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. 1998 Feb;51(2):154–158. doi: 10.1136/jcp.51.2.154

Differentiation between actinic reticuloid and cutaneous T cell lymphoma by T cell receptor gamma gene rearrangement analysis and immunophenotyping.

V Bakels 1, J W van Oostveen 1, A H Preesman 1, C J Meijer 1, R Willemze 1
PMCID: PMC500512  PMID: 9602691

Abstract

AIMS: Differentiation between actinic reticuloid and cutaneous T cell lymphoma can be extremely difficult. Demonstration of clonal T cell receptor (TCR) gene rearrangements has been suggested as a potential diagnostic criterion, but the results obtained thus far have been conflicting. This study investigated whether TCR gamma gene rearrangement analysis, using polymerase chain reaction (PCR) in combination with denaturing gradient gel electrophoresis (DGGE) and immunohistochemistry, can serve as a diagnostic criterion. METHODS: PCR/DGGE was performed on skin, peripheral blood mononuclear cells, and/or lymph nodes of seven patients with actinic reticuloid, 11 patients with Sézary syndrome, and 15 patients with a benign form of erythroderma. The results of PCR/DGGE and Southern blot analysis of TCR beta gene rearrangements were compared. In addition, CD4:CD8 ratios in skin and peripheral blood samples were investigated. RESULTS: Clonal T cell populations were detected in 19 of 21 samples obtained from patients with Sézary syndrome but were not detected in any of the 12 samples from patients with actinic reticuloid. Clonal T cells were detected in the peripheral blood of only one of 15 patients with a benign form of erythroderma. PCR/DGGE and Southern blot analysis gave concordant results in 28 of 29 samples. Immunophenotypic analysis demonstrated increased proportions of CD8+ T cells in skin (seven of seven cases) and peripheral blood (four of seven cases) of patients with actinic reticuloid. CONCLUSION: The results of this study demonstrate that gene rearrangement analysis, in combination with immunohistochemistry, may be an important adjunct in differentiating between actinic reticuloid and cutaneous T cell lymphoma. In patients suspected of having actinic reticuloid, application of both techniques is recommended.

