CD4+ T helper (Th) Cells are part of the adaptive immune system and are responsible for activating other immune Cells, such as B Cells, CD8+ T Cells, macrophages, mast Cells, neutrophils, eosinophils, and basophils. Differentiation of CD4+ T Cells is influenced by cytokines and stimulation of the T Cell receptor by different antigens. The pattern of cytokine secretion can be altered under specific conditions from one Cell line to another, indicating that Th Cells have plasticity. In fact, active and master regulators collaborate with transcription factors like signal transducers, activator transducers, and activators of transcription (STATs) in developing the Differentiation process. The signals provided by cytokines activate specific transcription factors in each Cell line. During this process, epigenetic modifications are actively involved. Epigenetics is defined as heritable alterations in the regulation of gene expression without any change in the DNA strand and includes DNA methylation, histone modification, and non-coding RNAs. The plasticity of CD4+ T Cells in Differentiation to multiple subsets allows Th Cells to exhibit the best immune response against the target microorganism. Failure to respond appropriately to multiple types of microorganisms can lead to disease. In this review, we have collected recent advances in understanding the role of epigenetic regulatory mechanisms in the Differentiation of Th Cells and, thereby, the commitment of CD4+ T Cells to a particular lineage to raise an appropriate response against a variety of microorganisms.

In this study a 31 y/o woman who was housewife, came from Mazandaran and lived in Behshahr is presented. Patient's complaints were diarrhea, bloating, abdominal pain and weight loss. Abdominal radiography showed loop dilatation. In primary Para clinic assessments she had Alb: 2.8, Ca: 6.4, P: 2.3 and PTH: 201. Considering malabsorption in early evaluation, upper endoscopy was done. Intestinal folds were disappeared in second and third part of duodenum in endoscopic view and duodenal biopsy was done. Then pathological assessment revealed a large accumulation of intraepithelial lymphocytes and obvious villus atrophy that was accordant to celiac sprue. She was advised to be on gluten free diet. After about 1 month, She was referred because of sever lower extremities edema. Serum albumin was checked that was 2. Enlarged mesenteric lymph nodes were detected in sonography. Considering non- responding treatment, IHC staining of intestinal biopsy was performed with celiac sprue complication suspicion.Therefore the patient was referred to chemotherapy center with the diagnosis of T-Cell lymphoma following celiac sprue. She was spent 6 course chemotherapy with CHOP regimen and radiotherapy.

Primary cutaneous CD30+ T Cell lymphoma is a rare lymphoma originally in and confined to the skin. These lymphomas usually present as a large solitary and often ulcerated nodule. Its prognosis is good and has a good response to radiotherapy. We report a 34-year-old man, who had primary cutaneous CD30+ T Cell lymphoma on his face, which presented as an ulcerated nodule.    

BI-ALCL is an uncommon T-Cell lymphoma. In 2011 FDA suggested that breast implants are possibly associated with development of BI-ALCL, since then more cases of BI-ALCL were reported. It is estimated that to this date more than 500 cases have been diagnosed as BI-ALCL around the world. In most of these cases implant surface was textured rather than smooth. Both silicone and saline filled implants have been reported to develop this problem. BIA-ALCL has two different presentations. Two-thirds of the cases present as periprosthetic fluid collection one year or later after implant insertion, and the remaining one-third as a capsular mass around breast implant. These presentations seem to be different stages of one disease. Although the best imaging-based screening is not identified, sonography, PET and CT are appropriate methods. Mammography has low sensitivity for screening of BI-ALCL. Every suspicious case should be confirmed with fine-needle aspiration and pathological examination for IHC (CD30) with insistence to rule out BI-ALCL before surgery. Operative treatment of confirmed cases should include removal of bilateral implants, total capsulectomy, and complete excision of any suspicious lymph node. The role of adjuvant treatments is under investigation. Although BIA-ALCL is rare lymphoma of breast, early diagnosis and appropriate treatment is necessary in the patients. Death has been reported in 9 patients in the U. S.