Peripheral T-cell lymphoma at the injection site of influenza vaccination.

Pseudolymphomas or B‑cell lymphoma at the vaccination site have been reported by several authors. However, onset of cutaneous T‑cell lymphoma with cytotoxic features is a rare complication of vaccination. We report a 27‑year‑old man who developed a nodule and ulcer that arose at the site of injection of influenza vaccine. The neoplastic cells reacted positively for CD56, CD3, CD2, perforin, and granzyme B, but negatively for CD4, CD8, CD10, CD19, CD30, CD34, CD79, and betaF1. Molecular studies showed T‑cell receptor γ (TCR‑γ) chain monoclonal rearrangement. A diagnosis of peripheral T‑cell lymphoma, not otherwise specified (NOS) was established. The patient had high fever, progressive liver dysfunction and a rapid fatal evolution.

CD-3 positive extranodal T-cell lymphoma of nasal type with skin involvement.

A 40-year-old previously healthy lady presented with nasal obstruction and localized plaques over the right arm. She developed complete nasal obstruction due to a mass in the right nasal cavity and skin lesions that ulcerated to present as ecthyma gangrenosum like lesions. Patient's condition deteriorated fast and she developed icterus with fatal outcome within 4 weeks of developing skin lesions. Nasal and skin biopsy revealed angiocentric T-cell lymphoma, which on immuno-phenotyping revealed CD-3 positive; and CD-20, CD-30, ALK and EMA negativity. She was seronegative for HIV. Final diagnosis of CD-3 positive extranodal T-cell lymphoma of nasal type was made. Extranodal T-cell lymphomas are very aggressive NHLs with poor prognosis. Prognosis depends on histology, stage of the disease and sites of involvement. NK/T cell lymphoma of nasal type is common with EBV association. Skin involvement is rare and is also an indicator of poor prognosis.

Clinical Characteristics and Outcomes of Posttransplant Lymphoproliferative Disorders Following Allogeneic Hematopoietic Stem Cell Transplantation in Korea

Between 1995 and 2003, seven cases of posttransplant lymphoproliferative disorder (PTLD) were identified among 1,116 patients who received allogeneic hematopoietic stem cell transplantations (HSCT) at Catholic HSCT Center (overall incidence 0.6%). Five (71.4%) patients had episodes of acute graft-versus-host-disease (GVHD) and were treated with steroids. Cervical lymphadenopathy was observed in most cases (71.4%), but clinical symptoms varied depending on the involved sites. Pathologic findings varied: 1 case of plasmacytic hyperplasia, 3 of polymorphic PTLD, 2 of diffuse large B-cell lymphoma, 1 of large T-cell lymphoma, which proved to be associated with Epstein-Barr virus (EBV). The proportion of EBV-negative PTLD was 33.3%. Five patients demonstrated a good response to treatment (treatment response rate 71.4%). The overall mortality was 42.8%, and one death was directly attributable to PTLD. The incidence of PTLD is expected to increase, based on the rising use of grafts from alternative donors and recent clinical features of PTLD manifested by a disseminated and fulminant nature. It is necessary to have a high level of suspicion when monitoring patients and readily adopt prompt and effective cellular immunotherapy for PTLD.

EBV and hemophagocytic syndrome: analysis of 3 cases, with speculation on clinical features, therapy and role of EBV.

The authors report three patients diagnosed with EBV associated HPCS. The first case died of a fatal EBV infection. The second and third cases had primary disease of malignant lymphoma. In case 2, T cell lymphoma associated HPCS was diagnosed early. However, despite the aggressive treatment of HPCS and T-cell lymphoma, the patient died because of the refractory lymphoma. In case 3, HPCS and B malignant lymphoma were diagnosed at post mortem. EBV was found very late in all three cases. Case 1 and case 2 had a very high DNA-EBV load in blood. Case 3 demonstrated EBV-RNA encoded antigen (EBER) in lymph node by in situ hybridization technique. The clinical features of HPCS were analysed. Four early manifestations in these three cases were emphasized, namely fever, splenomegaly, progressive pancytopenia and impaired liver function test without severe jaundice. The authors stress the most important factor to save the life of the patients is to give early diagnosis and early proper management of HPCS as well as the etiologic diseases. The treatment of choice of early HPCS are pulse corticosteroid, IVIgG. Combination immunochemotherapy including pulse corsticosteroid, IVIgG, cyclosporin A, etoposide and plasma exchange should be given promptly in severe cases. From the present report, it indicates that the association of EBV with HPCS is not uncommon in Thailand. EBV is very important because it gives a very poor prognosis either by being an etiologic cause of HPCS or by association with ML with HPCS. Clinicians should be aware of EBV and recognize it early. The early treatment of EBV should helpfully changes the prognosis of the patients. The role of EBV on the occurrence of HPCS and T-ML is also discussed

HTLV-I (Human T- cell lymphotropic virus), algo que decir? / HTLV-I (Human T-cell lymphotropic virus): something to say?

El virus HTLV-I se asocia a varias patologías siendo las más relevantes la paraparesia espástica y la leucemia/linfoma de células T del adulto. No tiene tratamiento específico y se han intentado varios esquemas terapéuticos para su manejo. Se revisa la literatura presentando los trabajos más actualizados en relación a la terapia.