Primary cutaneous follicle centre lymphoma
Haematolymphoid Tumours (WHO Classification, 5th ed.)
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editContent Update To WHO 5th Edition Classification Is In Process; Content Below is Based on WHO 4th Edition ClassificationThis page was converted to the new template on 2023-12-07. The original page can be found at HAEM4:Primary Cutaneous Follicle Centre Lymphoma.
(General Instructions – The main focus of these pages is the clinically significant genetic alterations in each disease type. Use HUGO-approved gene names and symbols (italicized when appropriate), HGVS-based nomenclature for variants, as well as generic names of drugs and testing platforms or assays if applicable. Please complete tables whenever possible and do not delete them (add N/A if not applicable in the table and delete the examples); to add (or move) a row or column to a table, click within the table and select the > symbol that appears to be given options. Please do not delete or alter the section headings. The use of bullet points alongside short blocks of text rather than only large paragraphs is encouraged. Additional instructions below in italicized blue text should not be included in the final page content. Please also see Author_Instructions and FAQs as well as contact your Associate Editor or Technical Support)
Primary Author(s)*
Linlin Gao, MD, PhD and Shivani Golem, PhD, FACMG
WHO Classification of Disease
| Structure | Disease |
|---|---|
| Book | Haematolymphoid Tumours (5th ed.) |
| Category | B-cell lymphoid proliferations and lymphomas |
| Family | Mature B-cell neoplasms |
| Type | Cutaneous follicle centre lymphoma |
| Subtype(s) | Primary cutaneous follicle centre lymphoma |
Definition / Description of Disease
Primary cutaneous follicle center lymphoma (PCFCL) is a tumor arising in skin composed of germinal center B cells, including centrocytes and centroblasts[1].
Synonyms / Terminology
- Reticulohistiocytoma of the dorsum
- Crosti lymphoma
Epidemiology / Prevalence
- It accounts for about 50% of primary cutaneous B-cell lymphomas with an incidence of 0.1-0.2 per 100,000 persons per year
- It mainly occurs in middle-aged adults
- Male: female ratio is approximately 1.5:1[2]
Clinical Features
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| Signs and Symptoms | EXAMPLE: Asymptomatic (incidental finding on complete blood counts)
EXAMPLE: B-symptoms (weight loss, fever, night sweats) EXAMPLE: Fatigue EXAMPLE: Lymphadenopathy (uncommon) |
| Laboratory Findings | EXAMPLE: Cytopenias
EXAMPLE: Lymphocytosis (low level) |
editv4:Clinical FeaturesThe content below was from the old template. Please incorporate above.
- Usually solitary, firm, and erythematous to violaceous plaques, nodules or tumors of variable size
- Multifocal in 15% of patients
- Lesions on the trunk may be surrounded by erythematous papules
- The skin surface is usually smooth and rarely ulcerated[2]
Sites of Involvement
- Head
- Trunk
Morphologic Features
- Perivascular, periadnexal, or diffuse infiltrates with sparing of the epidermis
- The growth patterns include follicular, follicular and diffuse, and diffuse patterns[3]
- The tumor is composed of centrocytes and variable numbers of centroblasts[1]
- In a tumor with follicular growth pattern, follicles are poorly defined and composed of monotonous follicle center cells with no polarization
- A follicular dendritic cell meshwork is present
- Tingible body macrophages are usually absent
- Mantle zones are attenuated or absent
- Proliferation rate is low
- In a tumor with diffuse growth pattern, tumor cells are mainly large centrocytes, some of which are multilobated or spindle-shaped[2]
- Variable numbers of large centroblasts
- Follicular dendritic cell meshwork may be lost
- Proliferation rate is generally high
Immunophenotype
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| Finding | Marker |
|---|---|
| Positive (universal) | EXAMPLE: CD1 |
| Positive (subset) | EXAMPLE: CD2 |
| Negative (universal) | EXAMPLE: CD3 |
| Negative (subset) | EXAMPLE: CD4 |
editv4:ImmunophenotypeThe content below was from the old template. Please incorporate above.
