References 1. Peripheral Tcell lymphoma presenting with angioedema and diffuse pulmonary infiltrates. N K Harrison 1, C Twelves, B J Addis, A J Taylor, R L Souhami, P G Isaacson 2. Cutaneous manifestations of angioimmunoblastic Tcell lymphoma Sidney Hoskins, Natalie Moriarty, Kevin White, Andrea Kalus, Andrei Shustov, Michi M Shinohara 3. Angioimmunoblastic T Cell Lymphoma Mimicking Chronic Urticaria Mohleen Kang 1, Nitasha Bhatia 1, Adrienne Sauder 2, Mirela Feurdean 4. Acquired Angioedema: A Rare Manifestation of Angioimmunoblastic T Cell Lymphoma Vijay G. Bidkar, Nita Rachel Rajan, Santosh Dasar, Ashok S. Naik Ravikala Rao 5. Acquired Angioedema and Large Granular TCell Leukemia Massimiliano Postorino, Livio Pupo, Maria Domenica Guarino, Federico Meconi, Benedetta Mariotti, Vito Maria Rapisarda, Jacopo Giammatteo, Marta Della Torre, Roberto Perricone, Maria Cantonettiand Giovanni Del Poeta 6. FDGPET lymph node uptake after COVID19 vaccines mimics cancer Will Morton, AuntMinnie.com staff writer 7. Antibody Responses after SARSCoV2 Vaccination in Lymphoma Sean Hua Lim MD1,, Nicola Campbell MD, Marina Johnson PhD, Debora JosephPietras PhD, Graham P Collins MD, Ann OCallaghan MD, Christopher P Fox MD, Matthew Ahearne MD, Peter WM Johnson MD, David Goldblatt MD, Andrew J Davies MD.8. Skin manifestation of angioimmunoblastic Tcell lymphoma mimicking Hansen’s disease on histology Anju Shukla, Sunil Sharad Dabadghao, Surbhi Gupta, Priyanka Jain 9. Allergic disease, corticosteroid use, and risk of Hodgkin lymphoma: A United Kingdom nationwide casecontrol study AndrewHaywardFIBiolb, CharlotteWarren, GashMBChBcSpiros, DenaxasPhD, ArturoGonzalez, IzquierdoPhD, GeorgiosLyratzopoulosMD, SaraThomasPhD 10. Angioimmunoblastic T Cell Lymphoma Mimicking Chronic Urticaria Mohleen Kang, Nitasha Bhatia, Adrienne Sauder, Mirela Feurdean, Bettina Wedi 11. High Immunoglobulin E Levels: A Cause for Concern in Cancer Risk? Helby J, Bojesen SE, Nielsen SF, Nordestgaard BG. 12. Effectiveness of lenalidomide in relapsed primary cutaneous diffuse large Bcell lymphoma, leg type Mahdi Al Dhafiri, Flore Sicre de Fontbrune, Eduardo Marinho, Lydia Deschamps, Julie DiLucca, Beatrice Crickx, Vincent Descamp 13. Lichen Planuslike Lesions as the First Manifestation of Adult Tcell LeukaemiaLymphoma Hayakazu Sumida, Makoto Sugaya, Masahiro Kamata, Hiraku Suga, Tomomitsu Miyagaki, Hanako Ohmatsu, Hideki Fujita and Shinichi Sato Department of Dermatology, Faculty of Medicine, The University of Tokyo, Tokyo, Japan 14. Skin Manifestations Associated With Mantle Cell Lymphoma: a Case Report Avinash Kumar Singh,1 Gaurav Dixit,1 Sanjeev Sharma,1 Suman Kumar,1 Rajni Yadav,2 Narendra Agrawal,1 Pravas Mishra,1 Tulika Seth,1 C. Sarkar,2 M. Mahapatra,1 and Renu Saxena1 15. Diffuse Mixed Cell Lymphoma MedGen UID: 42542 •Concept ID: C0079757 •Neoplastic Process
ALLERGIC CUTANEOUS MANIFESTATIONS OF LYMPHOMA Nguyễn Thị Hồng Anh, MD Out Patient Deparment • Mantle cell lymphoma (MCL) is a malignant tumor derived from B cells in the mantle zone of lymphoid follicles characterized by specific pathologic, immunophenotypic and molecular genetics features, and usually takes an aggressive clinical course, defined in the World Health Organization (WHO) classification.1–3 Histologically, it shows a diffuse or nodular monotonous proliferation of small lymphoid cells with scant cytoplasm and irregular nuclear contours in lymphnodes • MCL frequently involves extra nodal organs, particularly the bone marrow, gastrointestinal tract and Waldeyer’s ring (Waldeyer’s ring is a collection of lymphoid tissue or follicles in the upper part of digestive system); However, MCL rarely affects the skin (1-2.5%) The commonly reported sites of skin involvement in MCL are trunk (60%), face (30%) followed by arm (20%), thigh, leg & scalp(11%): nodular lesions, macular or maculopapular lesions, tumoral or infiltrated plaques