Clinical and Pathological Characteristics and Outcomes Among Patients With Subcutaneous Panniculitis-like T-Cell Lymphoma and Related Adipotropic Lymphoproliferative Disorders.

Importance: There is a knowledge gap about subcutaneous panniculitis-like T-cell lymphoma (SPTCL) owing to its rarity and diagnostic difficulty, resulting in an absence of well-documented large case series published to date. Objective: To generate consensus knowledge by a joint multi-institutional review of SPTCL and related conditions. Design, Setting, and Participants: This retrospective clinical and pathological review included cases initially diagnosed as SPTCL at 6 large US academic centers. All cases were reviewed by a group of pathologists, dermatologists, and oncologists with expertise in cutaneous lymphomas. Through a process of group consensus applying defined clinical and pathological diagnostic criteria, the cohort was classified as (1) SPTCL or (2) adipotropic lymphoproliferative disorder (ALPD) for similar cases with incomplete histopathological criteria for SPTCL designation. Exposures: Cases of SPTCL diagnosed between 1998 and 2018. Main Outcomes and Measures: The main outcome was disease presentation and evolution, including response to therapy, disease progression, and development of hemophagocytic lymphohistiocytosis. Results: The cohort of 95 patients (median [range] age, 38 [2-81] years; female-to-male ratio, 2.7) included 75 cases of SPTCL and 20 cases of ALPD. The clinical presentation was similar for both groups with multiple (61 of 72 [85%]) or single (11 of 72 [15%]) tender nodules mostly involving extremities, occasionally resulting in lipoatrophy. Hemophagocytic lymphohistiocytosis (HLH) was only observed in SPTCL cases. With a mean follow-up of 56 months, 60 of 90 patients (67%) achieved complete remission with a median (range) of 3 (1-7) cumulative therapies. Relapse was common. None of the patients died of disease progression or HLH. Two patients with ALPD eventually progressed to SPTCL without associated systemic symptoms or HLH. Conclusions and Relevance: In this case series of patients initially diagnosed as having SPTCL, results showed no evidence of systemic tumoral progression beyond the adipose tissue. The SPTCL experience in this study confirmed an indolent course and favorable response to a variety of treatments ranging from immune modulation to chemotherapy followed by hematopoietic stem cell transplantation. Morbidity was primarily associated with HLH.

Morphology of Mycosis Fungoides and Sézary Syndrome in Skin of Color.

Although mycosis fungoides (MF) and Sézary syndrome (SS) commonly affect Black patients, dermatologic educational resources primarily describe the appearance of these conditions in lighter skin types. Skin of color (SoC) patients with Fitzpatrick skin types (FSTs) IV to VI tend to have variable morphologies compared to the erythematous patches, plaques, or tumors in non-sun-exposed areas seen in non-SoC patients (FSTs I-III). We performed a single-institution review of clinical photographs of patients with FSTs I to VI with the primary outcome of determining the frequency of various morphologic features of MF/SS in SoC vs non-SoC patients. Providers need to be familiar with the differences in morphologic features across skin types to ensure early diagnosis and treatment.

Clinical Trial of High-Dose Pegylated-Interferon-Alfa-2b Combined With Phototherapy in Advanced Stage Mycosis Fungoides.

The combination of Interferon-α-2b (IFN-α-2b) and phototherapy is highly effective in treating mycosis fungoides (MF) but side effects often lead to discontinuation of therapy.1.

High incidence of adnexotropism in cytotoxic cutaneous lymphomas.

BACKGROUND: Primary cutaneous gamma-delta T-cell lymphoma (PCγδTCL) and primary cutaneous aggressive epidermotropic T-cell lymphomas (PCAETCL) are rare aggressive cytotoxic cutaneous lymphomas (CyCL) often difficult to diagnose. Histopathologically, PCAETCL and PCγδTCL may resemble mycosis fungoides (MF) and the presence of adnexotropism in CyCL (CyCL) contributes to this diagnostic challenge, especially in the setting of atypical and double-negative phenotypes. METHODS: In this retrospective study clinical data and histopathological section of 91 patients were analyzed for signs of clinical and histopathological signs adnexotropism. RESULTS: Adnexotropism was identified in 48.4% (44/91) of cases, including PCAETCL (40.9%, 18/44), PCγδTCL and cytotoxic cutaneous lymphomas, not otherwise specified (CyCTCL, NOS) (43.2%, 19/44 and 15.9%, 7/44). Comparison between disease-related mortality with Kaplan-Meier survival analysis of non-adnexotropic vs adnexotropic CyCL did not show any significant difference between the two groups (P = 0.8). Clinically they present with patches, plaques, and tumors and commonly with ulceration, but follicular prominence or alopecia are rare. Clinical signs of adnexotropism such as alopecia and hypo- or anhidrosis were rarely seen. CONCLUSION: Adnexotropism is a common finding in CyCL, especially in PCAETCL. Adnexotropic CyCL may be histopathologically difficult to distinguish from folliculotropic mycosis fungoides. A comprehensive IHC panel should be routinely performed in such cases.

