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Blanchard M, Morren MA, Busschots AM, Hauben E, Alberti-Violetti S, Berti E, Avallone G, Tavoletti G, Panzone M, Quaglino P, Colonna C, Melchers RC, Vermeer MH, Gniadecki R, Mitteldorf C, Gosmann J, Stadler R, Jonak C, Oren-Shabtai M, Hodak E, Friedland R, Gordon E, Geskin LJ, Scarisbrick JJ, Mayo Martínez F, Noguera Morel L, Pehr K, Amarov B, Faouzi M, Nicolay JP, Kempf W, Blanchard G, Guenova E. Paediatric-onset lymphomatoid papulosis: results of a multicentre retrospective cohort study on behalf of the EORTC Cutaneous Lymphoma Tumours Group (CLTG). Br J Dermatol 2024; 191:233-242. [PMID: 38595050 DOI: 10.1093/bjd/ljae150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2023] [Revised: 03/23/2024] [Accepted: 04/09/2024] [Indexed: 04/11/2024]
Abstract
BACKGROUND Lymphomatoid papulosis (LyP) is a rare cutaneous T-cell lymphoproliferative disorder. Comprehensive data on LyP in the paediatric population are scarce. OBJECTIVES To characterize the epidemiological, clinical, histopathological and prognostic features of paediatric LyP. METHODS This was a retrospective multicentre international cohort study that included 87 children and adolescents with LyP diagnosed between 1998 and 2022. Patients aged ≤ 18 years at disease onset were included. LyP diagnosis was made in each centre, based on clinicopathological correlation. RESULTS Eighty-seven patients from 12 centres were included. Mean age at disease onset was 7.0 years (range 3 months-18 years) with a male to female ratio of 2 : 1. Mean time between the onset of the first cutaneous lesions and diagnosis was 1.3 years (range 0-14). Initial misdiagnosis concerned 26% of patients. LyP was most often misdiagnosed as pityriasis lichenoides et varioliformis acuta, insect bites or mollusca contagiosa. Erythematous papules or papulonodules were the most frequent clinical presentation. Pruritus was specifically mentioned in 21% of patients. The main histological subtype was type A in 55% of cases. When analysed, monoclonal T-cell receptor rearrangement was found in 77% of skin biopsies. The overall survival rate was 100%, with follow-up at 5 years available for 33 patients and at 15 years for 8 patients. Associated haematological malignancy (HM) occurred in 10% of cases (n = 7/73), including four patients with mycosis fungoides, one with primary cutaneous anaplastic large cell lymphoma (ALCL), one with systemic ALCL and one with acute myeloid leukaemia. If we compared incidence rates of cancer with the world population aged 0-19 years from 2001 to 2010, we estimated a significantly higher risk of associated malignancy in general, occurring before the age of 19 years (incidence rate ratio 87.49, 95% confidence interval 86.01-88.99). CONCLUSIONS We report epidemiological data from a large international cohort of children and adolescents with LyP. Overall, the disease prognosis is good, with excellent survival rates for all patients. Owing to an increased risk of associated HM, long-term follow-up should be recommended for patients with LyP.
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Affiliation(s)
- Maël Blanchard
- Department of Dermatology, CHUV Lausanne, University of Lausanne, Switzerland
- Division of Dermatology and Venereology, Geneva University Hospitals, Geneva, Switzerland
| | - Marie-Anne Morren
- Department of Dermatology, CHUV Lausanne, University of Lausanne, Switzerland
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Gabriela Blanchard
- Department of Dermatology, CHUV Lausanne, University of Lausanne, Switzerland
- Division of Dermatology and Venereology, Geneva University Hospitals, Geneva, Switzerland
| | - Emmanuella Guenova
- Department of Dermatology, CHUV Lausanne, University of Lausanne, Switzerland
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2
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Nikolaou V, Kaliampou S, Koumprentziotis IA, Papanikou S, Gerochristou M, Tsimpidakis A, Stratigos A, Marinos L. Primary cutaneous lymphoma in children and adolescents: An epidemiological descriptive study in a Greek population. J Eur Acad Dermatol Venereol 2024. [PMID: 38923120 DOI: 10.1111/jdv.20186] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2024] [Accepted: 06/05/2024] [Indexed: 06/28/2024]
Affiliation(s)
- Vasiliki Nikolaou
- 1st Department of Dermatology-Venereology, Medical School, National and Kapodistrian University of Athens, "A. Sygros" Hospital for Skin and Venereal Diseases, Athens, Greece
| | - Stella Kaliampou
- 1st Department of Dermatology-Venereology, Medical School, National and Kapodistrian University of Athens, "A. Sygros" Hospital for Skin and Venereal Diseases, Athens, Greece
| | - Ioannis-Alexios Koumprentziotis
- 1st Department of Dermatology-Venereology, Medical School, National and Kapodistrian University of Athens, "A. Sygros" Hospital for Skin and Venereal Diseases, Athens, Greece
| | - Sofia Papanikou
- 1st Department of Dermatology-Venereology, Medical School, National and Kapodistrian University of Athens, "A. Sygros" Hospital for Skin and Venereal Diseases, Athens, Greece
| | - Maria Gerochristou
- 1st Department of Dermatology-Venereology, Medical School, National and Kapodistrian University of Athens, "A. Sygros" Hospital for Skin and Venereal Diseases, Athens, Greece
| | - Antonios Tsimpidakis
- 1st Department of Dermatology-Venereology, Medical School, National and Kapodistrian University of Athens, "A. Sygros" Hospital for Skin and Venereal Diseases, Athens, Greece
| | - Alexander Stratigos
- 1st Department of Dermatology-Venereology, Medical School, National and Kapodistrian University of Athens, "A. Sygros" Hospital for Skin and Venereal Diseases, Athens, Greece
| | - Leonidas Marinos
- Hemopathology Department, "Evangelismos" General Hospital, Athens, Greece
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3
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Melchionda V, Ieremia E, Matin R, McPherson T. Five paediatric patients with mycosis fungoides and our approach to provide age-appropriate information and psychological support. Clin Exp Dermatol 2024; 49:497-501. [PMID: 38169346 DOI: 10.1093/ced/llad457] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Revised: 10/27/2023] [Accepted: 12/22/2023] [Indexed: 01/05/2024]
Abstract
Cutaneous lymphoproliferative diseases in childhood are rare and they are clinically and pathologically heterogeneous, which makes their diagnosis challenging. Although there is limited long-term data and guidance on management, evidence suggests these to be different conditions from cutaneous lymphoma in adults, highlighting the need for age-appropriate patient information. We present clinical outcomes for our paediatric cohort of five patients with mycosis fungoides, emphasizing that despite diagnostic delays, mycosis fungoides in this age group tends to yield a good prognosis. It remains uncommon to provide clinical expertise together with psychological support in a dermatology paediatric service. Here, we provide our experience in offering this combined service. In conjunction with these patients, we have co-produced an accessible patient information leaflet targeted at a younger audience for support and to clarify potential misconceptions from a diagnosis of cutaneous lymphoma.
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Affiliation(s)
| | - Eleni Ieremia
- Histopathology, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
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4
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Alberti-Violetti S, Avallone G, Colonna C, Tavoletti G, Venegoni L, Merlo V, Cambiaghi S, Marzano AV, Berti E, Cavalli R. Paediatric cutaneous lymphomas including rare subtypes: A 40-year experience at a tertiary referral centre. J Eur Acad Dermatol Venereol 2024. [PMID: 38650545 DOI: 10.1111/jdv.20028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2023] [Accepted: 03/08/2024] [Indexed: 04/25/2024]
Abstract
BACKGROUND Primary cutaneous lymphomas are neoplasms of the immune system with a distinct tropism for the skin and an absence of extracutaneous manifestations at the time of diagnosis. Studies focusing on cutaneous lymphomas in children and adolescents remain scarce and often do not encompass the rare subtypes. OBJECTIVES To address this knowledge gap by describing the clinical, histological and molecular characteristics of a large group of paediatric patients affected by primary cutaneous lymphoma. We also provided the Paediatric Primary Cutaneous Lymphoma Atlas that illustrates the clinicopathological spectrum of observed presentations, in the hope of supporting other physicians in the diagnostic process. METHODS Retrospective chart review of paediatric patients diagnosed with primary cutaneous lymphomas between 1980 and 2022 at the Paediatric Dermatology Unit of Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan. RESULTS A total of 101 patients (58 males, 43 females) met the inclusion criteria. The most common subtypes were lymphomatoid papulosis (n = 48) and mycosis fungoides (n = 31). These were followed by primary cutaneous CD4+ small/medium T-cell lymphoproliferative disorders (n = 7), primary cutaneous anaplastic large-cell lymphomas (n = 5), primary cutaneous marginal zone B-cell lymphomas (n = 3), primary cutaneous follicle centre lymphomas (n = 2), subcutaneous panniculitis-like T-cell lymphomas (n = 2), primary cutaneous peripheral T-cell lymphoma not otherwise specified (n = 1), primary cutaneous precursor B-lymphoblastic lymphoma (n = 1) and Sézary syndrome (n = 1). Clinical follow-up data covering a median of 70.8 months (range 1-324) were available for 74 patients, of whom three died due to cutaneous lymphoma. CONCLUSIONS Our findings shed light on the peculiar aspects and long-term outcomes of paediatric cutaneous lymphomas, particularly emphasizing their distinctive features in comparison to their adult counterparts and exploring the less common subtypes. Further larger-scale studies are warranted to better characterize these entities and to achieve a more rapid and accurate diagnosis.