and subcutaneous nodules • As , awareness of MCL is crucial for dermatologists and haematologists to establish an early diagnosis and perform an appropriate treatment (a) Generalized pruritic macules and plaques on the lower limbs (b) Close-up picture of beansized well-circumscribed violaceous plaques with fine scales on the left lower limb Cutaneous nodules are present in the chest, back primary cutaneous diffuse large B-cell lymphoma, leg type Angioedema - Subcutaneous nonpruritic swelling(face, limbs, genitals) - Edema of the gastrointestinal mucosa with partial obstruction and consequent severe abdominal pain - High risk of death by suffocation due to the obstruction of the upper airways - Hereditary Angioedema (HAE): Defect in an enzymatic function or of a structural deficient gene - Acquired Angioedema (AAE) : - Rare syndrome due to an acquired deficiency of C1 inhibitor (INH), enzyme involved in the regulation of C1 factor activity C1-INH deficiency leads to C4 and C2 components depletion, while the terminal complement components remain normal - Neutralizing autoantibodies (autoAb) against C1-INH on the background of a lymphoproliferative disorder - But sometimes autoAb are not found in the serum because of C1-INH consumption during inflammatory activation due to the aberrant expression of some cytokines by subpopulations of lymphocytes • Angioedema resulting from immune-mediated complement depletion is a rare complication of B-cell tumors, usually associated with B cell lymph proliferative disorders often on the basis of auto Ab intervention Acquired angioedema has been associated also with monoclonal gammopathy of undetermined significance secondary to C1 inhibitor deficiencies • The initial corticosteroid therapy induced just a partial response of patient's angioedema The only data that could hypothesize that angioedema might be a paraneoplastic presentation of Large Granular Lymphocytic Leukemia (LGLL) was the efficacious ex iuvantibus therapy with MTX plus support therapy with C1-INH In fact, the success of the therapy with C1-INH was also explained by the absence of neutralizing antibodies against C1-INH complement factor We still not have clear which was the exact mechanism that led to angioedema, even if it is clear that cytotoxic therapy caused the stabilization of the lymph proliferative disorder and, at the same time, the regression of the angioedema • There has been one reported case of peripheral T-cell lymphoma (PTCL) presenting with angioedema, which was published in 1988 Patient with peripheral T-cell lymphoma and normal serum complement levels suggest that patient developed angioedema independent of abnormalities in the complement cascade • Angioimmunoblastic T-cell lymphoma (AITL) is a rare form of nonHodgkin lymphoma often accompanied by autoimmune and paraneoplastic phenomena, with an aggressive course and high mortality Most patients are diagnosed late in the disease and usually present with generalized lymphadenopathy • Angioimmunoblastic T-cell lymphoma (AITL) is an uncommon form of peripheral T-cell lymphoma now put under the category of nodal Tcell lymphoma with follicular T helper phenotype 50% cases of AITL have varied cutaneous manifestations including macules, papules, petechiae, purpura, nodules, non-specific rash and urticaria There was a case of AITL initially presented as maculopapular rash which on histology was mimicking as Hansen’s disease with perineural and perivascular inflammation; however, an infective organism could not be demonstrated Later on, a delayed diagnosis was made on lymph node biopsy and immunohistochemistry and patient responded well with chemotherapy Multivariable Adjusted Hazard Ratio for Patients with 10-fold Higher IgE Plasma Levels • Studies have reported intramuscular COVID-19 vaccinations may induce ipsilateral axillary lymph node reactivity that may be falsely attributed