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Peripheral blood T lymphocytosis in thymoma: an insight into immunobiology

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Abstract

Purpose

Peripheral blood T lymphocytosis (PBTL) is a rare, yet poorly understood manifestations of thymoma, which is postulated to be linked with autoimmune/paraneoplastic manifestations such as myasthenia gravis (MG), pure red cell aplasia (PRCA), etc.; more commonly encountered in this neoplasm.

Method

We aim to describe the flowcytometric immunophenotypic data of PBTL in a 43-year-old male; 6 months after successful completion of chemoradiotherapy (CT/RT) for a large, invasive, and metastatic type B1 thymoma; and present a comprehensive review of all such cases reported over last 42 years (N = 21) (1977–2019).

Result

A larger size of the tumors (≥ 10 cm), presence of local invasion and/or distant metastasis, and type B (cortical or lymphocyte rich) histology were more likely to be associated with PBTL. Tumors associated with MG/PRCA (N = 9/21) tend to have lower PBTL compared to those without such manifestations; and PBTL subsided following thymectomy with or without CT/RT. Immunophenotypic analysis of PB revealed a CD8 +  > CD4 + mature (naïve) polyclonal T cells resembling late cortical thymocytes.

Conclusion

Thymic intratumoral microenvironment might influence occurrence PBTL that may have a pathophysiologic link to development of autoimmune manifestations. Immunophenotypic characteristics of peripheral blood lymphoid cells should be the clue for accurate characterization and to avoid a misdiagnosis of a lymphoproliferative neoplasm.

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Authors and Affiliations

  1. Department of Pathology and Laboratory Medicine, All India Institute of Medical Sciences, Bhubaneswar, Odisha, 751019, India

    Shruti Mishra, Somanath Padhi, Amit Kumar Adhya & Gaurav Chhabra

  2. Department of Radiotherapy, All India Institute of Medical Sciences, Bhubaneswar, Odisha, 751019, India

    Saroj Kumar DasMajumdar & Ashutosh Pattnaik

Authors
  1. Shruti Mishra
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  2. Somanath Padhi
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  3. Amit Kumar Adhya
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  4. Saroj Kumar DasMajumdar
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  5. Ashutosh Pattnaik
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  6. Gaurav Chhabra
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Contributions

SM and SP: conceptual design, diagnosis (flow cytometry), literature review, data analysis, writing and editing of manuscript. AKA: literature review, diagnosis, and review of manuscript for intellectual content, SKD and AP: provided the management and follow-up data, GC; diagnosis and review of manuscript for intellectual content.

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Correspondence to Somanath Padhi.

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Mishra, S., Padhi, S., Adhya, A.K. et al. Peripheral blood T lymphocytosis in thymoma: an insight into immunobiology. J Cancer Res Clin Oncol 147, 295–301 (2021). https://doi.org/10.1007/s00432-020-03440-2

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  • DOI: https://doi.org/10.1007/s00432-020-03440-2

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