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Affiliation(s)
- Silvia Alberti-Violetti
- Dermatology Unit, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy
- Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
| | - Gianluca Avallone
- Dermatology Unit, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy
- Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
- Dermatology Clinic, Department of Medical Sciences, University of Turin, Turin, Italy
| | - Cristiana Colonna
- Pediatric Dermatology Unit, Department of Clinical Sciences and Community Health, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Gianluca Tavoletti
- Dermatology Unit, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy
- Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
| | - Luigia Venegoni
- Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
| | - Valentina Merlo
- Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
| | - Stefano Cambiaghi
- Pediatric Dermatology Unit, Department of Clinical Sciences and Community Health, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Angelo V Marzano
- Dermatology Unit, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy
- Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
| | - Emilio Berti
- Dermatology Unit, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy
- Inter-Hospital Pathology Division, IRCCS MultiMedica, Milan, Italy
| | - Riccardo Cavalli
- Pediatric Dermatology Unit, Department of Clinical Sciences and Community Health, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
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Assaf C, Dobos G, Zech IM, Doess A, May M, Jadasz J. Epidemiologie reifzelliger T- und NK-Zell-Lymphome in Deutschland - Eine repräsentative Querschnittanalyse von GKV-Routinedaten: Epidemiology of mature T/NK-cell lymphomas in Germany - A representative cross-sectional study based on SHI claims data. J Dtsch Dermatol Ges 2023; 21:1320-1328. [PMID: 37946651 DOI: 10.1111/ddg.15187_g] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Accepted: 06/18/2023] [Indexed: 11/12/2023]
Abstract
ZusammenfassungHintergrundPrimäre kutane Lymphome sind seltene lymphoproliferative Neoplasien und gehören zur heterogenen Gruppe der Non‐Hodgkin‐Lymphome. Sie umfassen ein klinisch und histologisch breites Spektrum an Manifestationsformen, wobei kutane T‐Zell‐Lymphome (CTCL) mit 73% am häufigsten sind. Aufgrund der Seltenheit der Erkrankungen sind bevölkerungsbasierte Untersuchungen zur Versorgungssituation und Epidemiologie kaum vorhanden.Patienten und MethodikAuf Basis anonymisierter, alters‐ und geschlechtsadjustierter GKV‐Routinedaten von circa fünf Millionen gesetzlich Krankenversicherten wurde im Sechsjahreszeitraum (2012–2017) eine retrospektive Analyse zur Bestimmung von Prävalenz, Inzidenz und Letalität von Patienten mit reifzelligen T/NK‐Zell Lymphomen in Deutschland durchgeführt.ErgebnisseInsgesamt 1336 T‐Zell‐Lymphom‐Patienten konnten im Beobachtungszeitraum identifiziert werden. Die Sechsjahres‐Prävalenz liegt demnach zwischen 27,35 und 43,58 pro 100 000 Einwohner. Die Patienten waren zu 65% männlich mit einem durchschnittlichen Alter von 66 Jahren (SD 15). Es verstarben 246 Patienten (circa 20 %) innerhalb der 6 Jahre, pro Jahr bis zu 7 %. Die ermittelte Inzidenz bei 153 identifizierten Patienten im Jahr 2017 liegt bei 3,65 bis 3,92 pro 100 000 Einwohner.SchlussfolgerungenErstmalig in Deutschland wurden mithilfe von Abrechnungsdaten der gesetzlichen Krankenversicherung (GKV‐Routinedaten), valide epidemiologische Erkenntnisse von Patienten mit reifzelligen T‐ und NK‐Zell Lymphomen gewonnen. Weitere Analysen für tiefergehende Einblicke in die Versorgung der Patienten mit dieser seltenen Erkrankung sind wünschenswert.
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Affiliation(s)
- Chalid Assaf
- Klinik für Dermatologie und Venerologie, HELIOS Klinikum Krefeld, Krefeld
- Institute for Molecular Medicine, Medical School Hamburg, Hamburg
- Klinik für Dermatologie, HELIOS Klinikum Schwerin, universitärer Campus der Medical School Hamburg, Schwerin
| | - Gabor Dobos
- Klinik für Dermatologie, Venerologie und Allergologie, Charité - Universitätsmedizin Berlin, gemeinsame Medizinische Fakultät Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin
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Assaf C, Dobos G, Zech IM, Doess A, May M, Jadasz J. Epidemiology of mature T/NK-cell lymphomas in Germany - A representative cross-sectional study based on SHI claims data. J Dtsch Dermatol Ges 2023; 21:1320-1327. [PMID: 37845021 DOI: 10.1111/ddg.15187] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Accepted: 06/18/2023] [Indexed: 10/18/2023]
Abstract
BACKGROUND Primary cutaneous lymphomas (PCL) are rare skin tumors of lymphoproliferative neoplasms and belong to the heterogeneous group of non-Hodgkin's lymphomas. PCL encompass a broad spectrum of clinical and histologic manifestations, with cutaneous T-cell lymphoma (CTCL) being the most common (73%). Due to the rarity of the diseases, population-based studies of care and epidemiology are limited. PATIENTS AND METHODS Based on anonymized, age- and sex-adjusted SHI (statutory health insurance) claims data of approximately five million SHI-insured patients, a retrospective analysis was conducted over a six-year period (2012-2017) to determine the prevalence, incidence, and lethality in patients with mature-cell T/NK-cell lymphoma in Germany. RESULTS A total of 1,336 patients with T-cell lymphoma were identified during the observation period. The six-year prevalence ranged from 27.35 to 43.58 per 100,000. Patients were 65% male with a mean age of 66 years (SD 15). There were 246 patients (approx. 20%) who died within the 6 years, up to 7% per year. The calculated incidence in 153 identified patients in 2017 is 3.65 to 3.92 per 100,000. CONCLUSIONS For the first time, valid epidemiologic findings of patients with mature T-cell and NK-cell lymphomas were obtained using SHI claims data in Germany. Further analyses are needed to gain a deeper insight into the healthcare reality of patients with this rare disease.
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Affiliation(s)
- Chalid Assaf
- Department of Dermatology and Venerology, HELIOS Klinikum Krefeld, Krefeld, Germany
- Institute for Molecular Medicine, Hamburg Medical School, Hamburg, Germany
- Department of Dermatology, HELIOS Klinikum Schwerin, University Campus of the Hamburg Medical School, Schwerin, Germany
| | - Gabor Dobos
- Clinic for Dermatology, Venerology and Allergology, Charité - Universitätsmedizin Berlin, Joint Faculty of Medicine of Freie Universität Berlin and Humboldt-Universität Berlin, Berlin, Germany
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Amitay-Laish I, Didkovsky E, Davidovici B, Friedland R, Ben Amitai D, Landov H, Greenberger S, Ollech A, Prag Naveh H, Hodak E, Barzilai A. Mycosis Fungoides in Solid-Organ Transplant Recipients: A Multicenter Retrospective Cohort Study. Dermatology 2023; 239:898-905. [PMID: 37751718 DOI: 10.1159/000534224] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Accepted: 09/18/2023] [Indexed: 09/28/2023] Open
Abstract
BACKGROUND Mycosis fungoides (MF) in solid-organ transplant recipients (SOTRs) is rare, with limited data on disease characteristics. OBJECTIVE The aim was to study the characteristics of MF in SOTRs with an emphasis on the immunosuppressive therapy. METHODS A retrospective cohort of patients diagnosed with MF, who were also SOTRs, were followed at 3 cutaneous lymphoma outpatient clinics, between January 2010 and February 2022. RESULTS Ten patients were included (7 male; median ages at transplantation and at diagnosis of MF were 33 and 48 years, respectively; 40% were diagnosed before the age of 18 years). Median time from transplantation to diagnosis of MF was 8 years (range 0.5-22). Transplanted organs and immunosuppressive treatments included: liver (n = 5; 4 treated with tacrolimus, 1 with tacrolimus and prednisone), kidney (n = 3), liver and kidney (n = 1), and heart (n = 1), all treated with mycophenolic acid, tacrolimus, and prednisone. Nine had early-stage MF (IA - 4, IB - 5; 40% with early folliculotropic MF), treated with skin-directed therapies, in 2 combined with acitretin, achieving partial/complete response. One patient had advanced-stage MF (IIIA) with folliculotropic erythroderma, treated with ultraviolet A and narrow-band ultraviolet B with acitretin, achieving partial response. Immunosuppression was modified in 3. At last follow-up (median 4 years, range 1-8), no stage progression was observed; 5 had no evidence of disease, 5 had active disease (IA/IB - 4, III - 1). CONCLUSIONS MF in SOTRs is usually diagnosed at an early stage, with overrepresentation of folliculotropic MF, and of children. Immunosuppressive therapy alterations, not conducted in most patients, should be balanced against the risk of organ compromise/rejection. Disease course was similar to MF in immunocompetent patients, during the limited time of follow-up.