to malignant abnormality • "Increased nodal FDG uptake, presumably from an inflammatory immune response to the vaccine, was observed up to 32 days after vaccination in this cohort, harboring the potential risk of mimicking or masking malignant disease," the authors wrote • Women were more likely to develop reactive nodes, which is an important implication for breast cancer imaging • COVID-19 vaccine should administer in the axilla contralateral to the previously or potentially involved site Also, nuclear medicine technologists should document the vaccine site, date, type, and whether the patient has received the first or second dose Antibody Responses after SARS-CoV-2 Vaccination in Lymphoma • Current data on vaccine responses in chronic lymphocytic leukaemia show antibody responses in 52-75% of individuals after the second dose • individuals with curable lymphoma subtypes such as Hodgkin and aggressive B-NHL can develop robust serological responses as early as six months post-treatment • Individuals vaccinated whilst undergoing systemic anti-lymphoma therapy, and those with indolent lymphomas may have impaired serological responses Low Alanine Aminotransferase and Risk of Major Chronic Diseases and Death • Potential Causes of Low ALT: • Vitamin B6 Deficiency • Smoking • Decrease in response to regular exercise, hormone replacement and birth control pills, or in chronic kidney disease • Health Effects Associated With Low ALT Levels: underlying cause that may be affecting both ALT levels and heart health • In the elderly, low ALT levels may indicate an aging liver, declining kidney function, or poor nutrition • In a meta-analysis of 12 studies with over 200k participants, extremely low ALT in elderly (less than U/L) was associated with a higher risk of dying due to all causes, as well as from heart disease and cancer • A study suggests that ALT may help the brain recover from stroke This could partially explain why extremely low levels can be harmful in the elderly • The risk of any cancer was highest for participants with “low alanine aminotransferase” or “high alanine aminotransferase” (20-year risk: 17.2% [95% confidence interval (CI): 6.3– 32.7%] and 18.2% [95% CI: 5.7– 36.3%], respectively) Conclusion: take home messages • Allergic disease, especially eczema, corticosteroid treatment are associated with increased risk of HL Immune system malfunction after allergic disease or immunosuppression is central to HL development • Sudden weight gain because of massive generalized edema (Acquired Angioedema), recurrent episodes of angioedema lasting for more than 3–5 days in the setting of an atypical urticaria which does not resolve with treatment within 24 hours should prompt further investigation • Presence of lymphadenopathy in the setting of angioedema is often a hallmark of underlying malignancy and should be investigated with a thorough workup until it is ruled out • Up to 50% of patients with AITL present with skin manifestations : medium-vessel vasculitis and chronic urticarial eruption, nonspecific maculopapular rash with or without pruritus • Primary Care physicians, dermatologists, and allergists must maintain a high index of suspicion for cutaneous manifestations of lymphoma, especially if the skin lesions are refractory to standard treatment Timely diagnosis is essential to improve survival • Abnormally low alanine aminotransferase measurements are at increased long-term risk of cancer and several chronic diseases References Peripheral T-cell lymphoma presenting with angioedema and diffuse pulmonary infiltrates N K Harrison 1, C Twelves, B J Addis, A J Taylor, R L Souhami, P G Isaacson Cutaneous manifestations of angioimmunoblastic T-cell lymphoma Sidney Hoskins, Natalie Moriarty, Kevin White, Andrea Kalus, Andrei Shustov, Michi M Shinohara Angioimmunoblastic T Cell Lymphoma Mimicking Chronic Urticaria Mohleen Kang 1, Nitasha Bhatia 