Nonneoplastic circulating Sézary-like cells in cutaneous T-cell lymphoma. Ultrastructural, immunologic, and T-cell receptor gene-rearrangement studies.

Approximately 67% of peripheral blood lymphocytes in a case of nonmycosis fungoides-type cutaneous T-cell lymphoma, exhibited Sézary-like changes. Immunotyping showed a helper phenotype with an abnormally faint expression of the T3 membrane antigen, while quantitative electron microscopic study was suggestive of neoplasia. However, T-cell receptor gene study did not show any DNA rearrangement in Ficoll-separated blood lymphocytes, whereas clonal T-cell proliferation was simultaneously evidenced in cutaneous (non-Sézary-like) tumor cells. It is concluded that reactive nonneoplastic Sézary-like cells may be present not only in various benign conditions, as previously known, but also in T-cell lymphomas. This study provides further evidence for the nonspecificity of Sézary-like changes, and stresses the utility of T-cell receptor gene rearrangement study for diagnostic and prognostic procedures during the course of T-cell lymphoproliferative disorders.