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Selected References

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  1. Bachelez H., Bioul L., Flageul B., Baccard M., Moulonguet-Michau I., Verola O., Morel P., Dubertret L., Sigaux F. Detection of clonal T-cell receptor gamma gene rearrangements with the use of the polymerase chain reaction in cutaneous lesions of mycosis fungoides and Sézary syndrome. Arch Dermatol. 1995 Sep;131(9):1027–1031. [PubMed] [Google Scholar]
  2. Bakels V., van Oostveen J. W., Gordijn R. L., Walboomers J. M., Meijer C. J., Willemze R. Frequency and prognostic significance of clonal T-cell receptor beta-gene rearrangements in the peripheral blood of patients with mycosis fungoides. Arch Dermatol. 1992 Dec;128(12):1602–1607. [PubMed] [Google Scholar]
  3. Bakels V., van Oostveen J. W., van der Putte S. C., Meijer C. J., Willemze R. Immunophenotyping and gene rearrangement analysis provide additional criteria to differentiate between cutaneous T-cell lymphomas and pseudo-T-cell lymphomas. Am J Pathol. 1997 Jun;150(6):1941–1949. [PMC free article] [PubMed] [Google Scholar]
  4. Bignon Y. J., Souteyrand P. Genotyping of cutaneous T-cell lymphomas and pseudolymphomas. Curr Probl Dermatol. 1990;19:114–123. doi: 10.1159/000418081. [DOI] [PubMed] [Google Scholar]
  5. Bourguin A., Tung R., Galili N., Sklar J. Rapid, nonradioactive detection of clonal T-cell receptor gene rearrangements in lymphoid neoplasms. Proc Natl Acad Sci U S A. 1990 Nov;87(21):8536–8540. doi: 10.1073/pnas.87.21.8536. [DOI] [PMC free article] [PubMed] [Google Scholar]
  6. Dosaka N., Tanaka T., Fujita M., Miyachi Y., Horio T., Imamura S. Southern blot analysis of clonal rearrangements of T-cell receptor gene in plaque lesion of mycosis fungoides. J Invest Dermatol. 1989 Nov;93(5):626–629. doi: 10.1111/1523-1747.ep12319746. [DOI] [PubMed] [Google Scholar]
  7. Huck S., Dariavach P., Lefranc M. P. Variable region genes in the human T-cell rearranging gamma (TRG) locus: V-J junction and homology with the mouse genes. EMBO J. 1988 Mar;7(3):719–726. doi: 10.1002/j.1460-2075.1988.tb02868.x. [DOI] [PMC free article] [PubMed] [Google Scholar]
  8. Ive F. A., Magnus I. A., Warin R. P., Jones E. W. "Actinic reticuloid"; a chronic dermatosis associated with severe photosensitivity and the histological resemblance to lymphoma. Br J Dermatol. 1969 Jul;81(7):469–485. doi: 10.1111/j.1365-2133.1969.tb16022.x. [DOI] [PubMed] [Google Scholar]
  9. Jensen N. E., Sneddon I. B. Actinic reticuloid with lymphoma. Br J Dermatol. 1970 Mar;82(3):287–291. doi: 10.1111/j.1365-2133.1970.tb12439.x. [DOI] [PubMed] [Google Scholar]
  10. Meyer J. C., Hassam S., Dummer R., Muletta S., Döbbeling U., Dommann S. N., Burg G. A realistic approach to the sensitivity of PCR-DGGE and its application as a sensitive tool for the detection of clonality in cutaneous T-cell proliferations. Exp Dermatol. 1997 Jun;6(3):122–127. doi: 10.1111/j.1600-0625.1997.tb00158.x. [DOI] [PubMed] [Google Scholar]
  11. Myers R. M., Maniatis T., Lerman L. S. Detection and localization of single base changes by denaturing gradient gel electrophoresis. Methods Enzymol. 1987;155:501–527. doi: 10.1016/0076-6879(87)55033-9. [DOI] [PubMed] [Google Scholar]
  12. Nakajima N., Tanaka T., Miyachi Y., Imamura S., Kakizuka A. Characterization of the lymphoproliferative diseases in the skin by DNA analysis. J Dermatol. 1991 Nov;18(11):627–634. doi: 10.1111/j.1346-8138.1991.tb03146.x. [DOI] [PubMed] [Google Scholar]
  13. Perrot H., Frionnet M., Frances C., Souteyrand P., Tissot M., Thivolet J. Sarcome ganglionnaire généralisé au cours de l'évolution d'une actino-réticulose. Ann Dermatol Venereol. 1978 Jan;105(1):33–40. [PubMed] [Google Scholar]
  14. Preesman A. H., Schrooyen S. J., Toonstra J., van der Putte S. C., Rademakers L. H., Willemze R., van Vloten W. A. The diagnostic value of morphometry on blood lymphocytes in erythrodermic actinic reticuloid. Arch Dermatol. 1995 Nov;131(11):1298–1303. [PubMed] [Google Scholar]
  15. Ralfkiaer E., O'Connor N. T., Crick J., Wantzin G. L., Mason D. Y. Genotypic analysis of cutaneous T-cell lymphomas. J Invest Dermatol. 1987 Jun;88(6):762–765. doi: 10.1111/1523-1747.ep12470458. [DOI] [PubMed] [Google Scholar]
  16. Thomsen K. The development of Hodgkin's disease in a patient with actinic reticuloid. Clin Exp Dermatol. 1977 Jun;2(2):109–113. doi: 10.1111/j.1365-2230.1977.tb01551.x. [DOI] [PubMed] [Google Scholar]
  17. Toonstra J. Actinic reticuloid. Semin Diagn Pathol. 1991 May;8(2):109–116. [PubMed] [Google Scholar]
  18. Toonstra J., Henquet C. J., van Weelden H., van der Putte S. C., van Vloten W. A. Actinic reticuloid. A clinical photobiologic, histopathologic, and follow-u study of 16 patients. J Am Acad Dermatol. 1989 Aug;21(2 Pt 1):205–214. [PubMed] [Google Scholar]
  19. Toonstra J., van Weelden H., Gmelig Meyling F. H., van der Putte S. C., Schiere S. I., Baart de la Faille H. Actinic reticuloid simulating Sézary syndrome. Report of two cases. Arch Dermatol Res. 1985;277(3):159–166. doi: 10.1007/BF00404310. [DOI] [PubMed] [Google Scholar]
  20. Wieselthier J. S., Koh H. K. Sézary syndrome: diagnosis, prognosis, and critical review of treatment options. J Am Acad Dermatol. 1990 Mar;22(3):381–401. doi: 10.1016/0190-9622(90)70054-l. [DOI] [PubMed] [Google Scholar]
  21. Willemze R., van Vloten W. A., Hermans J., Damsteeg M. J., Meijer C. J. Diagnostic criteria in Sézary's syndrome: a multiparameter study of peripheral blood lymphocytes in 32 patients with erythroderma. J Invest Dermatol. 1983 Nov;81(5):392–397. doi: 10.1111/1523-1747.ep12521991. [DOI] [PubMed] [Google Scholar]
  22. Wood G. S., Tung R. M., Haeffner A. C., Crooks C. F., Liao S., Orozco R., Veelken H., Kadin M. E., Koh H., Heald P. Detection of clonal T-cell receptor gamma gene rearrangements in early mycosis fungoides/Sezary syndrome by polymerase chain reaction and denaturing gradient gel electrophoresis (PCR/DGGE). J Invest Dermatol. 1994 Jul;103(1):34–41. doi: 10.1111/1523-1747.ep12389114. [DOI] [PubMed] [Google Scholar]
  23. van der Putte S. C., Toonstra J., van Wichen D. F., van Unnik J. A., van Vloten W. A. Aberrant immunophenotypes in mycosis fungoides. Arch Dermatol. 1988 Mar;124(3):373–380. doi: 10.1001/archderm.124.3.373. [DOI] [PubMed] [Google Scholar]

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