What are the highest yielding search strategy terms for systematic reviews in atopic dermatitis? A systematic review.

The impact of search strategies on systematic reviews (SR) of atopic dermatitis (AD) is unknown. The purpose of this review was to evaluate search strategies used in SR of AD and their impact on the frequency of manuscripts identified. MEDLINE and EMBASE were searched for SR related to AD. Simulations were performed by running combinations of search terms in MEDLINE and EMBASE. Overall, 250 SR met inclusion criteria, of which 225 specified search strategies. SR using 5-6 terms (20.0% to 12.1%) or ≥ 7 (40.0% to 18.8%) terms decreased, whereas SR using 3-4 terms numerically increased (18.8% to 30.2%) and 1-2 terms remained similar (37.5% to 38.9%) from 1999-2009 to 2015-2019. The most commonly searched terms were "atopic dermatitis" (n = 166), followed by "eczema" (n = 156), "dermatitis atopic'" (n = 81), "atopic eczema" (n = 74), "neurodermatitis" (n = 59), "Besniers prurigo" (n = 29), "infantile eczema" (n = 27), and "childhood eczema" (n = 19). Simulations revealed that "eczema" and "atopic dermatitis" yielded the most hits. The number of search terms that maximized hits in MEDLINE and EMBASE was 5 and 4, respectively. Search strategies for AD were heterogeneous, with high proportions of search strategies providing few search hits. Future studies should use standardized and optimized search terms.

Refuging rainbow trout selectively exploit flows behind tandem cylinders.

Fishes may exploit environmental vortices to save in the cost of locomotion. Previous work has investigated fish refuging behind a single cylinder in current, a behavior termed the Kármán gait. However, current-swept habitats often contain aggregations of physical objects, and it is unclear how the complex hydrodynamics shed from multiple structures affect refuging in fish. To begin to address this, we investigated how the flow fields produced by two D-shaped cylinders arranged in tandem affect the ability of rainbow trout (Oncorhynchus mykiss) to Kármán gait. We altered the spacing of the two cylinders from l/D of 0.7 to 2.7 (where l=downstream spacing of cylinders and D=cylinder diameter) and recorded the kinematics of trout swimming behind the cylinders with high-speed video at Re=10,000-55,000. Digital particle image velocimetry showed that increasing l/D decreased the strength of the vortex street by an average of 53% and decreased the frequency that vortices were shed by ∼20% for all speeds. Trout were able to Kármán gait behind all cylinder treatments despite these differences in the downstream wake; however, they Kármán gaited over twice as often behind closely spaced cylinders (l/D=0.7, 1.1, and 1.5). Computational fluid dynamics simulations show that when cylinders are widely spaced, the upstream cylinder generates a vortex street that interacts destructively with the downstream cylinder, producing weaker, more widely spaced and less-organized vortices that discourage Kármán gaiting. These findings are poised to help predict when fish may seek refuge in natural habitats based on the position and arrangement of stationary objects.

Evaluation of the use of metallothionein as a biomarker for detecting physiological responses to mercury exposure in the bonnethead, Sphyrna tiburo.

Previous studies have demonstrated that sharks, perhaps more so than any other fishes, are capable of bioaccumulating the non-essential toxic metal mercury (Hg) to levels that threaten the health of human seafood consumers. However, few studies have explored the potential effects of Hg accumulation in sharks themselves. Therefore, the goal of this study was to examine if physiological effects occur in sharks in response to environmentally relevant levels of Hg exposure. To address this goal, the relationship between muscle Hg concentrations and muscle/hepatic levels of metallothionein (MT), a widely used protein biomarker of toxic metal exposure in fish, was examined in bonnetheads, Sphyrna tiburo, from three Florida estuaries. Total Hg concentrations in bonnethead muscle, as determined using thermal decomposition and atomic absorption spectrometry, ranged from 0.22 to 1.78 µg/g wet weight and were correlated with animal size. These observations were consistent with earlier studies on Florida bonnetheads, illustrating that they experience bioaccumulation of Hg, often to levels that threaten the health of these animals or consumers of their meat. However, despite this, MT concentrations measured using Western blot analysis were not correlated with muscle Hg concentrations. These results suggest that either environmentally relevant levels of Hg exposure and uptake are below the physiological threshold for inducing effects in sharks or MT is a poor biomarker of Hg exposure in these fishes. Of these two explanations, the latter is favored based on a growing body of evidence that questions the use of MTs as specific indicators of Hg exposure and effects in fish.