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Differentiation and Clonality of Lesional Lymphocytes in Small Plaque Parapsoriasis

Differentiation and Clonality of Lesional Lymphocytes in Small Plaque Parapsoriasis Abstract Background: Small plaque parapsoriasis is an idiopathic chronic dermatosis characterized by patches on the trunk and extremities that are often smaller than 5 cm in diameter and that sometimes have a digitate contour. These latter cases are often referred to as digitate dermatosis. Histopathologic examination reveals a mild superficial perivascular lymphocytic infiltrate associated with mild spongiosis and parakeratosis. To characterize this disease more completely, we analyzed the differentiation and clonality of lesional lymphocytes using immunohistologic and molecular biologic methods. Observations: We studied five cases using a frozen-section immunoperoxidase technique. In each case, there was a predominantly CD4+ T-cell infiltrate admixed with CD8+ T cells, Langerhans cells/indeterminate cells, and macrophages. In three cases, the clonality of lesional T cells was studied by denaturing gradient gel electrophoresis of polymerase chain reaction—amplified T-cell receptor-γ gene rearrangements. Two cases showed a dominant clonal pattern, while one case exhibited a polyclonal pattern. Clinical follow-up disclosed persistent disease in one of the two clonal cases, while lesions in the other clonal case and the polyclonal case gradually resolved. Conclusions: Our findings indicate that small plaque parapsoriasis is a clinically indolent, histopathologically nonspecific, predominantly CD4+ T-cell— mediated disease that, at least in some cases, contains a dominant T-cell clone. These features put small plaque parapsoriasis into a category with certain other members of the parapsoriasis group, namely, pityriasis lichenoides and lymphomatoid papulosis, which have been shown to be clonal T-cell disorders despite their clinically benign course. It remains to be determined if the dominant T-cell clones identified in some cases of small plaque parapsoriasis can ever be the direct precursors of overt cutaneous T-cell lymphomas.(Arch Dermatol. 1995;131:321-324) References 1. Lambert W, Everett MA. The nosology of parapsoriasis . J Am Acad Dermatol. 1981;5:373-395.Crossref 2. King-Ismael D, Ackerman AB. Guttate parapsoriasis/digitate dermatosis (small plaque parapsoriasis) is mycosis fungoides . Am J Dermatopathol. 1992;14: 518-535.Crossref 3. Piamphoingsant T. Parapsoriasis and related conditions . Ann Acad Med Singapore. 1988;17:486-491. 4. Zelickson BD, Peters MS, Muller SA, et al. T-cell receptor gene rearrangement analysis: cutaneous T-cell lymphoma, peripheral T-cell lymphoma, and premalignant and benign cutaneous lymphoproliferative disorders . J Am Acad Dermatol. 1991;25:787-796.Crossref 5. Lambert WC. Premycotic eruptions . Dermatol Clin. 1985;3:629-645. 6. Wood GS, Warnke R. The immunophenotyping of bone marrow biopsies and aspirates: frozen section techniques . Blood. 1982;59:913-922. 7. Wood GS, Tung RM, Haeffner AC, et al. Detection of clonal TCR-γ gene rearrangements in early mycosis fungoides/Sézary syndrome by polymerase chain reaction and denaturing gradient gel electrophoresis (PCR/DGGE) . J Invest Dermatol. 1994;103:34-41.Crossref 8. Benmaman 0, Sanchez JL. Comparative clinicopathological study on pityriasis lichenoides chronica and small plaque parapsoriasis . Am J Dermatopathol. 1988; 10:189-196.Crossref 9. Ralfkiaer E, Wantzin GL, Mason DY, Hou-Jensen K, Stein H, Thomsen K. Phenotypic characterization of lymphocyte subsets in mycosis fungoides: comparison with large plaque parapsoriasis and benign chronic dermatoses . Am J Clin Pathol. 1985;84:610-619. 10. Wood GS, Volterra AS, Abel EA, Nickoloff BJ, Adams RM. Allergic contact dermatitis: novel immunohistologic features . J Invest Dermatol. 1986;87:688-693.Crossref 11. Weiss LM, Wood GS, Trela M, Warnke RA, Sklar J. Clonal T-cell populations in lymphomatoid papulosis: evidence of lymphoproliferative origin for a clinically benign disease . N Engl J Med. 1986;315:475-479.Crossref 12. Weiss LM, Wood GS, Ellisen LW, Reynolds TC, Sklar J. Clonal T-cell populations in pityriasis lichenoides et varioliformis acuta (Mucha-Habermann disease) . Am J Pathol. 1987;126:417-421. 13. Kadin ME. Hodgkin's disease: immunobiology and pathogenesis . In: Knowles DM, ed. Neoplastic Hematopathology . Baltimore, Md: Williams & Wilkins; 1992: 540-541. 14. Davis TH, Morton CC, Miller-Cassman R, Balk SP, Kadin ME. Hodgkin's disease, lymphomatoid papulosis, and cutaneous T-cell lymphoma derived from a common T-cell clone . N Engl J Med. 1992;326:1115-1122.Crossref 15. Wood GS. Cutaneous lymphoproliferative disorders: strategies for molecular biological analysis and their major findings . Springer Semin Immunopathol. 1992;13:387-399.Crossref http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Archives of Dermatology American Medical Association

Differentiation and Clonality of Lesional Lymphocytes in Small Plaque Parapsoriasis

