{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,11,20]],"date-time":"2025-11-20T04:04:47Z","timestamp":1763611487036,"version":"3.45.0"},"reference-count":19,"publisher":"Oxford University Press (OUP)","issue":"5","license":[{"start":{"date-parts":[[2025,9,17]],"date-time":"2025-09-17T00:00:00Z","timestamp":1758067200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/pages\/standard-publication-reuse-rights"}],"funder":[{"DOI":"10.13039\/100000982","name":"Conquer Cancer Foundation of the American Society of Clinical Oncology","doi-asserted-by":"publisher","award":["#: 69224320101"],"award-info":[{"award-number":["#: 69224320101"]}],"id":[{"id":"10.13039\/100000982","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2025,11,19]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>Accurate blood staging in mycosis fungoides (MF)\/S\u00e9zary syndrome (SS) is essential for precise diagnosis, prognostication, and effective management. Through 3 illustrative cases, we highlight the complexity of blood staging of MF\/SS caused by expanded CD4-positive T-cell large granular lymphocyte (T-LGL) populations that mimic malignant involvement and complicate accurate disease assessment.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We identified 3 patients with MF\/SS and more than 250\/\u00b5L of CD4-positive, CD7-negative and\/or CD4-positive, CD26-negative T cells in blood but with discordant T-cell receptor profiles between blood and skin samples. We also analyzed 100 consecutive T-cell blood flow cytometry panels ordered for patients evaluated in our cutaneous lymphoma clinic to determine the frequency of such populations.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Each case demonstrated expanded CD4-positive T-LGL populations in the blood characterized by at least partial CD8, CD56, and CD57 expression and absent or decreased CD26 and\/or CD7 expression. Blood from these patients exhibited distinct clonotypes from skin lesions, suggesting a reactive rather than malignant origin. Analysis of 100 consecutive cutaneous lymphoma staging blood flow cytometry cases identified similar CD4-positive, CD57-positive T cells of 250\/\u03bcL or more in 3 of 100 cases, plus 1 atypical case of SS with partial, dim CD57 expression.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>The presence of expanded T-LGL populations in blood can confound accurate staging of MF\/SS, potentially leading to misclassification and ineffective or unnecessary treatment. These cases exemplify how comprehensive molecular and immunophenotypic profiling, including multicolor flow cytometry and T-cell receptor comparisons, along with morphologic evaluation of blood ensure accurate disease assessment to inform better clinical decision-making in MF\/SS.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/ajcp\/aqaf097","type":"journal-article","created":{"date-parts":[[2025,8,22]],"date-time":"2025-08-22T11:42:03Z","timestamp":1755862923000},"page":"644-649","source":"Crossref","is-referenced-by-count":0,"title":["Expanded CD4+CD57+ T-large granular lymphocytes: A diagnostic pitfall in blood staging of mycosis fungoides\/S\u00e9zary syndrome"],"prefix":"10.1093","volume":"164","author":[{"given":"Yumeng","family":"Zhang","sequence":"first","affiliation":[{"name":"Department of Malignant Hematology, H. Lee Moffitt Cancer Center and Research Institute , Tampa, FL ,","place":["United States"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Dahui","family":"Qin","sequence":"additional","affiliation":[{"name":"Department of Pathology and Laboratory Medicine, H. Lee Moffitt Cancer Center and Research Institute , Tampa, FL ,","place":["United States"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Oluwatobi","family":"Ozoya","sequence":"additional","affiliation":[{"name":"Department of Pathology and Laboratory Medicine, H. Lee Moffitt Cancer Center and Research Institute , Tampa, FL ,","place":["United States"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Frank","family":"Glass","sequence":"additional","affiliation":[{"name":"Department of Cutaneous Oncology, H. Lee Moffitt Cancer Center and Research Institute , Tampa, FL ,","place":["United States"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Lubomir","family":"Sokol","sequence":"additional","affiliation":[{"name":"Department of Malignant Hematology, H. Lee Moffitt Cancer Center and Research Institute , Tampa, FL ,","place":["United States"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4600-2963","authenticated-orcid":false,"given":"Christopher B","family":"Ryder","sequence":"additional","affiliation":[{"name":"Department of Pathology and Laboratory Medicine, H. 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