CD30 expression: a diagnostic pitfall for primary cutaneous gamma delta T cell lymphoma
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LETTER TO THE EDITOR
CD30 expression: a diagnostic pitfall for primary cutaneous gamma delta T cell lymphoma Karen H. K. Tang 1 & Rex Au-Yeung 2 & Shun-Hin Ting 3 & Yok-lam Kwong 1 Received: 7 August 2020 / Accepted: 24 August 2020 # Springer-Verlag GmbH Germany, part of Springer Nature 2020
Dear Editor, In primary cutaneous T cell lymphomas (TCL), the expression of two molecules, CD30 and gamma delta T cell receptor (TCRγδ), may occasionally cause diagnostic difficulties. The CD30 antigen is typically expressed in lymphomatoid papulosis and primary cutaneous anaplastic large cell lymphoma (C-ALCL), being positive in > 75% and often nearly 100% of neoplastic cells [1]. In mycosis fungoides and Sezary syndrome, especially during large cell transformation, and rarely other cutaneous TCLs, CD30 may variably be expressed [1, 2]. In these non-ALCL cutaneous TCLs, CD30 is only focally expressed. TCRγδ is expressed predominantly in primary cutaneous gamma delta T cell lymphoma (PCGD-TCL), but can be found occasionally in mycosis fungoides and lymphomatoid papulosis [3, 4]. Therefore, CD30 and TCRγδ are not entirely specific for any cutaneous T cell lymphoma, and their expression must be interpreted with careful histopathologic and immunophenotypic examination for accurate diagnoses to be made. A 44-year-old woman presented with a 3-month history of left groin swelling. Physical examination showed an ulcerated 10-cm cutaneous lesion. Additionally,
* Yok-lam Kwong [email protected] 1
Department of Medicine, Queen Mary Hospital, Pok Fu Lam, Hong Kong
2
Department of Pathology, Queen Mary Hospital, Pok Fu Lam, Hong Kong
3
Department of Pathology, Queen Elizabeth Hospital, Yau Ma Tei, Hong Kong
involvement of bilateral inguinal and iliac lymph nodes, and subtle infiltration of skin in the right groin, were found on positron emission tomography-computed tomography (Fig. 1a). Incisional biopsy of the left groin mass showed a large cell lymphoma positive for CD3, CD30, and CD56, but negative for ALK (Fig. 2). A diagnosis of primary cutaneous anaplastic large cell lymphoma (C-ALCL) was made. Bone marrow biopsy was normal. She received six cycles of CHOP (cyclophosphamide, adriamycin, vincristine, prednisolone). Partial remission was achieved (Fig. 1b), and radiotherapy (40 Gy) to the left groin was given. Disease progression occurred 1 month later, with rapid development of multiple new subcutaneous nodules and generalized lymphadenopathy (Fig. 1c). Treatment with GDP (gemcitabine, cisplatin, dexamethasone) resulted in transient improvement. However, widespread subcutaneous lesions appeared soon afterwards, and she was referred for further treatment. On referral, disseminated violaceous subcutaneous nodules of varying sizes were noted (Fig. 1d). Biopsy of a nodule on the abdomen showed fibroadipose tissue infiltrated by neoplastic lymphoid cells. Different from the initial biopsy, lymphoma cells were smaller and monotonous in appearance. They were positive for CD2, CD3, CD56, and TIA-1. Interestingly, CD30 had become t
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