New prognostic relevant factors in primary cutaneous diffuse large B-cell lymphomas

• Published in: Journal of the American Academy of Dermatology 2007-04, Vol.56 (4), p.588-597
• Main Authors: Hallermann, Christian, MD, Niermann, Christoph, MD, Fischer, Rudolf-Josef, MD, PhD, Schulze, Hans-Joachim, MD, PhD
• Format: Article
• Language: English
• Subjects: Adult; Age Factors; Aged; Aged, 80 and over; Biological and medical sciences; Biomarkers, Tumor - analysis; Biopsy, Needle; Cohort Studies; Combined Modality Therapy; Dermatology; Female; Genes, bcl-2 - genetics; Hematologic and hematopoietic diseases; Humans; Immunohistochemistry; Leukemias. Malignant lymphomas. Malignant reticulosis. Myelofibrosis; Lymphoma, Large B-Cell, Diffuse - mortality; Lymphoma, Large B-Cell, Diffuse - pathology; Lymphoma, Large B-Cell, Diffuse - therapy; Male; Medical sciences; Middle Aged; Multivariate Analysis; Organic Cation Transporter 1 - genetics; Organic Cation Transporter 1 - metabolism; Probability; Prognosis; Proportional Hazards Models; Risk Factors; Sampling Studies; Sensitivity and Specificity; Sex Factors; Skin Neoplasms - mortality; Skin Neoplasms - pathology; Skin Neoplasms - therapy; Survival Analysis; Syndecan-1 - genetics; Syndecan-1 - metabolism; Tissue Culture Techniques
• ISSN: 0190-9622; 1097-6787
• DOI: 10.1016/j.jaad.2006.12.026

Background There is a growing body of literature that has enhanced our understanding of the biology of primary cutaneous diffuse large B-cell lymphoma (PCDLBCL) including in the context of gene profiling studies. Recent studies have demonstrated an activated proliferation profile associated with leg type lymphoma including overexpression of proto-oncogenes PIM1, PIM2, and cMYC, and the transcription factors MUM1 and OCT2. Although gene profiling is very useful in understanding the molecular basis of diffuse large B-cell lymphoma (LBCL), it is not practical from a routine diagnostic perspective. In this regard, the purpose of the study was to further define an armamentarium of easily applied immunohistochemical stains to accurately prognosticate PCDLBCL. Methods In all, 35 patients with PCDLBCL, 14 of follicle center and 21 of leg type, were analyzed using antibodies against CD5, CD138, BCL2, BCL6, OCT2, MUM1, FOXP1, and cMYC. Findings were correlated with clinical data. Results All cases stained negative for CD5 and CD138. Both subtypes differed in distinct staining patterns for BCL6, BCL2, OCT2, MUM1, and FOXP1. Staining for BCL2, OCT2, and/or MUM1 was associated with poor, and BCL6 with a favorable prognosis. Expression of cMYC was irrespective of prognosis or subtype, whereas ulceration or primary manifestation on the leg or multiple lesions was indicative for worse prognosis. Limitations Case number was a limitation. Conclusion Discriminating PCDLBCL supports the validity of the World Health Organization/European Organization for Research and Treatment of Cancer classification. To identify risk factors in patients with PCDLBCL we recommend thorough evaluation of clinical presentation and exploratory staining pattern for BCL2, BCL6, MUM1 and OCT2.