Finding Marker Positive (universal) CD20, CD79a, BCL6 Positive (tumor with a follicular growth pattern) CD10 Negative (universal) CD5, CD43 Negative (most cases) BCL2, MUM1, FOXP1
Chromosomal Rearrangements (Gene Fusions)
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| Chromosomal Rearrangement | Genes in Fusion (5’ or 3’ Segments) | Pathogenic Derivative | Prevalence | Diagnostic Significance (Yes, No or Unknown) | Prognostic Significance (Yes, No or Unknown) | Therapeutic Significance (Yes, No or Unknown) | Notes |
|---|---|---|---|---|---|---|---|
| EXAMPLE: t(9;22)(q34;q11.2) | EXAMPLE: 3'ABL1 / 5'BCR | EXAMPLE: der(22) | EXAMPLE: 20% (COSMIC)
EXAMPLE: 30% (add reference) |
Yes | No | Yes | EXAMPLE:
The t(9;22) is diagnostic of CML in the appropriate morphology and clinical context (add reference). This fusion is responsive to targeted therapy such as Imatinib (Gleevec) (add reference). |
editv4:Chromosomal Rearrangements (Gene Fusions)The content below was from the old template. Please incorporate above.The t(14;18)(q32;q21), IGH/BCL2 translocation, the genetic hallmark of nodal follicular lymphoma, is rare in primary cutaneous follicle center lymphoma[4][5].
Chromosomal Rearrangement Genes in Fusion (5’ or 3’ Segments) Pathogenic Derivative Prevalence t(14;18)(q32;q21) 5'BCL2/3'IGH der(14) 7% t(14;18)(q32;q21) 5'MALT1/3'IGH der(14) 2%
editv4:Clinical Significance (Diagnosis, Prognosis and Therapeutic Implications).Please incorporate this section into the relevant tables found in:
- Chromosomal Rearrangements (Gene Fusions)
- Individual Region Genomic Gain/Loss/LOH
- Characteristic Chromosomal Patterns
- Gene Mutations (SNV/INDEL)
- Chromosomal abnormalities in PCFCL involving BCL2 or MALT1 do not correlate with a poor prognosis[2].
Individual Region Genomic Gain / Loss / LOH
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| Chr # | Gain / Loss / Amp / LOH | Minimal Region Genomic Coordinates [Genome Build] | Minimal Region Cytoband | Diagnostic Significance (Yes, No or Unknown) | Prognostic Significance (Yes, No or Unknown) | Therapeutic Significance (Yes, No or Unknown) | Notes |
|---|---|---|---|---|---|---|---|
| EXAMPLE:
7 |
EXAMPLE: Loss | EXAMPLE:
chr7:1- 159,335,973 [hg38] |
EXAMPLE:
chr7 |
Yes | Yes | No | EXAMPLE:
Presence of monosomy 7 (or 7q deletion) is sufficient for a diagnosis of AML with MDS-related changes when there is ≥20% blasts and no prior therapy (add reference). Monosomy 7/7q deletion is associated with a poor prognosis in AML (add reference). |
| EXAMPLE:
8 |
EXAMPLE: Gain | EXAMPLE:
chr8:1-145,138,636 [hg38] |
EXAMPLE:
chr8 |
No | No | No | EXAMPLE:
Common recurrent secondary finding for t(8;21) (add reference). |
editv4:Genomic Gain/Loss/LOHThe content below was from the old template. Please incorporate above.
Chromosome Number Gain/Loss/Amp/LOH Region 1 Loss chr 1p36 18 Amplification chr 18q21.33
Characteristic Chromosomal Patterns
Put your text here (EXAMPLE PATTERNS: hyperdiploid; gain of odd number chromosomes including typically chromosome 1, 3, 5, 7, 11, and 17; co-deletion of 1p and 19q; complex karyotypes without characteristic genetic findings; chromothripsis. Do not delete table.)
