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Joan Guitart, MD; Karen Kaul, MD, PhD

Arch Dermatol. 1999;135:158-162.

Objective  To evaluate a new, rapid, and sensitive method for the detection of T-cell clonality in patients with lesions suggestive of cutaneous T-cell lymphoma (CTCL).

Design  Skin specimens were obtained from 48 patients with possible CTCL. Polymerase chain reaction amplification of the T-cell receptor (TCRG) gene was performed using consensus primers to the V and J regions. Clonal populations having identical N-region sequences are detected by single-strand conformation polymorphism analysis using a semiautomated electrophoresis system with a silver-staining method for gel visualization. The results of clinicopathological assessment were compared with those of immunohistochemistry and polymerase chain reaction analysis.

Setting  Cutaneous lymphoma clinic at a university medical center.

Patients  Forty-eight patients with skin lesions suggestive of CTCL.

Results  Based on the clinicopathological assessment, 26 patients were diagnosed as having CTCL. Of them, clonality was detected in 19 patients (73%) and an abnormal phenotype in 17 (68%) of 25 patients. Combining both tests, abnormal results were noted in 24 (92%) of 26 patients with CTCL. Clonality was also identified in 2 (12%) of 17 patients with presumably benign lesions on clinicopathological assessment.

Conclusions  Polymerase chain reaction and single-strand conformation polymorphism analysis of the TCRG gene is a rapid and sensitive method that can contribute to the diagnosis of CTCL. The new method is especially useful when used in conjunction with immunophenotyping.

From the Department of Dermatology, Northwestern University Medical Center, Chicago (Dr Guitart), and the Department of Pathology, Evanston Northwestern Hospital, Evanston (Dr Kaul), Ill.

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