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Affiliation(s)
- Iris Amitay-Laish
- Division of Dermatology, Tel Aviv University, Tel Aviv, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Elena Didkovsky
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Institute of Pathology, Rabin Medical Center Beilinson Hospital, Tel Aviv, Israel
| | - Batya Davidovici
- Division of Dermatology, Tel Aviv University, Tel Aviv, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Rivka Friedland
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Pediatric Dermatology Unit, Schneider Children's Medical Center, Petach Tikva, Israel
| | - Dan Ben Amitai
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Pediatric Dermatology Unit, Schneider Children's Medical Center, Petach Tikva, Israel
| | - Hagai Landov
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Department of Dermatology, Sheba Medical Center, Tel Hashomer, Israel
| | - Shoshana Greenberger
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Department of Dermatology, Sheba Medical Center, Tel Hashomer, Israel
| | - Ayelet Ollech
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Department of Dermatology, Sheba Medical Center, Tel Hashomer, Israel
| | | | - Emmilia Hodak
- Division of Dermatology, Tel Aviv University, Tel Aviv, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Aviv Barzilai
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Department of Dermatology, Sheba Medical Center, Tel Hashomer, Israel
- Institute of Pathology, Sheba Medical Center, Tel Hashomer, Israel
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8
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Hu ZH, Lu L, Feng JD, Song HB, Zhang SY, Yang L, Wang T, Liu YH. Real-World Clinical Characteristics, Management, and Outcomes of 44 Paediatric Patients with Hypopigmented Mycosis Fungoides. Acta Derm Venereol 2023; 103:adv6226. [PMID: 37606155 PMCID: PMC10461309 DOI: 10.2340/actadv.v103.6226] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Accepted: 06/19/2023] [Indexed: 08/23/2023] Open
Abstract
Hypopigmented mycosis fungoides is a rare form of mycosis fungoides that is characterized by achromic lesions, early onset of disease, a predilection for darker skinned populations, and a predominance of CD8+ T cells. Due to the rarity and heterogeneous presentation of hypopigmented mycosis fungoides, there are no criteria that clearly define the clinical characteristics and treatment regimens for this condition. This retrospective study of 44 paediatric patients with hypopigmented mycosis fungoides aimed to summarize their epidemiological and clinical characteristics and assess the effectiveness and safety of different treatment regimens. Clinical manifestations were further classified into 3 morphological groups: hypopigmented lesions, papules overlying hypopigmented lesions, and erythematous plaques overlying hypopigmented lesions. In addition, the results of this study suggest that interferon alpha might be an effective and well-tolerated therapy that could shorten the treatment time to complete response compared with other treatments. Maintenance therapy and long-term follow-up reduced the recurrence rate.
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Affiliation(s)
- Zhong-Hui Hu
- Department of Dermatology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, State Key Laboratory of Complex Severe and Rare Diseases, National Clinical Research Center for Dermatologic and Immunologic Diseases, Beijing, China
| | - Lu Lu
- Department of Dermatology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, State Key Laboratory of Complex Severe and Rare Diseases, National Clinical Research Center for Dermatologic and Immunologic Diseases, Beijing, China
| | - Jin-Di Feng
- Department of Dermatology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, State Key Laboratory of Complex Severe and Rare Diseases, National Clinical Research Center for Dermatologic and Immunologic Diseases, Beijing, China
| | - Hong-Bin Song
- Department of Dermatology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, State Key Laboratory of Complex Severe and Rare Diseases, National Clinical Research Center for Dermatologic and Immunologic Diseases, Beijing, China
| | - Shi-Yu Zhang
- Department of Dermatology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, State Key Laboratory of Complex Severe and Rare Diseases, National Clinical Research Center for Dermatologic and Immunologic Diseases, Beijing, China
| | - Lu Yang
- Department of Dermatology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, State Key Laboratory of Complex Severe and Rare Diseases, National Clinical Research Center for Dermatologic and Immunologic Diseases, Beijing, China
| | - Tao Wang
- Department of Dermatology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, State Key Laboratory of Complex Severe and Rare Diseases, National Clinical Research Center for Dermatologic and Immunologic Diseases, Beijing, China.
| | - Yue-Hua Liu
- Department of Dermatology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, State Key Laboratory of Complex Severe and Rare Diseases, National Clinical Research Center for Dermatologic and Immunologic Diseases, Beijing, China.
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Mirmovich Morvay O, Ramon M, Khamaysi Z, Avitan-Hersh E. Paediatric Mycosis Fungoides: Clinical Variants, Treatment Modalities and Response to Therapy. Acta Derm Venereol 2023; 103:adv6557. [PMID: 37449370 PMCID: PMC10391534 DOI: 10.2340/actadv.v103.6557] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2023] [Accepted: 03/28/2023] [Indexed: 07/18/2023] Open
Abstract
Mycosis fungoides is a rare cutaneous lymphoma in the paediatric population. The aim of this study was to examine the epidemiological, clinical, and histological characteristics, as well as the treatment modalities and response to therapy of paediatric patients with mycosis fungoides. This retrospective cohort study reviewed the records of 37 paediatric patients treated at Rambam Medical Center, Israel, between 2013 and 2021. Extracted data included epidemiology, clinical presentation, histological reports, infiltrate clonality status, treatment modalities and response to therapy. The mean follow-up period was 60 months. All patients were diagnosed with stage IA or IB disease. Folliculotropic mycosis fungoides was the most prevalent variant (49%). Most patients were treated with phototherapy (90%), with a response rate of 85%, and a complete response rate of 55% after the first course. There were no significant differences in response to phototherapy between the folliculotropic or other variants (p = 0.072). Similarly, delayed diagnosis, atopic diathesis, clonality, phototherapy type or number of treatments, were not associated with response to therapy, while protracted phototherapy was associated with prolonged remission. In conclusion, mycosis fungoides in the paediatric population is an indolent disease with a favourable prognosis and potentially prolonged response to phototherapy.
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Affiliation(s)
| | - Michal Ramon
- Department of dermatology, Rambam Health Care Campus, Haifa, Israel
| | - Ziad Khamaysi
- Department of dermatology, Rambam Health Care Campus, Haifa, Israel
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10
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Diagnosis and management of cutaneous lymphomas and lymphoid proliferations in children, adolescents and young adults (CAYA). Best Pract Res Clin Haematol 2023; 36:101448. [PMID: 36907638 DOI: 10.1016/j.beha.2023.101448] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Accepted: 02/06/2023] [Indexed: 02/12/2023]
Abstract
Cutaneous lymphomas and lymphoid proliferations (LPD) in children, adolescents, and young adults (CAYA) are a heterogeneous group of lymphoid neoplasms that present formidable diagnostic challenges to clinicians and pathologists alike. Although rare overall, cutaneous lymphomas/LPD occur in real-world settings and awareness of the differential diagnosis, potential complications, and various therapeutic approaches will help ensure the optimal diagnostic work-up and clinical management. Lymphomas/LPD involving the skin can occur as primary cutaneous disease in a patient that characteristically has lymphoma/LPD confined to the skin, or as secondary involvement in patients with systemic disease. This review will comprehensively summarize both primary cutaneous lymphomas/LPD that occur in the CAYA population as well as those CAYA systemic lymphomas/LPD with propensity for secondary cutaneous involvement. Focus on the most common primary entities occurring in CAYA will include lymphomatoid papulosis, primary cutaneous anaplastic large cell lymphoma, mycosis fungoides, subcutaneous panniculitis-like T-cell lymphoma, and hydroa vacciniforme lymphoproliferative disorder.
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Miyashiro D, Sanches JA. Mycosis fungoides and Sézary syndrome: clinical presentation, diagnosis, staging, and therapeutic management. Front Oncol 2023; 13:1141108. [PMID: 37124514 PMCID: PMC10140754 DOI: 10.3389/fonc.2023.1141108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Accepted: 03/27/2023] [Indexed: 05/02/2023] Open
Abstract
Mycosis fungoides (MF) and Sézary syndrome (SS) are cutaneous T-cell lymphomas. MF is the most common cutaneous lymphoma, and it is classified into classic Alibert-Bazin MF, folliculotropic MF, pagetoid reticulosis, and granulomatous slack skin, each with characteristic clinical presentation, histopathological findings, and distinct clinical behaviors. SS is an aggressive leukemic variant of cutaneous lymphoma, and it is characterized by erythroderma, lymphadenopathy, and peripheral blood involvement by malignant cells. There is a wide range of dermatological manifestations of MF/SS, and prompt recognition is essential for early diagnosis. Skin biopsy for histopathology and immunohistochemical analysis is imperative to confirm the diagnosis of MF/SS. Histopathology may also provide information that may influence prognosis and treatment. Staging follows the TNMB system. Besides advanced stage, other factors associated with poorer prognosis are advanced age, male gender, folliculotropism in histopathology of patients with infiltrated plaques and tumors in the head and neck region, large cell transformation, and elevated lactate dehydrogenase. Treatment is divided into skin-directed therapies (topical treatments, phototherapy, radiotherapy), and systemic therapies (biological response modifiers, targeted therapies, chemotherapy). Allogeneic bone marrow transplantation and extracorporeal photopheresis are other treatment modalities used in selected cases. This review discusses the main clinical characteristics, the histopathological/immunohistochemical findings, the staging system, and the therapeutic management of MF/SS.
