TdT+ T-lymphoblastic populations are increased in Castleman disease, in Castleman disease in association with follicular dendritic cell tumors, and in angioimmunoblastic T-cell lymphoma

Am J Surg Pathol. 2012 Nov;36(11):1619-28. doi: 10.1097/PAS.0b013e318264e223.

Abstract

T-lymphoblastic lymphoma is an aggressive neoplasm requiring prompt clinical treatment. Conversely, indolent T-lymphoblastic proliferation mimics T-lymphoblastic lymphoma but consists of a proliferation of non-neoplastic TdT+ T cells, requiring no treatment. Recently, we identified several cases of indolent T-lymphoblastic proliferations in extrathymic lymphoid tissues: 1 in a patient suffering from Castleman disease (CD) associated with a follicular dendritic cell sarcoma/tumor, 1 in a patient with a history of angioimmunoblastic T-cell lymphoma (AITL), and 1 in association with acinic cell carcinoma. Interestingly, in the case of the patient with a history of AITL, these TdT+ T cells were seen in multiple anatomic sites over the span of 5 years. Here we review these 3 cases and extend our findings by demonstrating that TdT+ T-lymphoblastic populations are increased in lymph nodes of patients with CD (P=0.011), CD in association with follicular dendritic cell tumors, and AITL (P<0.01) compared with other T-cell or B-cell lymphomas or reactive lymph nodes. Finally, analysis of 352 nonhematolymphoid tumors including carcinomas, melanomas, and sarcomas demonstrates that TdT+ T cells are not increased in these tumors. Our studies not only present several detailed cases of indolent T-lymphoblastic proliferations, but also correlate these populations with specific hematologic diseases.

Publication types

  • Case Reports

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Aged, 80 and over
  • Castleman Disease / metabolism
  • Castleman Disease / pathology*
  • Cell Proliferation
  • DNA Nucleotidylexotransferase / metabolism*
  • Dendritic Cell Sarcoma, Follicular / metabolism
  • Dendritic Cell Sarcoma, Follicular / pathology*
  • Dendritic Cells / metabolism
  • Dendritic Cells / pathology*
  • Female
  • Humans
  • Immunoblastic Lymphadenopathy / metabolism
  • Immunoblastic Lymphadenopathy / pathology*
  • Lymph Nodes / metabolism
  • Lymph Nodes / pathology
  • Lymphoma, T-Cell / metabolism
  • Lymphoma, T-Cell / pathology*
  • Male
  • Middle Aged
  • Tissue Array Analysis
  • Young Adult

Substances

  • DNA Nucleotidylexotransferase