography (PET-CT), histological and immunohistochemical examination (IHC) of the biopsy sample of skin with subcutaneous fat from the affected areas were performed.Results:The clinical picture of PLTСL was characterized by generalized red-crimson moderately painful (VAS pain intensity 45mm) subcutaneous nodes on the upper limbs and trunk (100%), face (60%) and lower extremities (75%), without ulceration and oily fluid leakage. A “trembling saucer” symptom was evident in 75% of the observed cases. All patients had febrile fever. No enlargement of the lymph nodes of the liver and spleen was observed. The blood test revealed leukopenia (up to 2.0·x 109 /l) in 50% of cases, an increase in ESR and CRP by three or more times in 100% of cases. The biochemical blood test demonstrated an increase in LDH activity by two or more times in all patients. PET-CT in 100% of cases revealed an intense accumulation of 18F-FDG in the nodes which correlated with a high proliferative activity index. The morphological picture resembled lobular panniculitis without vasculitis. Tumor lymphocytes had an immunophenotype of cytotoxic T-lymphocytes: CD3+, CD8+, granzyme B+. To confirm the tumor nature of the infiltrate the rearrangements of the T-cell receptor genes were studied. Glucocorticoid therapy (23.5±9.6 mg/day) was ineffective which required polychemotherapy in most patients.Conclusion:PLTСL presents a complex diagnostic task that requires a multidisciplinary approach to verify the diagnosis and treatment tactics.Disclosure of Interests:None declared

scholarly journals Imaging of Chemokine Receptor-4 Targeted PET/CT with 68Ga-Pentixafor in Non-Hodgkin Lymphoma: Comparison to 18F-FDG

2020 ◽  
Author(s):  
Qingqing Pan ◽  
Yaping Luo ◽  
Yan Zhang ◽  
Long Chang ◽  
Ji Li ◽  
...  
Keyword(s):  
T Cell ◽  
B Cell ◽  
Hodgkin Lymphoma ◽  
Marginal Zone ◽  
Cell Lymphoma ◽  
B Cell Lymphoma ◽  
T Cell Lymphoma ◽  
Lymphoplasmacytic Lymphoma ◽  
Non Hodgkin Lymphoma ◽  
Pet Ct

Abstract Background: In order to study the CXCR4 expression with 68Ga-Pentixafor PET in different types of non-Hodgkin lymphoma, we performed a retrospective study to describe the 68Ga-Pentixafor PET/CT imaging in a spectrum of lymphomas and to compare it with 18F-FDG PET/CT. Results: Twenty-seven patients with newly diagnosed non-Hodgkin lymphoma were recruited retrospectively. 68Ga-Pentixafor PET showed increased radioactivity in lymphoplasmacytic lymphoma (n = 8), marginal zone lymphoma (n = 4), diffuse large B cell lymphoma (n = 3), follicular lymphoma (n = 2), mantle cell lymphoma (n = 1), unclassified indolent B cell lymphoma (n = 3) and enteropathy associated T cell lymphoma (n = 3). However, peripheral T cell lymphoma, not otherwise specified (n = 1), and NK/T cell lymphoma (n = 2) were not avid for 68Ga-Pentixafor. In comparison to 18F-FDG PET, 68Ga-Pentixafor PET demonstrated more extensive disease and higher radioactivity in lymphoplasmacytic lymphoma and marginal zone lymphoma. Conclusion: CXCR4 expression varies in different types of non-Hodgkin lymphoma. Overexpression of CXCR4 was detected with 68Ga-Pentixafor PET/CT in lymphoplasmacytic lymphoma, marginal zone lymphoma, diffuse large B cell lymphoma, follicular lymphoma, mantle cell lymphoma, unclassified indolent B cell lymphoma, and enteropathy associated T cell lymphoma.

scholarly journals A puzzling diagnosis: mycosis fungoides masquerading as pyoderma gangrenosum