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Kothari R, Szepietowski JC, Bagot M, Sandhu S, Patil A, Grabbe S, Goldust M. Mycosis fungoides in pediatric population: comprehensive review on epidemiology, clinical presentation, and management. Int J Dermatol 2022; 61:1458-1466. [PMID: 35193164 DOI: 10.1111/ijd.16098] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2021] [Revised: 10/29/2021] [Accepted: 01/06/2022] [Indexed: 12/26/2022]
Abstract
Mycosis fungoides (MF) is the most common type of cutaneous T-cell lymphoma. However, it is rare in pediatric population. Most of the cases of pediatric MF present with hypopigmented patches and/or various other forms, which may often mimic common childhood dermatoses, thereby causing a delay in the diagnosis. There are no established treatment guidelines for pediatric MF. As the progression of childhood MF is extremely rare and it has an indolent course, it is usually diagnosed at an early stage (IA, IB, IIA), and hence phototherapy with a response rate of >80% is a well-established effective treatment in children. However, as recurrences are frequently seen on stopping the therapies, a maintenance regimen and long-term follow-up is equally important. This article reviews the epidemiological factors, clinical presentations, diagnosis, and various treatment modalities used in pediatric MF. We analyzed and compared the data of almost 616 childhood MF cases from various studies undertaken from 1988 to 2021.
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Affiliation(s)
- Rohit Kothari
- Department of Dermatology, Armed Forces Medical College, Pune, India
| | - Jacek C Szepietowski
- Department of Dermatology, Venereology and Allergology, Wroclaw Medical University, Wroclaw, Poland
| | - Martine Bagot
- Faculté de Médecine Paris Diderot, AP-HP, Service de Dermatologie, Hôpital Saint-Louis, Paris, France
| | - Sunmeet Sandhu
- Department of Dermatology, Command Hospital Air Force, Bangalore, India
| | - Anant Patil
- Department of Pharmacology, Dr. DY Patil Medical College, Navi Mumbai, India
| | - Stephan Grabbe
- Department of Dermatology, University Medical Center of the Johannes Gutenberg University, Mainz, Germany
| | - Mohamad Goldust
- Department of Dermatology, University Medical Center of the Johannes Gutenberg University, Mainz, Germany
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13
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Boede M, Gellrich S, Hillen U. Keratosis pilaris-artige Mycosis fungoides bei einem Kind. AKTUELLE DERMATOLOGIE 2022. [DOI: 10.1055/a-1887-3101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
ZusammenfassungDie Mycosis fungoides (MF) im Kindes- und Jugendalter ist selten und macht 0,5–7% der MF-Fälle aus. Bei Kindern und Jugendlichen sind häufiger MF-Varianten als die klassische MF zu beobachten. Wir berichten über einen 11 Jahre alten Jungen mit einer Keratosis pilaris-artigen MF (KPMF). Die KPMF ist eine seltene Manifestation der follikulotropen MF, die sich mit umschriebenen follikulären Papeln mit spikeartigen Hyperkeratosen darstellt, ggf. begleitet von mildem Juckreiz. Da die Läsionen sehr unscheinbar sein können, wird die Diagnose einer MF oft zunächst nicht in Betracht gezogen, sondern an eine Keratosis pilaris, einen Lichen spinulosus, Lichen planopilaris oder multiple filiforme Hyperkeratosen gedacht. Unter Therapie mit topischen Glukokortikoiden in Kombination mit einer Creme-PUVA-Therapie konnte bei unserem Patienten eine vollständige Remission erreicht werden. In nunmehr 3 Jahren nach Erstdiagnose traten mehrfach Rezidive auf, die jeweils mit hautgerichteter Therapie in komplette Remission gebracht werden konnten.
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Affiliation(s)
- Marcel Boede
- Klinik für Dematologie und Venerologie, Vivantes Klinikum Neukölln, Berlin, Deutschland
| | | | - Uwe Hillen
- Klinik für Dematologie und Venerologie, Vivantes Klinikum Neukölln, Berlin, Deutschland
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14
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Pediatric Mycosis Fungoides: Retrospective Analysis of a Series With CD8 + Profile and Female Predominance. J Pediatr Hematol Oncol 2022; 44:e994-e998. [PMID: 34699461 DOI: 10.1097/mph.0000000000002354] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Accepted: 09/21/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND Mycosis fungoides (MF) in children is a rare disease and there are limited data regarding the behavior of the disease in this age group. We aimed to collect additional data to better understand the clinicopathologic features of MF in children. MATERIALS AND METHODS This study was a retrospective analysis of pediatric MF patients (diagnosed at age 0 to 18 y). RESULTS Thirteen pediatric patients with MF were identified. Female predominance was observed with a ratio of 1.6:1. Median values for age of onset of skin lesions and age at the time of histologic diagnosis were 5 and 12 years, respectively. All patients had early stage (stage IA to IIA) of MF at the time of diagnosis. Hypopigmented MF comprised 77% of all study patients, followed by classic MF (15%) and pagetoid reticulosis (8%). The lower extremity (especially proximal leg) followed by trunk and upper extremity were most commonly affected sites. Seven of 9 patients who had available immunohistochemistry data showed CD8 + predominance. Five of 8 patients whose follow-up data was available, achieved complete response with narrowband ultraviolet B treatment, while 2 and 1 had near complete response and partial response, respectively. CONCLUSIONS Our study demonstrated female sex and CD8 + profile predominance. Hypopigmented MF constituted the majority of cases. We observed good responses with narrowband ultraviolet B treatment.
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15
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Jung JM, Lee MY, Won CH, Chang SE, Lee MW, Lee WJ. Hyperpigmented mycosis fungoides: a retrospective and comparative analysis with other subtypes of mycosis fungoides. Leuk Lymphoma 2022; 63:1598-1606. [PMID: 35201905 DOI: 10.1080/10428194.2022.2043303] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
In this study, the clinicopathologic features and survival outcomes of patients with hyperpigmented MF from a single tertiary referral center database were retrospectively evaluated. Hyperpigmented MF accounted for 10.9% (14/128) of all MF cases. The mean age at diagnosis was 46.9 years, and the female-to-male ratio was 1:1.3. Concurrent hypopigmented, ichthyosiform, and poikilodermatous lesions were detected in 21.4%, 14.3%, and 14.3% of the patients, respectively. Histopathologically, most patients (85.7%) showed interface change with pigment incontinence. Double negative (CD4- and CD8-) immunophenotypes were more frequent in patients with hyperpigmented MF (25%) than in those with other MF subtypes (9.8%). Most patients (85.7%) had early-stage disease at diagnosis. The survival outcomes did not differ significantly between hyperpigmented and other MF subtypes. In conclusion, hyperpigmented MF often accompanies other atypical MF variants and is frequently associated with atypical immunophenotypes. The outcomes of hyperpigmented MF are comparable to those of other MF subtypes.
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Affiliation(s)
- Joon Min Jung
- Department of Dermatology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Mi Young Lee
- Department of Dermatology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Chong Hyun Won
- Department of Dermatology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Sung Eun Chang
- Department of Dermatology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Mi Woo Lee
- Department of Dermatology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Woo Jin Lee
- Department of Dermatology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
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16
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Assaf C, Booken N, Dippel E, Guenova E, Jonak C, Klemke CD, Nicolay JP, Schlaak M, Wobser M, Trautinger F. Chlormethin-Gel zur Behandlung der Mycosis fungoides: Ein Expertenkonsens aus Deutschland, Österreich und der Schweiz (DACH-Region) zum Therapiemanagement. J Dtsch Dermatol Ges 2022; 20:579-588. [PMID: 35578416 DOI: 10.1111/ddg.14688_g] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2021] [Accepted: 11/11/2021] [Indexed: 11/26/2022]
Abstract
HINTERGRUND Chlormethin-Gel ist in Europa zur Therapie von Patienten mit Mycosis fungoides in allen Krankheitsstadien zugelassen. Die optimalen Behandlungsregime hinsichtlich Frequenz, Dosierung, Kombinations- oder Erhaltungstherapien sind noch nicht vollständig etabliert. METHODIK Zehn in der Erforschung und Behandlung kutaner T-Zell-Lymphome erfahrene Experten aus Deutschland, Österreich und der Schweiz (DACH-Region) wurden schriftlich zu Indikation, Anwendungsfrequenz, Beurteilung des Therapieerfolgs, Begleittherapie, Nebenwirkungen, Kombinationstherapien in späteren Krankheitsstadien, Erhaltungstherapie und Adhärenz im Rahmen der Therapie der Mycosis fungoides mit Chlormethin-Gel befragt. Die strukturiert aufbereiteten Ergebnisse der Umfrage wurden in einer Konsensuskonferenz diskutiert und Empfehlungen zum Management der Therapie mit Chlormethin-Gel entwickelt. ERGEBNISSE Wesentlich für die Therapie mit Chlormethin-Gel ist ein individuelles, symptomorientiertes Therapiemanagement. Systemische Nebenwirkungen des Wirkstoffs sind wegen der fehlenden systemischen Verfügbarkeit bei topischer Anwendung unwahrscheinlich. Die häufig auftretende allergische oder irritativ-toxische Kontaktdermatitis kann durch eine Anpassung des Therapieregimes, Therapiepausen sowie nebenwirkungsspezifische und unterstützende Maßnahmen häufig beherrscht werden. Ein einschleichender Therapiebeginn mit Anwendung von Chlormethin-Gel jeden zweiten Tag kann die Tolerabilität wesentlich verbessern, insbesondere wenn die Therapie alternierend mit topischen Kortikosteroiden erfolgt. SCHLUSSFOLGERUNGEN Die Anwendung von Chlormethin-Gel bei Mycosis fungoides wird durch die begleitende Kontaktdermatitis häufig eingeschränkt. Mit einem geeigneten Therapie- und Nebenwirkungsmanagement können vermeidbare Therapieabbrüche verhindert werden und mehr Patienten von der Therapie profitieren.
