Nasal-type extranodal natural killer/T-cell lympholmas: A cliniclopathologic and genotypic study of 42 cases in Singapore

Department of Pathology, Singapore General Hospital, Singapore.
Modern Pathology (Impact Factor: 6.36). 10/2004; 17(9):1097-107. DOI: 10.1038/modpathol.3800157
Source: PubMed

ABSTRACT We studied the clinicopathologic features of 42 cases of nasal-type extranodal natural killer (NK)/T-cell lymphoma in Singapore and compared our findings with other series reported in the Asian and Western populations. A panel of immunohistochemical stains, which included CD2, CD3, CD4, CD8, CD56, T-cell intracellular Antigen-1 and granzyme B, and in situ hybridization for Epstein-Barr virus encoded RNA (EBER) were performed. Polymerase chain reaction for T-cell receptor-gamma gene rearrangement using both gel and capillary electrophoresis were evaluated to determine the proportion of tumors which are of true T-cell lineage. We also studied the functional status of the overexpressed p53 protein in these lymphomas by correlating p53 expression with its downstream target protein, p21. In all, 31 out of 42 cases presented in the upper aerodigestive tract. The other sites of involvement included gastrointestinal tract, skin, soft tissue, testis, liver, spleen, bone marrow and brain. The tumors displayed characteristic morphologic features. In situ hybridization for EBER was detected in 41 out of 42 cases (97.6%). The only significant adverse prognostic factor identified was an International Prognostic Index of two or more. A significantly higher proportion of the tumors (27%), compared to previous studies, demonstrated monoclonal T-cell receptor-gamma gene rearrangement. There was, however, no difference in survival or clinicopathologic features between the true NK-cell tumors and their T-cell counterparts. Overexpression of p53 was present in 40% of the cases, but no significant difference in survival rate was detected in patients with p53 overexpression and there was no association between p53 overexpression with large cell morphology, and advanced stage of disease. These findings suggest that molecular aberrations other than those of the p53 pathway may be operative in the pathogenesis of this malignancy.

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    • "In one study, survival analysis failed to show significant difference in survival among the different histologic subtypes [9]. However, Quintanilla- Martinez et al. reported that nasal ENKTL with large cell morphology were more likely to be associated with p53 mutation [10], even though these findings were not confirmed by other study [11]. Here, we measured the nuclear diameter of tumor cells and CD30 expression to evaluate their prognostic value. "
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    ABSTRACT: Extranodal natural killer/T-cell lymphoma, nasal type (nasal ENKTL) is a distinct clinicopathologic entity of lymphoid tumors with variable size and differentiation of tumor cells. Nasal ENKTL is related to infection of the tumor cells with Epstein-Barr virus (EBV) and virtually all cases contain monoclonal episomal EBV DNA and detectable EBV encoded small nuclear RNAs (EBERs). Several clinical factors are known for their relation to the prognosis, but histopathologic prognostic factors of nasal ENKTL have not yet been well established. We evaluated the prognostic value of the longest nuclear diameter of EBER+ tumor cells (NDTC) along with the result of CD30 expression. Twenty two patients with newly diagnosed nasal ENKTL were evaluated regarding clinicopathologic characteristics. NDTC was measured using a computerized image analysis system. The results were expressed as the mean diameter of ≥ 50 cells in a patient. Median of the mean NDTC of the patients was 7.32 μm (5.15-11.27). Patients with larger mean NDTC (≥ 7.35 μm) had a poorer event-free survival (EFS) than those with smaller mean NDTC (<7.35 μm; p = 0.024) and had a tendency of inferior overall survival (OS) (p = 0.08). Patients with CD30 expression had a inferior EFS (p = 0.018) and OS (p = 0.011) compared those without CD30 expression. The NDTC of EBV infected tumor cell and CD30 expression had relation to survival in the current exploratory analysis.
    International journal of clinical and experimental pathology 01/2012; 5(9):939-47.
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    • "Notably, a subset of nasal-type NK/T cell lymphoma lacked expression of the natural killer cell marker CD56/NCAM as reported by Ng et al. in a study of patients in Singapore [5]. However, the biological behaviour is similar to classic CD56' cases provided there is expression of cytotoxic granules and evidence of EBV infection, both of which were present in this biopsy. "
    Acta oncologica (Stockholm, Sweden) 03/2009; 48(4):637-9. DOI:10.1080/02841860902740923
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    ABSTRACT: Extranodal natural killer (NK)/T-cell lymphoma, nasal type (ENKTCL) is a rarely kind of non-Hodgkin lymphoma (NHL). It is much more frequent in Asian and Latin American countries than other part of the world. It typically affects nasal cavity. In China, one of its endemically places, ENKTCL accounts for 74%–96% of nasal NHL. Patients with ENKTCL usually show a highly aggressive clinical course, and its etiology is unclear. However, it is already proved that ENKTCL is associated with Epstein-Barr virus (EBV) infection, regardless patients’, ethnicity and areas. Some studies show that the risk will increase among several occupations, such as farmer, who are frequently exposure to pesticides and chemical solvent and risk can be cut down if taking some protective measures.
    The Chinese-German Journal of Clinical Oncology 05/2012; 11(5). DOI:10.1007/s10330-012-0962-4
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