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Publisher
American Medical Association
Copyright
Copyright © 1995 American Medical Association. All Rights Reserved.
ISSN
0003-987X
eISSN
1538-3652
DOI
10.1001/archderm.1995.01690150085017
Publisher site
See Article on Publisher Site

Abstract

Abstract Background: Small plaque parapsoriasis is an idiopathic chronic dermatosis characterized by patches on the trunk and extremities that are often smaller than 5 cm in diameter and that sometimes have a digitate contour. These latter cases are often referred to as digitate dermatosis. Histopathologic examination reveals a mild superficial perivascular lymphocytic infiltrate associated with mild spongiosis and parakeratosis. To characterize this disease more completely, we analyzed the differentiation and clonality of lesional lymphocytes using immunohistologic and molecular biologic methods. Observations: We studied five cases using a frozen-section immunoperoxidase technique. In each case, there was a predominantly CD4+ T-cell infiltrate admixed with CD8+ T cells, Langerhans cells/indeterminate cells, and macrophages. In three cases, the clonality of lesional T cells was studied by denaturing gradient gel electrophoresis of polymerase chain reaction—amplified T-cell receptor-γ gene rearrangements. Two cases showed a dominant clonal pattern, while one case exhibited a polyclonal pattern. Clinical follow-up disclosed persistent disease in one of the two clonal cases, while lesions in the other clonal case and the polyclonal case gradually resolved. Conclusions: Our findings indicate that small plaque parapsoriasis is a clinically indolent, histopathologically nonspecific, predominantly CD4+ T-cell— mediated disease that, at least in some cases, contains a dominant T-cell clone. These features put small plaque parapsoriasis into a category with certain other members of the parapsoriasis group, namely, pityriasis lichenoides and lymphomatoid papulosis, which have been shown to be clonal T-cell disorders despite their clinically benign course. It remains to be determined if the dominant T-cell clones identified in some cases of small plaque parapsoriasis can ever be the direct precursors of overt cutaneous T-cell lymphomas.(Arch Dermatol. 1995;131:321-324) References 1. Lambert W, Everett MA. The nosology of parapsoriasis . J Am Acad Dermatol. 1981;5:373-395.Crossref 2. King-Ismael D, Ackerman AB. Guttate parapsoriasis/digitate dermatosis (small plaque parapsoriasis) is mycosis fungoides . Am J Dermatopathol. 1992;14: 518-535.Crossref 3. Piamphoingsant T. Parapsoriasis and related conditions . Ann Acad Med Singapore. 1988;17:486-491. 4. Zelickson BD, Peters MS, Muller SA, et al. T-cell receptor gene rearrangement analysis: cutaneous T-cell lymphoma, peripheral T-cell lymphoma, and premalignant and benign cutaneous lymphoproliferative disorders . J Am Acad Dermatol. 1991;25:787-796.Crossref 5. Lambert WC. Premycotic eruptions . Dermatol Clin. 1985;3:629-645. 6. Wood GS, Warnke R. The immunophenotyping of bone marrow biopsies and aspirates: frozen section techniques . Blood. 1982;59:913-922. 7. Wood GS, Tung RM, Haeffner AC, et al. Detection of clonal TCR-γ gene rearrangements in early mycosis fungoides/Sézary syndrome by polymerase chain reaction and denaturing gradient gel electrophoresis (PCR/DGGE) . J Invest Dermatol. 1994;103:34-41.Crossref 8. Benmaman 0, Sanchez JL. Comparative clinicopathological study on pityriasis lichenoides chronica and small plaque parapsoriasis . Am J Dermatopathol. 1988; 10:189-196.Crossref 9. Ralfkiaer E, Wantzin GL, Mason DY, Hou-Jensen K, Stein H, Thomsen K. Phenotypic characterization of lymphocyte subsets in mycosis fungoides: comparison with large plaque parapsoriasis and benign chronic dermatoses . Am J Clin Pathol. 1985;84:610-619. 10. Wood GS, Volterra AS, Abel EA, Nickoloff BJ, Adams RM. Allergic contact dermatitis: novel immunohistologic features . J Invest Dermatol. 1986;87:688-693.Crossref 11. Weiss LM, Wood GS, Trela M, Warnke RA, Sklar J. Clonal T-cell populations in lymphomatoid papulosis: evidence of lymphoproliferative origin for a clinically benign disease . N Engl J Med. 1986;315:475-479.Crossref 12. Weiss LM, Wood GS, Ellisen LW, Reynolds TC, Sklar J. Clonal T-cell populations in pityriasis lichenoides et varioliformis acuta (Mucha-Habermann disease) . Am J Pathol. 1987;126:417-421. 13. Kadin ME. Hodgkin's disease: immunobiology and pathogenesis . In: Knowles DM, ed. Neoplastic Hematopathology . Baltimore, Md: Williams & Wilkins; 1992: 540-541. 14. Davis TH, Morton CC, Miller-Cassman R, Balk SP, Kadin ME. Hodgkin's disease, lymphomatoid papulosis, and cutaneous T-cell lymphoma derived from a common T-cell clone . N Engl J Med. 1992;326:1115-1122.Crossref 15. Wood GS. Cutaneous lymphoproliferative disorders: strategies for molecular biological analysis and their major findings . Springer Semin Immunopathol. 1992;13:387-399.Crossref

Journal

Archives of DermatologyAmerican Medical Association

Published: Mar 1, 1995

References