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Is PLC a Clonal T-Cell Lymphoproliferative Disorder?

The nature of pityriasis lichenoides chronica (PLC) and its relationship to pityriasis lichenoides et varioliformis acuta (PLEVA) and mycosis fungoides (MF) remain enigmatic. Recently, evidence of clonal proliferation has been reported in cases of PLEVA, strengthening the evidence that these entities may be part of a spectrum of lymphoproliferative disorders. The present study evaluated biopsies from 6 patients with PLC for the presence of clonal T-cell gene rearrangements. In addition, the researchers performed immunophenotyping of the infiltrating lymphocytes.

All patients demonstrated a classic combination of clinical and histologic features of the disease. A clonal rearrangement was detected in 3 of the 6 cases. All cases demonstrated a predominance of CD4+ infiltrates. The authors suggest that these findings provide additional evidence that PLC, PLEVA, and MF are related.

Comment: The data are very convincing, but caution is nonetheless essential in interpreting the findings. While clonality has been associated with lymphomas and may portend an aggressive clinical course, evidence is mounting that not all clonal processes result in adverse outcomes. The/significance of clonality within cutaneous T-cell infiltrates remains to be seen. Long-term follow-up studieswith large numbers of patients will be necessary before anydefinitive statements can be made.

— BR Smoller

Published in Journal Watch Dermatology May 3, 2001

Citation(s):

Shieh S et al. Differentiation and clonality of lesional lymphocytes in pityriasis lichenoides chronica. Arch Dermatol 2001 Mar 137 305-308.

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