PMC6324548_01
Patient #1 - Sections of the initial skin biopsy from the right forearm, stained with hematoxylin/eosin (A, x4), CD3 (B, x10), CD4 (C, x10) and CD8 (D, x10). The CD4/CD8 ratio was approximately 6 : 1 (immunoperoxidase technique, hematoxylin counterstain).
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F1
The infiltrate was mainly composed of mediumlarge atypical cells with few small lymphocytes (Fig. 1A). T lymphocytes (Fig. 1B), positive for CD4 (Fig. 1C). CD8 stained mostly small reactive lymphocytes (Fig. 1D). The approximate CD4 to CD8 ratio was 6 : 1.
Patient #1 - Sections of a late skin biopsy from the right forearm, stained with hematoxylin/eosin (A, x4), CD3 (B, x10), CD4 (C, x10) and CD8 (D, x10). The CD4/CD8 ratio is in this case reversed compared to that seen in Fig. 1, and it is approximately 1 : 6 (immunoperoxidase technique, hematoxylin counterstain)
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F2
The atypical lymphocytes in this biopsy were less pleomorphic and smaller than those seen in previous specimens (Fig. 2A). While only rare cells displayed CD4 positivity (Fig. 2C), the cells were predominantly CD8+ (Fig. 2D), with an approximate CD4 : CD8 ratio of 1 : 6.
Patient #1 - Molecular analysis for T-cell receptor gene rearrangement using PCR. The top panel (A, B) shows TCR beta chain PCR products revealing peaks of identical sizes (260 bp) in both CD4+ (left) and CD8+ (right) lesions. The bottom (C, D) panel shows the TCR gamma chain analysis. Again, two clonal peaks of identical size (160 bp) were identified in both CD4+ (left) and CD8+ (right) lesions.
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F3
TCR on the initial CD4+ and the late CD8+ lesions (Fig. 3A-D). The patient died of disease 17 months after his initial biopsy.
PMC6324548_02
Patient #2 - Sections of the conventional plaque of MF from the breast initially received and stained with hematoxylin/eosin (A, x4), CD3 (B, x20), CD4 (C, x20) and CD8 (D, x20). The CD4/CD8 ratio is, in this biopsy, of approximately 5:1 (immunoperoxidase technique, hematoxylin counterstain).
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F4
Histopathologic examination of a lesion on her breast showed an atypical perivascular lymphocytic infiltrate with epidermotropism and folliculotropism, consistent with MF (Fig. 4A). The phenotype of this lesion was CD3+/CD4+ (Fig. 4B,C, respectively), CD8- (Fig. 4D), with loss of expression of CD5 and CD2.
Patient #2 - Clinical appearance of a scaly erythematous plaque corresponding to a epidermotropic CD8+lesion.
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F5
However, in 2011 the patient presented with new painful scaly erythematous plaques with superficial ulceration affecting both lower extremities, especially the soles (Fig. 5).
Patient #2 - Sections of the skin biopsy from the sole received two years after that seen in Fig. 4, stained with hematoxylin/eosin (A, x10), CD3 (B, x10), CD4 (C, x20) and CD8 (D, x10). There is an obvious predominance of CD8 cells in this biopsy, with a CD4/CD8 ratio of approximately 1:10 (immunoperoxidase technique, hematoxylin counterstain)
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F6
Prominent epidermotropism with pagetoid pattern of growth was seen (Fig. 6A). The atypical lymphocytes expressed CD3 (Fig. 6B), but lacked positivity for CD4 (Fig. 6C) while gained expression of CD8 (Fig. 6D).
PMC6324548_03
Patient #3 - Sections of the initial skin biopsy from the posterior neck, stained with hematoxylin/eosin (A, x4), CD3 (B, x10), CD4 (C, x10) and CD8 (D, x10). The CTCL displayed aCD3+/CD4-/CD8+ phenotype (immunoperoxidase technique, hematoxylin counterstain).
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F7
There was only focal exocytosis of small lymphocytes, and the lesion was classified as PTCL, NOS (Fig. 7A). T cells (Fig. 7B), and showed a CD4-, CD8+ phenotype (Fig. 7C,D, respectively). The patient was treated with the Promace
Patient #3 - Sections of lung showing involvement by lymphoma, 4 years after the initial biopsy seen in Fig. 7. The sections were stained with hematoxylin/eosin (A, x4), CD3 (B, x10), CD4 (C, x10) and CD8 (D, x10). There is diffuse and weak expression of CD4 by the lymphoma cells. Only scattered small CD8+T cells are seen (immunoperoxidase technique, hematoxylin counterstain).
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F8
An open lung biopsy revealed PTCL (Fig. 8A,B). At this time the tumor cells displayed diffuse labeling for CD4 (Fig. 8C) and only scattered small lymphocytes were positive for CD8 (Fig. 8D).