1, Adrienne Sauder 2, Mirela Feurdean Acquired Angioedema: A Rare Manifestation of Angioimmunoblastic T Cell Lymphoma Vijay G Bidkar, Nita Rachel Rajan, Santosh Dasar, Ashok S Naik & Ravikala Rao Acquired Angioedema and Large Granular T-Cell Leukemia Massimiliano Postorino, Livio Pupo, Maria Domenica Guarino, Federico Meconi, Benedetta Mariotti, Vito Maria Rapisarda, Jacopo Giammatteo, Marta Della Torre, Roberto Perricone, Maria Cantonettiand Giovanni Del Poeta FDG-PET lymph node uptake after COVID-19 vaccines mimics cancer Will Morton, AuntMinnie.com staff writer Antibody Responses after SARS-CoV-2 Vaccination in Lymphoma Sean Hua Lim MD1,, Nicola Campbell MD, Marina Johnson PhD, Debora Joseph-Pietras PhD, Graham P Collins MD, Ann O'Callaghan MD, Christopher P Fox MD, Matthew Ahearne MD, Peter WM Johnson MD, David Goldblatt MD, Andrew J Davies MD Skin manifestation of angioimmunoblastic T-cell lymphoma mimicking Hansen’s disease on histology Anju Shukla, Sunil Sharad Dabadghao, Surbhi Gupta, Priyanka Jain Allergic disease, corticosteroid use, and risk of Hodgkin lymphoma: A United Kingdom nationwide casecontrol study AndrewHaywardFIBiolb, CharlotteWarren, GashMBChBcSpiros, DenaxasPhD, ArturoGonzalez, IzquierdoPhD, GeorgiosLyratzopoulosMD, SaraThomasPhD 10 Angioimmunoblastic T Cell Lymphoma Mimicking Chronic Urticaria Mohleen Kang, Nitasha Bhatia, Adrienne Sauder, Mirela Feurdean, Bettina Wedi 11 High Immunoglobulin E Levels: A Cause for Concern in Cancer Risk? Helby J, Bojesen SE, Nielsen SF, Nordestgaard BG 12 Effectiveness of lenalidomide in relapsed primary cutaneous diffuse large B-cell lymphoma, leg type Mahdi Al Dhafiri, Flore Sicre de Fontbrune, Eduardo Marinho, Lydia Deschamps, Julie Di-Lucca, Beatrice Crickx, Vincent Descamp 13 Lichen Planus-like Lesions as the First Manifestation of Adult T-cell Leukaemia/Lymphoma Hayakazu Sumida, Makoto Sugaya, Masahiro Kamata, Hiraku Suga, Tomomitsu Miyagaki, Hanako Ohmatsu, Hideki Fujita and Shinichi Sato Department of Dermatology, Faculty of Medicine, The University of Tokyo, Tokyo, Japan 14 Skin Manifestations Associated With Mantle Cell Lymphoma: a Case Report Avinash Kumar Singh,1 Gaurav Dixit,1 Sanjeev Sharma,1 Suman Kumar,1 Rajni Yadav,2 Narendra Agrawal,1 Pravas Mishra,1 Tulika Seth,1 C Sarkar,2 M Mahapatra,1 and Renu Saxena1 15 Diffuse Mixed Cell Lymphoma MedGen UID: 42542 •Concept ID: C0079757 •Neoplastic Process 16 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3266581/ 17 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4937711/ 18 https://www.aaaai.org/global/latest-researchsummaries/Current-JACI-Research/risks 19 https://www.ijaai.in/article.asp?issn=09726691;year%3D2015;volume%3D29;issue%3D2;spage%3D88;epa ge%3D91;aulast%3DMohamed 20 https://www.cancer.org/cancer/skin-lymphoma/detectiondiagnosis-staging/signs-and-symptoms.html 21.https://www.cancer.org/content/dam/CRC/PDF/Public/8728 00.pdf 22.https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4266895/?f bclid=IwAR3qTgjjVXUuuzvvbfeRklM643PNboZ_eLjUJZ3okTVXEAynbAkzMMaqDE 23 https://www.dovepress.com/alanine-aminotransferase-and20-year-risk-of-major-chronic-diseases-an-peer-reviewedfulltext-articleCLEP?fbclid=IwAR1MiLKcIaqNhawcDnxMoIR14YlBcHyRAUJRqdB DB6wFfdNUJXt7rQkmABI 24 https://labs.selfdecode.com/blog/low-alt/ THANK YOU ... not a skin lymphoma • Most cutaneous lymphomas are NHL with T cell lymphomas constituting up to 65% of cases Extracutaneous involvement is seen in up to 25% of these cases in the form of nodal... T-cell lymphoma (AITL) is an uncommon form of peripheral T-cell lymphoma now put under the category of nodal Tcell lymphoma with follicular T helper phenotype 50% cases of AITL have varied cutaneous. .. non-Hodgkin lymphoma starts only in the skin (not in other organs or tissues) it is called a skin lymphoma (or cutaneous lymphoma) A lymphoma that starts in lymph nodes or another part of the body