2020 ◽  
Vol 6 (6) ◽  
pp. 784
Author(s):  
Neil K. Jairath ◽  
Ruple Jairath ◽  
Krislyn Porter ◽  
Jon C. Davis
Keyword(s):  
T Cells ◽  
T Cell ◽  
Mycosis Fungoides ◽  
Pyoderma Gangrenosum ◽  
Cell Receptor ◽  
Skin Lesions ◽  
Inflammatory Cell Infiltrate ◽  
Clonal Proliferation ◽  
Positron Emission ◽  
Metastatic Involvement

<p class="abstract">Mycosis fungoides (MF) is a form of cutaneous T cell lymphoma that initially affects the epidermis, and is characterized by the clonal proliferation of mature cluster of differentiation (CD4)+T cells. We report a 73-year old male presenting with chin and right axillary skin lesions that had ulceration and granulating areas. Initial biopsy revealed mixed inflammatory cell infiltrate, which suggested an initial diagnosis of pyoderma gangrenosum. Despite treatment, the progressive worsening of the skin lesions prompted multiple repeat biopsies, which eventually revealed a predominance of T cells within the infiltrate. A T cell receptor rearrangement resulted in elevated monoclonal T cell populations, confirming a diagnosis of MF. Subsequent positron emission tomography (PET) scans revealed metastatic involvement of the disease, which ultimately led to the patient’s death. Clinical presentations of MF can mimic several different clinical entities, including pyoderma gangrenosum. This report highlights the importance of a multimodal approach to the diagnosis of unidentified skin lesions.</p>

scholarly journals The value of complete remission according to positron emission tomography prior to autologous stem cell transplantation in lymphoma: a population-based study showing improved outcome

2020 ◽  
Author(s):  
Kristina Noring ◽  
Mattias Carlsten ◽  
Kristina Sonnevi ◽  
Björn Wahlin
Keyword(s):  
Positron Emission Tomography ◽  
Stem Cell ◽  
T Cell ◽  
Stem Cell Transplantation ◽  
B Cell ◽  
Cell Lymphoma ◽  
Emission Tomography ◽  
Positron Emission ◽  
Pet Ct ◽  
Improved Outcome

Abstract Background Chimeric antigen-receptor T-cell and bispecific antibody therapies will likely necessitate a reconsideration of the role of autologous stem-cell transplantation (ASCT) in lymphoma. Patients who are likely to profit from ASCT need to be better identified. Methods Here, we investigated the value of positron emission tomography/computerized tomography (PET/CT) before ASCT. All 521 patients transplanted for lymphoma 1994–2019 at Karolinska (497 conditioned with BEAM) were included. Results Outcome improved over three calendar periods 1994–2004, 2005–2014, 2015–2019 (2-year overall survival [OS]: 66%, 73%, 83%; P = 0.018). Non-relapse mortality (NRM) at 100 days over the three periods were 9.8%, 3.9%, 2.9%, respectively. The OS improvement between 1994–2004 and 2005–2014 was due to lower NRM (P = 0.027), but the large OS advance from 2015 was not accompanied by a significant reduction in NRM (P = 0.6). The fraction of PET/CT as pre-ASCT assessment also increased over time: 1994–2004, 2%; 2005–2014, 24%; 2015–2019, 60% (P < 0.00005). Complete responses (PET/CT-CR) were observed in 77% and metabolically active partial responses (PET/CT-PR) in 23%. PET/CT-CR was a predictor for survival in the entire population (P = 0.0003), also in the subpopulations of aggressive B-cell (P = 0.004) and peripheral T-cell (P = 0.024) lymphomas. Two-year OS and progression-free survival (OS/PFS) for patients in PET/CT-CR were in relapsed/refractory aggressive B-cell lymphoma 87%/75% and peripheral T-cell lymphoma 91%/78%. The corresponding figures in PET/CT-PR were 43%/44% and 33%/33%. Patients with solitary PET/CT-positive lesions showed acceptable outcome with ASCT followed by local irradiation (2-year OS/PFS 80%/60%). CT was less discriminative: 2-year OS/PFS: CT-CR, 76%/66%; CT-PR, 62%/51%. Outcome was inferior after BEAC compared with BEAM conditioning. Conclusions We conclude that the improved outcome reflects better, PET/CT-informed, identification of patients who should proceed to ASCT. The excellent survival of patients in PET/CT-CR indicates that ASCT should remain part of standard therapy for lymphoma.

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