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Affiliation(s)
- Chalid Assaf
- Klinik für Dermatologie und Venerologie, HELIOS Klinikum Krefeld, Krefeld, Deutschland
| | - Nina Booken
- Klinik und Poliklinik für Dermatologie und Venerologie, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Deutschland
| | - Edgar Dippel
- Hautklinik Ludwigshafen, Ludwigshafen, Deutschland
| | - Emmanuella Guenova
- Klinik für Dermatologie der Universitätsklinik Lausanne, Fakultät für Biologie und Medizin der Universität Lausanne, Lausanne, Schweiz
| | - Constanze Jonak
- Universitätsklinik für Dermatologie, Medizinische Universität Wien, Wien, Österreich
| | - Claus-Detlev Klemke
- Hautklinik und Hauttumorzentrum, Städtisches Klinikum Karlsruhe, Akademisches Lehrkrankenhaus der Universität Freiburg, Freiburg, Deutschland
| | - Jan P Nicolay
- Klinik für Dermatologie, Venerologie und Allergologie, Universitätsklinikum Mannheim GmbH, Mannheim, Deutschland
| | - Max Schlaak
- Klinik für Dermatologie, Venerologie und Allergologie, Hauttumorcentrum, Charité - Universitätsmedizin Berlin corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Deutschland
| | - Marion Wobser
- Klinik und Poliklinik für Dermatologie, Venerologie und Allergologie, Universitätsklinikum Würzburg, Würzburg, Deutschland
| | - Franz Trautinger
- Abteilung für Haut- und Geschlechtskrankheiten, Universitätsklinikum St. Pölten, Karl Landsteiner Privatuniversität für Gesundheitswissenschaften, St. Pölten, Österreich
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17
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Assaf C, Booken N, Dippel E, Guenova E, Jonak C, Klemke C, Nicolay JP, Schlaak M, Wobser M, Trautinger F. The optimal use of chlormethine gel for mycosis fungoides: An expert consensus from Germany, Austria and Switzerland (DACH region). J Dtsch Dermatol Ges 2022; 20:579-586. [DOI: 10.1111/ddg.14688] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2021] [Accepted: 11/11/2021] [Indexed: 11/29/2022]
Affiliation(s)
- Chalid Assaf
- Department of Dermatology and Venereology HELIOS Klinikum Krefeld Krefeld Germany
| | - Nina Booken
- Department of Dermatology and Venereology University Hospital Hamburg‐ Eppendorf Hamburg Germany
| | - Edgar Dippel
- Department of Dermatology Ludwigshafen Medical Center Ludwigshafen Germany
| | - Emmanuella Guenova
- Department of Dermatology Lausanne University Hospital Faculty of Biology and Medicine University of Lausanne Lausanne Switzerland
| | - Constanze Jonak
- Department of Dermatology Medical University of Vienna Vienna Austria
| | - Claus‐Detlev Klemke
- Department of Dermatology and Skin Tumor Center Karlsruhe Medical Center Karlsruhe Germany Academic Teaching Hospital of the University of Freiburg Freiburg Germany
| | - Jan P. Nicolay
- Department of Dermatology Venereology and Allergology University Medical Center Mannheim Mannheim Germany
| | - Max Schlaak
- Department of Dermatology Venereology and Allergology Skin Tumor Center Charité – Universitätsmedizin Berlin corporate member of Freie Universität Berlin and Humboldt‐Universität zu Berlin Berlin Germany
| | - Marion Wobser
- Department of Dermatology Venereology and Allergology Würzburg University Hospital Würzburg Germany
| | - Franz Trautinger
- Department of Dermatology and Venereology University Hospital St. Pölten Karl Landsteiner University of Health Sciences St. Pölten Austria
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18
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Colmant C, Demers MA, Hatami A, Coulombe J, McCuaig CC, Piram M, Marcoux D, Kokta V, Powell J. Pediatric Cutaneous Hematologic Disorders: Cutaneous Lymphoma and Leukemia Cutis: Experience of a Tertiary-Care Pediatric Institution and Review of the Literature. J Cutan Med Surg 2022; 26:349-360. [PMID: 35167768 DOI: 10.1177/12034754221077694] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Cutaneous hematologic malignancies are rare in children, and the literature about them is still sparse. OBJECTIVE The purpose of our study was to report our experience with pediatric cases of cutaneous hematologic disorders and describe their clinical and histological features. METHODS Data were retrospectively collected from the histopathologic database of the CHU Sainte-Justine, University of Montreal, Montreal, Canada. All patients up to 18 years of age with a diagnosis of a primary cutaneous lymphoma (including lymphomatoid papulosis), secondary cutaneous lymphoma or cutaneous manifestations of leukemia, followed from 1980 to 2019 at our center were reviewed. RESULTS Thirty-six patients were included. Age at presentation ranged from birth to 18 years of age (mean 7.83 ± 5.16; median 7.0). Ten different hematologic disorders were identified according to the WHO-EORTC classifications: lymphomatoid papulosis (10 cases), mycosis fungoides (6 cases), anaplastic large cell lymphoma (4 cases), pre-B acute lymphoid leukemia (5 cases), primary cutaneous marginal zone B-cell lymphoma (4 cases), primary cutaneous CD4+medium T-cell lymphoproliferative disorder (1 case), extranodal NK/T-cell lymphoma (1 case), hydroa vacciniforme-like lymphoproliferative disorder (1 case), B-cell lymphoblastic lymphoma (1 case) and acute myeloid leukemia (3 cases). CONCLUSION The most common subtype of cutaneous hematologic disease in our single institution study was lymphomatoid papulosis (type A and type C), followed by mycosis fungoides. Recognition of this large clinical and histological spectrum by dermatologists is important because diagnosis is often established by biopsy of skin lesions, even in secondary cutaneous cases. Moreover, the clinicopathological correlation is of utmost importance for the final diagnosis of those pathologies.
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Affiliation(s)
- Caroline Colmant
- Division of Pediatric Dermatology, Department of Pediatrics, Sainte-Justine University Hospital Center, University of Montreal, Montreal, Quebec, Canada
| | - Marc-André Demers
- Division of Pediatric Dermatology, Department of Pediatrics, Sainte-Justine University Hospital Center, University of Montreal, Montreal, Quebec, Canada
| | - Afshin Hatami
- Division of Pediatric Dermatology, Department of Pediatrics, Sainte-Justine University Hospital Center, University of Montreal, Montreal, Quebec, Canada
| | - Jerome Coulombe
- Division of Pediatric Dermatology, Department of Pediatrics, Sainte-Justine University Hospital Center, University of Montreal, Montreal, Quebec, Canada
| | - Catherine Cameron McCuaig
- Division of Pediatric Dermatology, Department of Pediatrics, Sainte-Justine University Hospital Center, University of Montreal, Montreal, Quebec, Canada
| | - Maryam Piram
- Division of Pediatric Dermatology, Department of Pediatrics, Sainte-Justine University Hospital Center, University of Montreal, Montreal, Quebec, Canada
| | - Danielle Marcoux
- Division of Pediatric Dermatology, Department of Pediatrics, Sainte-Justine University Hospital Center, University of Montreal, Montreal, Quebec, Canada
| | - Victor Kokta
- Department of Pathology, Sainte-Justine University Hospital Center, University of Montreal, Montreal, Quebec, Canada
| | - Julie Powell
- Department of Pathology, Sainte-Justine University Hospital Center, University of Montreal, Montreal, Quebec, Canada
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19
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Reiter O, Amitay-Laish I, Oren-Shabtai M, Feinmesser M, Amitai DB, Hodak E. Pediatric mycosis fungoides - characteristics, management, and outcomes with particular focus on the folliculotropic variant. J Eur Acad Dermatol Venereol 2022; 36:671-679. [PMID: 35080278 DOI: 10.1111/jdv.17971] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2021] [Revised: 11/22/2021] [Accepted: 12/07/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND The literature on pediatric mycosis fungoides (MF) and especially its folliculotropic variant (FMF) is sparse. OBJECTIVES To describe the clinical manifestations, treatments, outcomes and long-term course of pediatric MF, including FMF. METHODS A retrospective analysis was conducted of all consecutive MF patients diagnosed at ≤18 years attending two medical centers in 1995-2015. RESULTS The cohort included 71 patients, all but 2 of whom had early-stage disease: hypopigmented (55%) folliculotropic (42%) and classical MF (39%), alone or in combination. The head and neck area was involved in 43% of patients with early-stage FMF compared to 12% of the non-FMF group (p=0.004). There was no difference in the involvement of other body areas between the groups. Pruritus, although mild, was more often recorded among patients with early-stage FMF compared to non-FMF (58% vs. 29%, respectively, P=0.02). Complete response (CR) was achieved in 60 of the 69 patients with early-stage MF (87%) after an average of 1.8 treatment modalities. NBUVB was the most administered treatment to non-FMF patients with CR rates of 63% versus 29% of FMF patients (P=0.04). Systemic/bath PUVA, or UVA+NBUVB were the most administered treatments to FMF patients with CR rates of 60% versus 81% for non-FMF patients (P=0.17). During a mean follow-up of 9.2 years (range 1-24), stage progression was observed in 4 (6%) of the patients with early-stage disease, 2 of whom (all FMF) to advanced stage. CONCLUSIONS Pediatric MF presents as an early-stage disease with over-representation of hypopigmented and FMF variants. NBUVB and UVA-based therapies yield good response rates in non-FMF and FMF patients, respectively. Disease course is indolent, and even on relatively long follow-up, it has a very low progression rate from early to advanced-stage disease, occurring in patients with FMF. We propose a treatment algorithm for pediatric MF.