| Chromosomal Pattern | Diagnostic Significance (Yes, No or Unknown) | Prognostic Significance (Yes, No or Unknown) | Therapeutic Significance (Yes, No or Unknown) | Notes |
|---|---|---|---|---|
| EXAMPLE:
Co-deletion of 1p and 18q |
Yes | No | No | EXAMPLE:
See chromosomal rearrangements table as this pattern is due to an unbalanced derivative translocation associated with oligodendroglioma (add reference). |
editv4:Characteristic Chromosomal Aberrations / PatternsThe content below was from the old template. Please incorporate above.In a study of the genetic abnormalities of primary cutaneous follicle center lymphoma, 1p36 deletion was reported to occur in 22% (5/21) and BCL2 gene break in 10% (2/20) of the cases. TNFRSF14 nonsense and missense mutations were detected in 4/17 (23.5%) cases with concomitant 1p36 deletion in 2 cases. In 43% (9/21) of the cases, high EZH2 protein expression with a BCL2 negative phenotype was detected[4]. In another study that investigated 57 patients with PCFCL, 1 case was found to have BCL2 chromosomal amplification, 4 cases had IGH/BCL2 translocation, and 1 case had IGH/MALT1 translocation[6]. In a case report of an aggressive PCFCL, c-MYC translocation and CDKN2A (9p21) deletion were detected[7].
Gene Mutations (SNV / INDEL)
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| Gene; Genetic Alteration | Presumed Mechanism (Tumor Suppressor Gene [TSG] / Oncogene / Other) | Prevalence (COSMIC / TCGA / Other) | Concomitant Mutations | Mutually Exclusive Mutations | Diagnostic Significance (Yes, No or Unknown) | Prognostic Significance (Yes, No or Unknown) | Therapeutic Significance (Yes, No or Unknown) | Notes |
|---|---|---|---|---|---|---|---|---|
| EXAMPLE: TP53; Variable LOF mutations
EXAMPLE: EGFR; Exon 20 mutations EXAMPLE: BRAF; Activating mutations |
EXAMPLE: TSG | EXAMPLE: 20% (COSMIC)
EXAMPLE: 30% (add Reference) |
EXAMPLE: IDH1 R123H | EXAMPLE: EGFR amplification | EXAMPLE: Excludes hairy cell leukemia (HCL) (add reference).
|
Note: A more extensive list of mutations can be found in cBioportal (https://www.cbioportal.org/), COSMIC (https://cancer.sanger.ac.uk/cosmic), ICGC (https://dcc.icgc.org/) and/or other databases. When applicable, gene-specific pages within the CCGA site directly link to pertinent external content.
editv4:Gene Mutations (SNV/INDEL)The content below was from the old template. Please incorporate above.
Gene Mutation Oncogene/Tumor Suppressor/Other Presumed Mechanism (LOF/GOF/Other; Driver/Passenger) Prevalence (COSMIC/TCGA/Other) TNFRSF14 W12Ter Tumor suppressor LOF 17.6% TNFRSF14 C53G Tumor suppressor LOF 6%
Epigenomic Alterations
- Not known in this specific subgroup.
Genes and Main Pathways Involved
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| Gene; Genetic Alteration | Pathway | Pathophysiologic Outcome |
|---|---|---|
| EXAMPLE: BRAF and MAP2K1; Activating mutations | EXAMPLE: MAPK signaling | EXAMPLE: Increased cell growth and proliferation |
| EXAMPLE: CDKN2A; Inactivating mutations | EXAMPLE: Cell cycle regulation | EXAMPLE: Unregulated cell division |
| EXAMPLE: KMT2C and ARID1A; Inactivating mutations | EXAMPLE: Histone modification, chromatin remodeling | EXAMPLE: Abnormal gene expression program |
editv4:Genes and Main Pathways InvolvedThe content below was from the old template. Please incorporate above.BCL2-mediated apoptosis pathway and NF-κB pathway
Genetic Diagnostic Testing Methods
- Fluorescence in situ hybridization with BCL2 break apart and 1p36/1q25 dual color probes
- Polymerase chain reaction for IGH rearrangements
- Chromosomal microarray or karyotype analysis for 1p36 deletion
- DNA sequencing for TNFRSF14 mutations
Familial Forms
- Not known in this specific subgroup.
Additional Information
Prognosis: Excellent prognosis with a 5-year survival rate >90%[8].
