ABSTRACT
BACKGROUND: Drug-induced skin reactions, including toxic epidermal necrolysis and Stevens-Johnson syndrome, are severe bullous cutaneous diseases of uncertain etiology, although cytotoxic T cells seem to be involved. Cutaneous T cell-attracting chemokine (CTACK/CCL27) is selectively expressed in skin and attracts CCR10-expressing cells. Exclusive CTACK expression by keratinocytes suggests its involvement in inflammatory skin diseases. OBJECTIVE: We addressed whether CTACK/CCL27 production by the epidermis and CCR10+ lymphocytes are involved in toxic epidermal necrolysis and Stevens-Johnson syndrome. METHODS: We measured CTACK expression by epidermal cells in 2 patients with drug-induced bullous skin reactions and compared it to lesional skin from several drug-induced exanthemas. In parallel we measured CCR10 mRNA in peripheral blood mononuclear cells from the patients during the course of the disease and in lymphocytes infiltrating the skin. RESULTS: CTACK expression levels in skin biopsies from the 2 patients with drug-induced bullous reactions were higher than those found in healthy subjects or in other drug-induced exanthemas. CCR10 mRNA levels were also elevated in peripheral blood lymphocytes and in lesional skin during the acute phase of the disease. Moreover, resolution was associated with a return to baseline of both CTACK and CCR10 receptor expression. CONCLUSION: CTACK-CCR10 interactions may be involved in the selective recruitment to the skin of cytotoxic lymphocytes in toxic epidermal necrolysis and Stevens-Johnson syndrome, as well as in less severe drug-induced cutaneous diseases.
Subject(s)
Chemokines, CC/physiology , Receptors, Chemokine/physiology , Stevens-Johnson Syndrome/etiology , Adult , Aged , Chemokine CCL27 , Chemokines, CC/biosynthesis , Chemokines, CC/genetics , Female , Humans , Male , Middle Aged , RNA, Messenger/analysis , Receptors, CCR10 , Receptors, Chemokine/geneticsABSTRACT
Extranodal NK/T-cell lymphoma, nasal type, is a predominantly extranodal lymphoma characterized histologically by prominent necrosis, angiocentric growth, and vascular destruction. Only one report describing its fine-needle aspiration (FNA) cytologic features is available and shows highly unusual findings for a lymphoma. The present case concerns a 58-yr-old patient that presented with a soft tissue mass of the thigh in addition to an ulcerative lesion of the palate and nodular hepatic and splenic lesions. FNA cytology of the thigh tumor was interpreted as a malignant mesenchymal lesion (sarcoma). The subsequent pathologic study revealed an NK/T-cell lymphoma. Our findings are very similar to those previously reported. They were highly unusual for a lymphoma and consisted of polymorphic, round to spindle neoplastic cells distributed in irregular aggregates, and single cells. No significant number of lymphoglandular bodies were present.
Subject(s)
Biopsy, Needle , Killer Cells, Natural/pathology , Lymphocyte Subsets/pathology , Lymphoma, T-Cell, Peripheral/pathology , Soft Tissue Neoplasms/pathology , Diagnosis, Differential , Fatal Outcome , Humans , Male , Sarcoma/pathologyABSTRACT
Waldenström's macroglobulinemia is a low-grade lymphoma that produces monoclonal IgM. Central nervous system symptoms are frequent in Waldenström's macroglobulinemia, mostly associated with blood hyperviscosity. Nevertheless, central nervous system infiltration by malignant cells (Bing-Neel syndrome) has rarely been reported. We describe the case of a 72-year-old man with Waldenstrom's macroglobulinemia and central nervous system infiltration by malignant cells with tumor formation. All similar cases reported in the literature are reviewed and the different therapeutic approaches discussed.