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Affiliation(s)
- O Reiter
- Division of Dermatology, Rabin Medical Center - Beilinson Hospital, Petach Tikva, 4941492, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - I Amitay-Laish
- Division of Dermatology, Rabin Medical Center - Beilinson Hospital, Petach Tikva, 4941492, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - M Oren-Shabtai
- Division of Dermatology, Rabin Medical Center - Beilinson Hospital, Petach Tikva, 4941492, Israel
| | - M Feinmesser
- Institute of Pathology, Rabin Medical Center - Beilinson Hospital, Petach Tikva, 4941492, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - D Ben Amitai
- Pediatric Dermatology Unit, Schneider Children's Medical Center of Israel, Petach Tikva, 49420235, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - E Hodak
- Division of Dermatology, Rabin Medical Center - Beilinson Hospital, Petach Tikva, 4941492, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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20
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Gosnell HL, Eikenberg JD, Grider DJ. Persistent Hypopigmented and Scaly Rash: Answer. Am J Dermatopathol 2021; 43:1000-1001. [PMID: 34797797 DOI: 10.1097/dad.0000000000002046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Hailey L Gosnell
- School of Medicine, Virginia Tech Carilion School of Medicine, Roanoke, VA
| | - Joshua D Eikenberg
- Division of Dermatology, Department of Internal Medicine, Virginia Tech Carilion School of Medicine, Roanoke, VA; and
| | - Douglas J Grider
- Division of Dermatology, Department of Internal Medicine, Virginia Tech Carilion School of Medicine, Roanoke, VA; and
- Department of Basic Science Education, Virginia Tech Carilion School of Medicine, Roanoke, VA
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21
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Torre-Castro J, Estrach T, Peñate Y, Acebo E, Fernández de Misa R, Blanes M, Suh-Oh HJ, Botella-Estrada R, Torrelo A, García-Doval I, Machan S. Primary cutaneous lymphomas in children: A prospective study from the Spanish Academy of Dermatology and Venereology (AEDV) Primary Cutaneous Lymphoma Registry. Pediatr Dermatol 2021; 38:1506-1509. [PMID: 34632613 DOI: 10.1111/pde.14811] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND/OBJECTIVES Primary cutaneous lymphomas are rare in pediatric patients. The clinical and histopathological manifestations may differ from those in adults. Due to their low frequency and the insidious clinical picture, the diagnosis is usually delayed. The Spanish Primary Cutaneous Lymphoma Registry was initiated in 2016 as a multicenter registry that would allow better insight into the epidemiological, clinical, histopathological, and treatment response characteristics of patients with primary cutaneous lymphomas. METHODS We conducted a prospective observational cohort study of primary cutaneous lymphomas in pediatric patients participating in the Spanish Academy of Dermatology and Venereology (AEDV) Primary Cutaneous Lymphoma Registry. RESULTS At the time of the analysis, 10 patients under 18 years of age out of 799 all-age cases (1.25%) had been included in the registry (7 males, 3 females). The mean age at diagnosis was 9.7 years (SD: 4.8). Seven (70%) had mycosis fungoides, 2 of them had the folliculotropic variant; and 3 (30%) had primary cutaneous marginal zone B-cell lymphoma. CONCLUSIONS Primary cutaneous lymphomas are extremely rare in pediatric patients and usually have a good prognosis. Therefore, a high level of suspicion is necessary for the diagnosis. We suggest management by experienced physicians and follow-up into adulthood.
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Affiliation(s)
- Juan Torre-Castro
- Department of Dermatology, Hospital Fundación Jiménez Díaz, Madrid, Spain
| | - Teresa Estrach
- Department of Dermatology, Hospital Clinic, IDIBAPS, University of Barcelona, Barcelona, Spain
| | - Yeray Peñate
- Department of Dermatology, Complejo Hospitalario Universitario Insular Materno-Infantil, Las Palmas, Spain
| | - Elvira Acebo
- Department of Dermatology, Hospital Universitario de Cruces, Bizkaia, Spain
| | - Ricardo Fernández de Misa
- Department of Dermatology, Hospital Universitario Nuestra Señora de Candelaria, Santa Cruz de Tenerife, Spain
| | - Mar Blanes
- Department of Dermatology, Hospital General Universitario de Alicante, Alicante, Spain
| | - Hae Jin Suh-Oh
- DIPO Research Group, Galicia Sur Health Research Institute (IIS Galicia Sur), SERGAS-UVIGO, Pontevedra, Spain
| | - Rafael Botella-Estrada
- Department of Dermatology, Hospital Universitario la Fé, Valencia, Spain.,Facultad de Medicina, Universidad de Valencia, Valencia, Spain
| | - Antonio Torrelo
- Department of Dermatology, Hospital Infantil Universitario Niño Jesús, Madrid, Spain
| | | | - Salma Machan
- Department of Dermatology, Hospital Fundación Jiménez Díaz, Madrid, Spain
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22
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Farabi B, Seminario-Vidal L, Jamgochian M, Akay BN, Atak MF, Rao BK, Karagaiah P, Grabbe S, Goldust M. Updated review on prognostic factors in mycosis fungoides and new skin lymphoma trials. J Cosmet Dermatol 2021; 21:2742-2748. [PMID: 34687485 DOI: 10.1111/jocd.14528] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2021] [Accepted: 10/04/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND Ten-year survival rates in mycosis fungoides (MF) broadly varies, however, there is no standardized prognostic index available. This is presumably due to low prevalence, heterogeneity, and diagnostic challenges in MF. Recent studies have focused on identifying objective prognostic indices by using different parameters for survival determinants. The Cutaneous Lymphoma International Prognostic Index (CLIPI) and the Prospective Cutaneous Lymphoma International Prognostic Index (PROCLIPI) represent prototypical studies that identify prognostic factors, seeking to improve management and outcomes in early-stage MF. Detecting these factors and stratifying MF patients according to their disease progression risk may help to manage these patients more efficiently. AIMS Review the current literature to determine the risk factors determining prognosis in MF. METHODOLOGY A Comprehensive literature search was performed using electronic online databases "PubMed" and "Google Scholar" using key words 'prognostic factor', 'prognostic indicator', 'mycosis fungoides', 'Sezary syndrome', 'Skin Lymphoma', 'Cutaneous Lymphoma'. Articles published in English language were considered for the review. RESULTS The strongest prognostic factor in MF patients is the stage of the disease. T stage and the presence of extracutaneous disease are the most important factors for survival. Other factors that are associated with worse prognosis are male gender, age >60, presence of plaques, folliculotropism, eosinophilia and lymph node stage above N1/Nx. Elevated LDH was associated with later tumor stages and large cell phenotype at diagnosis had a better prognosis. KIR3DL2 was associated with malignant transformation. CONCLUSION The PROCLIPI study has assessed risk factors collected in MF patients from different countries and across different ethnicities following a rigorous clinicopathologic process. The findings presented here illustrated that disease prognosis in early stages depends on many contributing factors. Detection and stratification of such factors may allow a personalized approach to management of these patients.
