Extranodal NK/T-cell Lymphoma, Nasal Type, Includes Cases of Natural Killer Cell and αβ, γδ, and αβ/γδ T-cell Origin

Department of Pathology, Division of Hematopathology, University of Pittsburgh School of Medicine, Pittsburgh 15213-2582, USA.
The American journal of surgical pathology (Impact Factor: 5.15). 02/2012; 36(4):481-99. DOI: 10.1097/PAS.0b013e31824433d8
Source: PubMed

ABSTRACT Extranodal NK/T-cell lymphoma (ENKTL), nasal type, may be of NK or T-cell origin; however, the proportion of T-ENKTLs and whether they are of αβ or γδ type remains uncertain. To elucidate the cell of origin and detailed phenotype of ENKTL and assess any clinicopathologic associations, 67 cases of ENKTL from Thailand were investigated, together with 5 γδ enteropathy-associated T-cell lymphomas (EATLs) for comparison. In all, 70% of the ENKTL were T-cell receptor (TCR) β,γ and, in cases tested, δ negative (presumptive NK origin); 5% were TCR γδ, 3% were TCR αβ, 1% were TCR αβ/γδ, and 21% were indeterminate. Out of 17 presumptive NK-ENKTLs tested, 3 had clonal TCR rearrangements. All cases were EBV and TIA-1; >85% were positive for CD3, CD2, granzyme B, pSTAT3, and Lsk/MATK; and all were CD16. Presumptive NK-ENKTLs had significantly more frequent CD56 (83% vs. 33%) and CXCL13 (59% vs. 0%) but less frequent PD-1 (0% vs. 40%) compared with T-ENKTLs. Of the NK-ENKTLs, 38% were Oct-2 compared with 0% of T-ENKTLs, and 54% were IRF4/MUM1 compared with 20% of T-ENKTLs. Only αβ T-ENKTLs were CD5. Intestinal ENKTLs were EBV and had significantly more frequent CD30, pSTAT3, and IRF4/MUM1 expression but less frequent CD16 compared with γδ EATL. Significant adverse prognostic indicators included a primary non-upper aerodigestive tract site, high stage, bone marrow involvement, International Prognostic Index ≥2, lack of radiotherapy, Ki67 >40%, and CD25 expression. The upper aerodigestive tract ENKTLs of T-cell origin compared with those of presumptive NK origin showed a trend for better survival. Thus, at least 11% of evaluable ENKTLs are of T-cell origin. Although T-ENKTLs have phenotypic and some possible clinical differences, they share many similarities with ENKTLs that lack TCR expression and are distinct from intestinal γδ EATL.

