TCRγ-Chain Gene Rearrangement by GeneScan: Incidence and Significance of Clonal Heterogeneity in Sézary Syndrome  Maria T. Fierro, Renata Ponti, Stefano Titli, Lisa Bonello, Alessandra Comessatti, Mauro Novelli, Paolo Fava, Paola Francia di Celle, Pietro Quaglino, Maria Grazia Bernengo  Journal of Investigative Dermatology  Volume 130, Issue 9, Pages 2312-2319 (September 2010) DOI: 10.1038/jid.2010.97 Copyright © 2010 The Society for Investigative Dermatology, Inc Terms and Conditions

Figure 1 Sézary syndrome (SS) patient 18 with heterogeneous pattern. (a, b) Skin and blood at diagnosis; and (c, d) skin and blood during follow-up (2 years later). Filled peak=pathological clone (296bp, VIγJγ family). *Reactive oligoclones present at diagnosis and stable during follow-up. **Onset of new oligoclones during treatment. Journal of Investigative Dermatology 2010 130, 2312-2319DOI: (10.1038/jid.2010.97) Copyright © 2010 The Society for Investigative Dermatology, Inc Terms and Conditions

Figure 2 Sézary syndrome (SS) patient 14. (a) Skin: heterogeneous pattern in skin biopsy at diagnosis with hidden pathological clone (251bp, VIIγJγ family); the comparison between skin (a) and blood (b) allows a correct identification. *Pathological clone; **reactive oligoclone. Journal of Investigative Dermatology 2010 130, 2312-2319DOI: (10.1038/jid.2010.97) Copyright © 2010 The Society for Investigative Dermatology, Inc Terms and Conditions

Figure 3 Sézary syndrome (SS) patient 24. (a) Unsorted peripheral blood lymphocyte (PBL) showing two emerging peaks from the background. (b) Sorted TCR-Vβ17- cells; only the reactive oligoclone is evident. (c) Sorted CD4+CD26-TCR-Vβ17+ cells showing the pathological 269VIγ clone. Journal of Investigative Dermatology 2010 130, 2312-2319DOI: (10.1038/jid.2010.97) Copyright © 2010 The Society for Investigative Dermatology, Inc Terms and Conditions

Figure 4 Molecular pattern modifications during treatment. (a) Patient 1 treated with alemtuzumab followed by extracorporeal photochemotherapy (ECP). (b) Patient 9 treated with ECP alone. Journal of Investigative Dermatology 2010 130, 2312-2319DOI: (10.1038/jid.2010.97) Copyright © 2010 The Society for Investigative Dermatology, Inc Terms and Conditions