Ann Dermatol.  2009 Feb;21(1):1-5. 10.5021/ad.2009.21.1.1.

Angioimmunoblastic T Cell Lymphomas: Frequent Cutaneous Skin Lesions and Absence of Human Herpes Viruses

• Yoon GS
• Choi YK
• Bak H
• Kim BJ
• Kim MN
• Choi J
• Rheu HM
• Huh J
• Choi JH
• Chang SE

• KMID: 2172057
• DOI: http://doi.org/10.5021/ad.2009.21.1.1

Abstract

BACKGROUND
Angioimmunoblastic T-cell lymphoma (AITL) is a complex lymphoproliferative disorder and often mimics a viral infection with frequent skin involvement. Epstein-Barr virus (EBV) and human herpes virus (HHV)-6 are reported to be associated with AITL, but there are conflicting results.
OBJECTIVE
We evaluated the association of EBV and HHV-6 with AITL.
METHODS
We reviewed the clinical, histological and immunophenotypical features of 19 cases of AITL. Among them, 11 lymph node biopsies of AITL were examined for HHV-6, -7, and -8 by polymerase chain reaction (PCR) using virus-specific primers. In situ hybridization of EBV early region RNA (EBER) was performed and T cell receptor (TCR) gene rearrangement was also investigated in some cases.
RESULTS
Among these 19 cases, maculopapular, plaque or nodular skin lesions accompanied AITL in 12 cases. Clonal TCR gene rearrangement was seen in 8/9 cases tested. EBER in situ hybridization was positive in 8 cases (57.1%). Among 7 cases with skin biopsies, five cases were consistent with cutaneous involvement of AITL, 1 case was a drug eruption, and the other case was Kaposi's sarcoma. Except a HHV-8 (+) case who also had Kaposi's sarcoma, all of these cases were negative for HHV-6, -7 and -8.
CONCLUSION
Skin manifestation seems to be a cardinal component of AITL, be it in the context of presentation, progression or recurrent disease. Recognition of clinicopathological features of skin lesions in AITL as diagnostic clues should be stressed among dermatologists. The lack of HHV-6, -7 and -8 in lymph node biopsy of AITL argues against a pathogenic role for HHVs in AITL.

Keyword

Angioimmunoblastic T-cell lymphoma; Epstein-Barr virus; Human herpes virus

MeSH Terms

Biopsy
Drug Eruptions
Gene Rearrangement
Genes, T-Cell Receptor
Herpesvirus 4, Human
Herpesvirus 6, Human
Herpesvirus 8, Human
Humans
In Situ Hybridization
Lymph Nodes
Lymphoma, T-Cell
Lymphoproliferative Disorders
Polymerase Chain Reaction
Receptors, Antigen, T-Cell
RNA
Sarcoma, Kaposi
Skin
Skin Manifestations
Viruses
RNA
Receptors, Antigen, T-Cell

Figure

• 

  Fig. 1 Absence of HHVs in 11 AITL cases according to hetero-duplex polymerase chain reaction (A) HHV-7 (B) HHV-6 (C) HHV-8.

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