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Affiliation(s)
- Banu Farabi
- Department of Internal Medicine, Saint Peter's University Hospital, New Brunswick, New Jersey, USA
| | - Lucia Seminario-Vidal
- Department of Dermatology, Department of Cutaneous Oncology, Moffitt Cancer Center and Research Institute, University of South Florida Health Morsani College of Medicine, Tampa, Florida, USA
| | - Marielle Jamgochian
- Department of Dermatology, Robert Wood Johnson Medical Center, Rutgers University, New Brunswick, New Jersey, USA
| | | | | | - Babar K Rao
- Dermatology Department, Weil Cornell Medicine, NY, Somerset, New Jersey, USA
| | - Priyanka Karagaiah
- Department of dermatology, Bangalore Medical College and Research Institute, Bangalore, India
| | - Stephan Grabbe
- Department of Dermatology, University Medical Center of the Johannes Gutenberg University, Mainz, Germany
| | - Mohamad Goldust
- Department of Dermatology, University Medical Center Mainz, Mainz, Germany
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Charli-Joseph Y, Kashani-Sabet M, McCalmont TH, Kornak J, Allen I, Ai WZ, LeBoit PE, Pincus LB. Association of a Proposed New Staging System for Folliculotropic Mycosis Fungoides With Prognostic Variables in a US Cohort. JAMA Dermatol 2021; 157:157-165. [PMID: 33295938 DOI: 10.1001/jamadermatol.2020.4372] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Importance A new cutaneous staging system for folliculotropic mycosis fungoides (FMF) has been purported to better estimate survival compared with the staging system for conventional mycosis fungoides. Objective To analyze predictive variables associated with survival and evaluate the effectiveness of the newly proposed staging system for estimating overall survival and disease-specific survival (DSS) in a US cohort. Design, Setting, and Participants This cohort study assessed 195 patients with FMF in the dermatopathology database of the University of California, San Francisco from January 1, 1990, to April 31, 2012, for eligibility. A total of 153 patients were excluded for the following reasons: (1) alternative diagnoses were favored ranging from benign dermatitides to other forms of cutaneous lymphoma; (2) technical problems with slides; and (3) lack of follow-up information. Data were analyzed from January 1, 2018, to August 31, 2020. Main Outcomes and Measures Kaplan-Meier curves were used to estimate overall survival and DSS for the entire cohort. Possible predictive variables associated with survival were evaluated using Cox proportional hazards regression modeling. Each variable was examined separately, followed by a multiple-variable model. Kaplan-Meier curves were used to estimate overall survival and DSS by subdividing the cohort into early- and advanced-stage cutaneous disease. Results Forty-two patients were included in the analysis (mean age at diagnosis, 55 [range, 8-89] years; 31 men [74%]). For the entire cohort, the estimated 5-year overall survival rate was 89% (95% CI, 79%-99%); 10-year rate, 78% (95% CI, 63%-92%); and 15-year rate, 58% (95% CI, 31%-85%). Estimated 5- and 10-year DSS rates were 89% (95% CI, 79%-99%); 15-year rate, 80% (95% CI, 61%-99%). For overall survival in the multiple-variable Cox proportional hazards regression model, only age was statistically significant (hazard ratio [HR] per 10-year age increase, 3.1; 95% CI, 1.4-7.2; P = .008), whereas for DSS, only cutaneous disease was statistically significant (HR, 11.4; 95% CI, 1.3-103.0; P = .03). When stage stratified, the 5-year estimated overall survival rate for early-stage disease was 96% (95% CI, 89%-103%); 10-year rate, 82% (95% CI, 65%-98%); and 15-year rate, 65% (95% CI, 33%-97%). For advanced-stage disease, the estimated 5- and 10-year overall survival rates were 70% (95% CI, 41%-98%); the 15-year rate, 53% (95% CI, 16%-89%). For early-stage cutaneous disease, the estimated 5-, 10- and 15-year DSS rates were all 96% (95% CI, 89%-103%). For advanced-stage cutaneous disease, the estimated 5- and 10-year DSS rates were 70% (95% CI, 41%-98%); the 15-year rate, 53% (95% CI, 16%-89%). Conclusions and Relevance Cox proportional hazards regression modeling demonstrated cutaneous stage to be the only statistically significant predictive variable associated with DSS. Subdividing FMF into early and advanced cutaneous stages was associated with effective estimation of survival in this cohort. Thus, findings suggest that FMF is a heterogeneous disease with early and advanced cutaneous stages; that the new staging system is effective in estimating survival in a US cohort; and that the poor prognosis initially associated with FMF only applies to the advanced cutaneous stage.
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Affiliation(s)
- Yann Charli-Joseph
- Cutaneous Hematopathology Clinic, Department of Dermatology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | | | - Timothy H McCalmont
- Dermatopathology Service, Departments of Pathology and Dermatology, University of California, San Francisco.,University of California, San Francisco Helen A. Diller Family Comprehensive Cancer Center
| | - John Kornak
- Department of Epidemiology and Biostatistics, University of California, San Francisco
| | - Isabel Allen
- Department of Epidemiology and Biostatistics, University of California, San Francisco
| | - Weiyun Z Ai
- Division of Hematology and Oncology, Department of Medicine, University of California, San Francisco
| | - Philip E LeBoit
- Dermatopathology Service, Departments of Pathology and Dermatology, University of California, San Francisco.,University of California, San Francisco Helen A. Diller Family Comprehensive Cancer Center
| | - Laura B Pincus
- Dermatopathology Service, Departments of Pathology and Dermatology, University of California, San Francisco
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24
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Miyashiro D, Sanches JA. Characteristics and outcomes of 727 patients with mycosis fungoides and Sézary syndrome from a Brazilian cohort. Int J Dermatol 2021; 61:442-454. [PMID: 34435672 DOI: 10.1111/ijd.15865] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2021] [Revised: 07/28/2021] [Accepted: 07/30/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND Mycosis fungoides (MF) and Sézary syndrome (SS) are the most prevalent cutaneous lymphomas. They were not described in a large Brazilian cohort yet. We aimed, with this single-center, retrospective cohort analysis, to describe the characteristics and outcomes of MF/SS in a tertiary public health service in Brazil. METHODS MF/SS patients evaluated at the University of São Paulo Medical School between 1989 and 2018 were included. Data were collected at diagnosis. Demographic, clinical, histopathological, immunopathological, molecular, laboratory, and follow-up data were analyzed. RESULTS Among 727 patients, 92.6% (673) were diagnosed with MF, 7.4% (54) with SS. There were 51.2% (372) of males, 48.8% (355) of females. The median age was 51.8 years; it was higher in erythrodermic MF (60.2) and SS (60.9). Among MF, 41.8% (281) had classic MF, 4.9% (33) folliculotropic MF, 1.8% (12) granulomatous slack skin, and 0.3% (2) pagetoid reticulosis. Common subtypes included erythrodermic (14.1%, 95), hypopigmented (10.8%, 73), and poikilodermatous MF (10.8%, 73). Extracutaneous involvement was rare. Five, 10, 20, and 30-year overall survival rates were 97.3%, 92.4%, 82.6%, and 82.6% for early-stage, and 58.6%, 42.7%, 20.8%, and 15.4% for advanced-stage disease, respectively. After multivariate analysis, SS diagnosis, folliculotropic MF, erythrodermic MF, clinical stage, age (≥60 years), increased lactate dehydrogenase, and large cell transformation conferred poorer prognosis. CONCLUSIONS We observed a higher percentage of hypopigmented MF compared to the literature, and demographic (older age) and prognostic (poorer prognosis) similarities between erythrodermic MF and SS, suggesting a possible relationship between these erythrodermic lymphomas. Factors associated with a poorer prognosis were compatible with the literature.
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Affiliation(s)
- Denis Miyashiro
- Division of Clinical Dermatology, Hospital das Clínicas, University of São Paulo Medical School, São Paulo, Brazil
| | - José A Sanches
- Division of Clinical Dermatology, Hospital das Clínicas, University of São Paulo Medical School, São Paulo, Brazil
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25
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Wohlmuth-Wieser I. Primary cutaneous T-cell lymphomas in childhood and adolescence. J Dtsch Dermatol Ges 2021; 19:563-581. [PMID: 33861015 DOI: 10.1111/ddg.14509] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2021] [Accepted: 03/09/2021] [Indexed: 12/12/2022]
Abstract
Primary cutaneous lymphomas are extranodal non-Hodgkin lymphomas of T- or B- cell origin, that predominantly affect older patients but have been reported in all age groups and as early as in the first years of life. Diagnosis of cutaneous lymphomas is challenging and requires high clinical suspicion and close collaboration between dermatologists, pediatric oncologists and pathologists. Skin involvement of non-Hodgkin lymphomas in children or adolescents can either be primary cutaneous or secondary due to an underlying nodal lymphoma. The most common primary cutaneous lymphomas encountered in children are of T-cell origin, with mycosis fungoides being the most prevalent cutaneous T-cell lymphoma, followed by CD30+ lymphoproliferative disorders. While cutaneous lymphomas share clinicopathologic characteristics between juvenile and adult forms, there are important differences in terms of clinical presentation, diagnosis and treatment. The hypopigmented variant of mycosis fungoides seems to be overrepresented in the pediatric age group. Prognosis and treatment of mycosis fungoides are stage dependent. The majority of children present with early-stage disease and respond well to topical corticosteroids and phototherapy.
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Affiliation(s)
- Iris Wohlmuth-Wieser
- Department of Dermatology and Allergology, Paracelsus Medical University Salzburg, Salzburg, Austria
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26
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Abstract
The cutaneous lymphomas are malignancies of T-cell and B-cell lymphocytes in which the skin is the primary organ of involvement. The cutaneous T-cell lymphomas include variants that can mimic the presentation of common skin diseases or arthropod bites. Mycosis fungoides, the most common cutaneous T-cell lymphoma, usually presents as fixed asymptomatic patches or plaques in sun-protected areas. The cutaneous B-cell lymphomas have fewer variants that often present as papules or nodules that can mimic nonmelanoma skin cancers. Some therapies for cutaneous lymphoma have unique side effects such as central hypothyroidism, hyperlipidemia, and peripheral neuropathy.