Links
- None
References
(use the "Cite" icon at the top of the page) (Instructions: Add each reference into the text above by clicking on where you want to insert the reference, selecting the “Cite” icon at the top of the page, and using the “Automatic” tab option to search such as by PMID to select the reference to insert. The reference list in this section will be automatically generated and sorted. If a PMID is not available, such as for a book, please use the “Cite” icon, select “Manual” and then “Basic Form”, and include the entire reference.)
- ↑ 1.0 1.1 Gulia, Andrea; et al. (2011-11). "Clinicopathologic features of early lesions of primary cutaneous follicle center lymphoma, diffuse type: Implications for early diagnosis and treatment". Journal of the American Academy of Dermatology. 65 (5): 991–1000.e7. doi:10.1016/j.jaad.2010.06.059. ISSN 0190-9622. Check date values in:
|date=(help) - ↑ 2.0 2.1 2.2 2.3 World health organization classification of tumours of haematopoietic and lymphoid tissues, revised 4th edition, Swerdlow SH, Campo E, Harris NL, et al. (Eds), IARC, Lyon 2017.
- ↑ Senff, Nancy J.; et al. (2007-04-20). "Reclassification of 300 primary cutaneous B-Cell lymphomas according to the new WHO-EORTC classification for cutaneous lymphomas: comparison with previous classifications and identification of prognostic markers". Journal of Clinical Oncology: Official Journal of the American Society of Clinical Oncology. 25 (12): 1581–1587. doi:10.1200/JCO.2006.09.6396. ISSN 1527-7755. PMID 17353548.
- ↑ 4.0 4.1 Gángó, Ambrus; et al. (2018-10). "Concomitant 1p36 deletion and TNFRSF14 mutations in primary cutaneous follicle center lymphoma frequently expressing high levels of EZH2 protein". Virchows Archiv: An International Journal of Pathology. 473 (4): 453–462. doi:10.1007/s00428-018-2384-3. ISSN 1432-2307. PMID 29858685. Check date values in:
|date=(help) - ↑ Goodlad, John R.; et al. (2003-12). "Primary cutaneous diffuse large B-cell lymphoma: prognostic significance of clinicopathological subtypes". The American Journal of Surgical Pathology. 27 (12): 1538–1545. doi:10.1097/00000478-200312000-00006. ISSN 0147-5185. PMID 14657713. Check date values in:
|date=(help) - ↑ Abdul-Wahab, Alya; et al. (2014-06). "Chromosomal anomalies in primary cutaneous follicle center cell lymphoma do not portend a poor prognosis". Journal of the American Academy of Dermatology. 70 (6): 1010–1020. doi:10.1016/j.jaad.2014.01.862. ISSN 0190-9622. Check date values in:
|date=(help) - ↑ Tsang, Hamilton C.; et al. (2017-03). "An Aggressive Primary Cutaneous Follicle Center Lymphoma With c-MYC Translocation and CDKN2A (9p21) Deletion: A Case Report and Review of the Literature". The American Journal of Dermatopathology. 39 (3): e44–e49. doi:10.1097/DAD.0000000000000738. ISSN 1533-0311. PMID 27759694. Check date values in:
|date=(help) - ↑ Lucioni, Marco; et al. (2016-10). "Primary cutaneous B-cell lymphoma other than marginal zone: clinicopathologic analysis of 161 cases: Comparison with current classification and definition of prognostic markers". Cancer Medicine. 5 (10): 2740–2755. doi:10.1002/cam4.865. ISSN 2045-7634. PMC 5083727. PMID 27665744. Check date values in:
|date=(help)
Notes
*Primary authors will typically be those that initially create and complete the content of a page. If a subsequent user modifies the content and feels the effort put forth is of high enough significance to warrant listing in the authorship section, please contact the CCGA coordinators (contact information provided on the homepage). Additional global feedback or concerns are also welcome. *Citation of this Page: “Primary cutaneous follicle centre lymphoma”. Compendium of Cancer Genome Aberrations (CCGA), Cancer Genomics Consortium (CGC), updated 09/6/2024, https://ccga.io/index.php/HAEM5:Primary_cutaneous_follicle_centre_lymphoma.