Cutaneous T-cell lymphomas (CTCL) are characterized by the presence of skin lesions containing malignant T cells in the background of a chronic inflammatory cell infiltrate. Early disease presents as limited skin patches or plaques and exhibits an indolent behavior. For many patients the disease never progresses but in approximately one third of patients the disease becomes progressive and the skin lesions start to expand and evolve.
Eventually, overt tumors develop and the malignant T cells may disseminate to the blood, lymph nodes, bone marrow and visceral organs, often with a fatal outcome. The transition from early indolent to progressive and advanced disease is accompanied by a significant shift in the nature of the tumor-associated inflammation. This shift does not appear to be an epiphenomenon but rather a critical step in disease progression.
Emerging evidence supports that the malignant T cells take control of the inflammatory environment suppressing cellular immunity and anti-tumor responses while promoting a chronic inflammatory milieu that fuels their own expansion. Here we review the inflammatory changes associated with disease progression in CTCL and point to their wider relevance in other cancer contexts. We further define the term “malignant inflammation” as a pro-tumorigenic inflammatory environment orchestrated by the malignant T cells and discuss some of the mechanisms driving the development of malignant inflammation in CTCL.
Thorbjørn Krejsgaard1, Lise M. Lindahl2, Nigel P. Mongan3, Mariusz A. Wasik4, Ivan V. Litvinov5, Lars Iversen2, Erik Langhoff6, Anders Woetmann1, Niels Odum1
Christenze Thode1, Anders Woetmann2, Hans H. Wandall3, Michael C. Carlsson3, Klaus Qvortrup4, Claudia S. Kauczok5, Marion Wobser5, Andreas Printzlau6, Niels Ødum2 and Sally Dabelsteen1
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