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Available from: Paisarn Boonsakan, Dec 26, 2014
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    • "Quintanilla et al reported 60% and 86% of p53-positive cases in Mexican and Peruvian populations, respectively [35], [41]. Pongpruttipan et al [29] found 68% of their cases from the Thai population to be positive, while Ye et al [42] found 33.3% of cases to be positive in the Chinese population. The latter two groups exhibited close correlation between p53 expression and both prognosis and advanced disease stage. "
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    ABSTRACT: NK/T-cell lymphoma (NKTCL) is the most frequent EBV-related NK/T-cell disease. Its clinical manifestations overlap with those of familial haemophagocytic lymphohistiocytosis (FHLH). Since PERFORIN (PRF1) mutations are present in FHLH, we analysed its role in a series of 12 nasal and 12 extranasal-NKTCLs. 12.5% of the tumours and 25% of the nasal-origin cases had the well-known g.272C>T(p.Ala91Val) pathogenic SNP, which confers a poor prognosis. Two of these cases had a double-CD4/CD8-positive immunophenotype, although no correlation was found with perforin protein expression. p53 was overexpressed in 20% of the tumoral samples, 80% of which were of extranasal origin, while none showed PRF1 SNVs. These results suggest that nasal and extranasal NKTCLs have different biological backgrounds, although this requires validation.
    PLoS ONE 03/2014; 9(3):e91521. DOI:10.1371/journal.pone.0091521 · 3.23 Impact Factor
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    • "Europeans have minor allele frequencies of 0.33, whereas African Americans have frequencies of 0.50, and Asians 0.42 for the allele of a single nucleotide polymorphism (rs 2392542) for TCRG.23 N-NK/T showed clonality for TCR in eight out of 12 (66.7%), which was higher than those of a Thai group (20/67, 30%) and a Taiwan study (0/8, 0%).17,18 Of seven ALCL cases, five (71.4%) had clonality for TCR, which was similar to data from a European study that reported clonality in 34 out of 43 (79.0%).12 "
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    ABSTRACT: A clonality test for immunoglobulin (IG) and T cell receptor (TCR) is a useful adjunctive method for the diagnosis of lymphoproliferative diseases (LPDs). Recently, the BIOMED-2 multiplex polymerase chain reaction (PCR) assay has been established as a standard method for assessing the clonality of LPDs. We tested clonality in LPDs in Koreans using the BIOMED-2 multiplex PCR and compared the results with those obtained in European, Taiwanese, and Thai participants. We also evaluated the usefulness of the test as an ancillary method for diagnosing LPDs. Two hundred and nineteen specimens embedded in paraffin, including 78 B cell lymphomas, 80 T cell lymphomas and 61 cases of reactive lymphadenitis, were used for the clonality test. Mature B cell malignancies showed 95.7% clonality for IG, 2.9% co-existing clonality, and 4.3% polyclonality. Mature T cell malignancies exhibited 83.8% clonality for TCR, 8.1% co-existing clonality, and 16.2% polyclonality. Reactive lymphadenitis showed 93.4% polyclonality for IG and TCR. The majority of our results were similar to those obtained in Europeans. However, the clonality for IGK of B cell malignancies and TCRG of T cell malignancies was lower in Koreans than Europeans. The BIOMED-2 multiplex PCR assay was a useful adjunctive method for diagnosing LPDs.
    The Korean Journal of Pathology 10/2013; 47(5):458-465. DOI:10.4132/KoreanJPathol.2013.47.5.458 · 0.17 Impact Factor
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    • "It is derived from either activated NK cells or, rarely, cytotoxic T-cells [17]. If a patient with NK or T-cell tumors has unusual reactions to treatment or unusual prognosis [18], it is better to differentiate the NK tumors from the T-cell tumors in our opinion. Simultaneously, several studies have demonstrated that it is necessary to elucidate the origin of NK/T cell lymphoma [18,19]. "
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    ABSTRACT: Extranodal natural killer (NK)/T-cell lymphoma, nasal type, is an uncommon lymphoma associated with the Epstein-Barr virus (EBV). It most commonly involves the nasal cavity and upper respiratory tract. Primary pulmonary NK/T cell lymphoma is extremely rare. If a patient with a NK or T-cell tumor has an unusual reaction to treatment or an unusual prognosis, it is wise to differentiate NK from T-cell tumors. The clinicopathologic characteristics, immunophenotype, EBV in situ hybridization, and T cell receptor (TCR) gene rearrangement of primary pulmonary NK cell lymphoma from a 73-year-old Chinese woman were investigated and the clonal status was determined using female X-chromosomal inactivation mosaicism and polymorphisms at the phosphoglycerate kinase (PGK) gene. The lesion showed the typical histopathologic characteristics and immunohistochemical features of NK/T cell lymphoma. However, the sample was negative for TCR gene rearrangement. A clonality assay demonstrated that the lesion was monoclonal. It is concluded that this is the first recorded case of genuine primary pulmonary NK cell lymphoma. The purpose of the present work is to recommend that pathologists carefully investigate the whole lesion to reduce the likelihood that primary pulmonary NK cell lymphoma will be misdiagnosed as an infectious lesion. In addition, TCR gene rearrangement and clonal analysis, which is based on female X-chromosomal inactivation mosaicism and polymorphisms at PGK and androgen receptor (AR) loci, were found to play important roles in differentiating NK cell lymphoma from T cell lymphoma. Virtual slides The virtual slide(s) for this article can be found here:
    Diagnostic Pathology 08/2013; 8(1):140. DOI:10.1186/1746-1596-8-140 · 2.60 Impact Factor
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