Studies of Clinical Diagnosis and Treatment on Cutaneous T-Cell Lymphoma

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(1) We studied surface markers presents in lymphoma of the skin by immunohistochemical staining, using the ABP (avidine-biotin-peroxidase complex) methods and PAP (peroxidase-anti-peroxidase complex) methods. 80 percent of T-cell lymphoma except ATL analyzed by the ABP methods showed a helper/inducer phenotype (Leu2a~, Leu3a^+), 6 percent showed a suppressor/cytotoxic phenotype (Leu2a^+, Leu3a~), one case showed an inducer phenotype, one case showed a phenotype of so-called Ki-1 lymphoma. These results showed that T-cell lymphoma of the skin is heterogeneous in nature. In other words, CTCL is one type but represents a major propotion of T-cell lymphomas of the skin. (2) An important disease entity distinct from cutaneous T-cell lymphoma in Japan is adult T-cell leukemia/lymphoma, which usually shows the same phenotype as CTCL, i. e., a helper/inducer T-cell phenotype, and usually involves the skin. Clinically, both CTCL and ATL are heterogeneous in nature. So, we demonstrated differenc … More es between CTCL and ATL in terms of clinical and immunopathologic cell surface features. In patients with ATL, the predominant clinical findings were peripheral lymph node involvement, skin lesions, hepatosplenomegary, leukemic manifestations, and an aggressive course. In patients with CTCL, by contrast, only skin lesions predominated at the onset of the disease and a relatively good prognosis was demonstrated. Phenotypic heterogeneity of ATL in the skin, i. e., CD4^-CD8^-, CD4^+CD8^-, and CD4^-CD8^+, was demonstrated. Expression of Leu8, CD7 (Leu9), and CD45RA (2H4) was high in both the skin-infiltrating ATL cells and peripheral blood and lymph node ATL cells compared with that in the skin-infiltrating CTCL cells. Expression of CD25 (IL-2R), CD71 (OKT9), HLA-DR, and HLA-DQ was high, and that of CD45RO (UCHL-1) was not significantly high in the skin-infiltrating CTCL cells compared with that in ATL cells. The most significant phenotype difference between ATL cells and CTCL cells was the expression of Leu8 (lymph node homing receptor), CD7 and CD25 antigens on the cell surface, and the main phenotypic difference between skin-infiltrating ATL and CTCL cells and peripheral blood and lymph node ATL cells was the expression of CD29 and CD45RA. These findings confirm that the difference in antigen expression on the cell surface might reflect the clinical features of ATL and CTCL, and suggest that the predominant phenotype of peripheral blood and lymph node ATL cells is that of naive, relatively immature or activated T-cells, and that CTCL cells are previously activated (memory) T-cells. In other words, CTCL cells do not share the same origin as ATL cells. These observations support the concept that ATL ia a disease distinct from CTCL. (3) The expression of PC (Ki-67) antigen, DNA polymerase-alpha and trasferrin receptor (OKT9 : CD71) were studied in 29 cases of cutaneous T-cell lymphomas and in a variety of benign cutaneous lymphoid infiltrates by immunohistochemistry. PCBeside, correlation with histologic grading of lymphomas and expression of those antigens on lymphoid cells was indicated : the high-grade types, e. g., immunoblastic type, exhibited greater positivity than intermediate grade types and much more than low-grade types. (4) We investigated the pretreatment characteristics and prognosis of T-cell lymphoma, including mycosis fungoids, T-cell lymphoma of the skin other than MF, and B-cell lymphoma of the skin. Percentage of CD3-positive cell and CD4-positive cell in the peripheral blood lymphocytes was one of the most useful prognostic factor. TNM staging of CTCL and international working formulation were also useful factor for prognosis. Less