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The role of T-cell phenotype and T-cell receptor rearrangement in the diagnosis of T-cell malignancies: author's reply

We appreciate the study by Sorigue et al. [1], investigating the role of immunophenotyping and T-cell receptor (TCR) rearrangement analysis in the diagnosis of peripheral T-cell lymphomas (PTCL). Interestingly, the authors report that only 31 from a total number of 56 cases with clonal TCR rearrangements were later confirmed to be PTCLs. Reassessment of initial clonal cases resulted in the identification of polyclonality in four out of nine cases, thereby indicating that clonality may not always imply neoplasia. In line with our own data, this study once more demonstrates that the discrimination of neoplastic and reactive conditions is complex and must ultimately rely on a mixture of clinical history, morphology, immunophenotype and molecular studies. Another aspect of these challenging neoplasms is the differential diagnosis of different PTCLs, since morphologic and immunophenotypic features of the most common PTCLs (PTCL not otherwise specified, angioimmunoblastic T-cell lymphoma and anaplastic large-cell lymphoma) largely overlap [2]. Recent studies have shown that gene expression profiling may become a useful tool when phenotype and morphology are not helpful and may even be of prognostic importance [2,3]. Hopefully, future studies investigating the pathobiology of PTCL will lead to the development of easy and reliable diagnostic tests for these complex neoplasms.