Nuclear Protrusions and Marker Chromosomes in Lymphocytes of Two Patients with Cutaneous T-Cell Lymphoma

Giovanni Emilia, Clinica Medica II, Policlinico, Via Del Pozzo 71, I-41100 Modena (Italy) In 1980, Liang et al. [1] reported the first observation of nuclear protrusions in lymphocytes of a patient affected with Sézary syndrome (SS). These authors correlate this anomaly with the presence of long marker chromosomes, a constant finding in this disease [2, 3]. SS, with mycosis fungoides (MF) and some cases of lymphomatoid papulosis, represents a group of chronic T-cell malignancies called cutaneous T-cell lymphoma (CTCL). The absence of anti-HTLV-1 (human T-cell leu-kemia-lymphoma virus, type 1) serum antibodies in the large majority of these patients suggested the lack of relations between CTCL and HTLV-1 associated malignancies, called ATLL (mature adult T-cell leu-kemia-lymphoma) and known to be clustered in Japan, Africa, North America and the Caribbean [4]. Nevertheless, recently HTLV-1 proviral sequences were detected in lymphomatous cells of a French patient with SS, in spite of the absence of anti-HTLV-1 serum antibodies [5]. We recently observed 1 case of SS (N.N., female, 77 years old) and 1 case of MF (C.P., male, 49 years old), the latter with a small number of Sézary cells. Both patients showed clear nuclear protrusions in nondividing white blood cells and absence of anti-HTLV-1 serum antibodies, while large marker chromosomes were observed in mitogen-stimulated peripheral lymphocytes of the SS patient. The diagnosis was made on the basis of peripheral blood, bone marrow, skin and lymph node examination. TEM analysis of peripheral mononuclear cells of both patients revealed the typical morphology of Sézary cells, with cerebriform nuclei in different percentages. The 90% of peripheral lymphocytes in SS and the 40% in MF were CD4 positive (T-helper). The sera of the patients examined for detection of HTLV antibodies by an ELISA assay [6] were found negative. Evident nuclear protrusions were detected in 20% of nondividing cells in the SS patient and in 9% of the MF case (fig. la). The cytogenetic investigations, performed on peripheral lymphocytes, stimulated with PHA and PWM, and on bone marrow cells without mitogen, revealed a normal diploid karyo-type in bone marrow cells of both patients. The analysis was carried out on patients off of therapy for at least 4 months. The karyotype of