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MESH Headings
- Aged
- Aged, 80 and over
- Animals
- Antineoplastic Agents/adverse effects
- Antineoplastic Agents, Immunological/adverse effects
- Arthropods
- Bexarotene/adverse effects
- Bites and Stings/diagnosis
- Brentuximab Vedotin/adverse effects
- Diagnosis, Differential
- Humans
- Hyperlipidemias/chemically induced
- Hypothyroidism/chemically induced
- Lymphoma, Primary Cutaneous Anaplastic Large Cell/diagnosis
- Lymphoma, T-Cell, Cutaneous/classification
- Lymphoma, T-Cell, Cutaneous/diagnosis
- Lymphoma, T-Cell, Cutaneous/therapy
- Lymphomatoid Papulosis/diagnosis
- Mycosis Fungoides/diagnosis
- Peripheral Nervous System Diseases/chemically induced
- Prognosis
- Sezary Syndrome/diagnosis
- Skin Diseases/diagnosis
- Skin Diseases/pathology
- Skin Neoplasms/pathology
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Affiliation(s)
- John A Zic
- Department of Dermatology, VU Cutaneous Lymphoma Clinic, Vanderbilt University Medical Center, Vanderbilt Dermatology, One Hundred Oaks, 719 Thompson Lane, Suite 26300, Nashville, TN 37204-3609, USA.
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27
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Clinical characteristics and long-term outcome of 223 patients with mycosis fungoides at a single tertiary center in Korea: A 29-year review. J Am Acad Dermatol 2021; 86:1275-1284. [PMID: 34197872 DOI: 10.1016/j.jaad.2021.06.860] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2021] [Revised: 06/16/2021] [Accepted: 06/20/2021] [Indexed: 11/23/2022]
Abstract
BACKGROUND Data regarding Asian patients with mycosis fungoides (MF) are limited. OBJECTIVE We aimed to investigate the clinical profile and long-term outcomes of patients with MF in Korea. METHODS A retrospective review of 223 patients with MF who were followed up for more than 6 months or died of MF within 6 months of diagnosis was performed. RESULTS Approximately 96.4% and 3.6% of the patients had an early stage and advanced stage, respectively. The mean age at diagnosis was 44.8 years. The mean duration of symptoms before diagnosis was 47.0 months. Various subtypes were noted, including mycosis fungoides palmaris et plantaris (21.5%), folliculotropic (8.5%), pityriasis lichenoides-like (6.7%), ichthyosiform (4.0%), lichenoid purpura-like (2.7%), and hypopigmented (2.2%) MF. Juvenile patients accounted for 16.6%. The higher the skin T stage, the poorer the response to treatment. The 10-year overall survival was 96.8% in early-stage patients and 25.0% in advanced-stage patients. General prognosis was favorable, while recurrence and subtype switching were seen in 29.4% and 2.7% of patients, respectively. LIMITATIONS Our patients may not represent all Korean patients with MF. CONCLUSION MF in Korea has a high proportion of variants, a younger age at onset, and favorable prognosis. A high index of suspicion and skin biopsy are needed for early diagnosis.
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Roca-Ginés J, Alfaro-Cervelló C, Sánchez-Arraez J, Torres-Navarro I, Navarro-Mira MÁ, Monteagudo C, Botella-Estrada R. Folliculotropic Mycosis Fungoides With Flexural Eruptive Cysts and Comedones in a 14-Year-Old Boy. Am J Dermatopathol 2021; 43:656-658. [PMID: 33989213 DOI: 10.1097/dad.0000000000001958] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
- Juncal Roca-Ginés
- Dermatology Department, Hospital Universitario y Politécnico la Fe, Valencia, Spain
| | - Clara Alfaro-Cervelló
- Pathology Department, Hospital Clínico Universitario de Valencia, Valencia, Spain; and.,Departments of Pathology, and
| | | | | | | | - Carlos Monteagudo
- Pathology Department, Hospital Clínico Universitario de Valencia, Valencia, Spain; and.,Departments of Pathology, and
| | - Rafael Botella-Estrada
- Dermatology Department, Hospital Universitario y Politécnico la Fe, Valencia, Spain.,Medicine, School of Medicine, Universitat de València, Valencia, Spain
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29
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Wohlmuth-Wieser I. Primär kutane T‐Zell‐Lymphome im Kindes‐ und Jugendalter. J Dtsch Dermatol Ges 2021; 19:563-583. [PMID: 33861014 DOI: 10.1111/ddg.14509_g] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2021] [Accepted: 03/09/2021] [Indexed: 12/18/2022]
Abstract
Primär kutane Lymphome sind extranodale T- oder B-Zell-Non-Hodgkin-Lymphome, die vorwiegend ältere Patienten betreffen, aber in allen Altersgruppen einschließlich der ersten Lebensjahre auftreten können. Die Diagnose kutaner Lymphome ist eine Herausforderung und erfordert einen hohen klinischen Verdacht sowie enge Zusammenarbeit zwischen Dermatologen, pädiatrischen Onkologen und Pathologen. Generell müssen primär kutane Lymphome von sekundär kutanen Lymphomen, welche meist von nodalen oder extranodalen Lymphomen ausgehen, unterschieden werden. Die häufigsten primär kutanen Lymphome im Kindesalter sind T-Zell Lymphome, wobei Mycosis fungoides das häufigste kutane T-Zell-Lymphom darstellt, gefolgt von CD30+ lymphoproliferativen Erkrankungen. Während klinisch-pathologische Merkmale kutaner Lymphome bei Jugendlichen und Erwachsenen ähnlich sind, gibt es wichtige Unterschiede bezüglich klinischer Präsentation, Diagnose und Behandlung. Die hypopigmentierte Variante der Mycosis fungoides scheint in der pädiatrischen Altersgruppe überrepräsentiert zu sein. Prognose und Behandlung der Mycosis fungoides sind stadienabhängig. Die Mehrheit der Kinder weist ein frühes Krankheitsstadium auf und spricht gut auf topische Kortikosteroide und Phototherapie an.
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Affiliation(s)
- Iris Wohlmuth-Wieser
- Klinik für Dermatologie und Allergologie, Paracelsus Medizinische Privatuniversität Salzburg, Österreich
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30
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Tomasini C, Michelerio A, Quaglino P. Spiky/keratosis-pilaris-like early follicular mycosis fungoides: A clinicopathologic study of 20 cases with extended follow-up. J Cutan Pathol 2021; 48:1124-1132. [PMID: 33675561 DOI: 10.1111/cup.14002] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2020] [Revised: 12/21/2020] [Accepted: 03/01/2021] [Indexed: 12/12/2022]
Abstract
BACKGROUNDS Follicular mycosis fungoides (FMFs) is a distinct form of T-cell lymphoma whose course is considered aggressive. METHODS A retrospective study with long-term follow-up of 20 patients diagnosed with spiky/keratosis-pilaris-like FMF between 2008 and 2017 was conducted. RESULTS Twelve males and eight females were identified, with a mean age at first diagnosis of 59 years (range 42-86). Hyperkeratotic follicular papules were the sole clinical finding in 16 of 20 patients. A diagnostic delay between first symptom development and initial diagnosis was frequent (mean 42 months). The head/neck region was concurrently affected only in two patients. Disease stage at diagnosis was IA in two patients (10%) and IB in 18 (90%). Five patients had almost complete lesion regression, whilst there was only a slight improvement, without regression in 14. Two patients developed infiltrated papules, comedones, and small cysts during follow-up. Only one patient progressed to tumor stage (IIB) five years after the first diagnosis. The mean follow-up was seven years (range: 12-180 months). None of them died of cutaneous lymphoma. CONCLUSIONS FMF presenting with only spiky/keratosis-pilaris-like lesions have an excellent prognosis at medium-term follow-up. Early recognition of patients with this peculiar FMF presentation might lead to identifying prognostic factors.
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Affiliation(s)
- Carlo Tomasini
- Dermatology Clinic, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy.,Department of Clinical-Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy
| | - Andrea Michelerio
- Dermatology Clinic, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy.,Department of Clinical-Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy
| | - Pietro Quaglino
- Department of Medical Sciences, Dermatologic Clinic, University of Turin, Turin, Italy
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31
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Clinicoprognostic implications of head and neck involvement by mycosis fungoides: A retrospective cohort study. J Am Acad Dermatol 2021; 86:1258-1265. [PMID: 33771590 DOI: 10.1016/j.jaad.2021.03.056] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2020] [Revised: 03/10/2021] [Accepted: 03/14/2021] [Indexed: 12/12/2022]
Abstract
BACKGROUND The clinicoprognostic implications of head and neck involvement of mycosis fungoides (MF) are poorly understood. OBJECTIVES To evaluate the association of head and neck involvement on the clinicoprognostic features of MF. METHODS The clinical features and survival outcomes of patients with MF in a Korean academic medical center database were retrospectively evaluated according to the presence of head and neck involvement at diagnosis. FINDINGS Cases of MF with (group A, n = 39) and without (group B, n = 85) head and neck involvement at diagnosis were identified. Advanced-stage disease (stages IIB-IVB) was more common in group A (43.6%) than in group B (5.9%) (P < .001). MF progression, extracutaneous dissemination, and large-cell transformation more commonly occurred in group A than in group B. The 10-year overall survival rate was worse in group A (53.4%) compared with group B (81.6%) (P < .001). Head and neck involvement at diagnosis was associated with poor prognosis in early-stage MF (stages IA-IIA) and was independently associated with worse progression-free survival (hazard ratio, 24.4; 95% confidence interval, 2.2-267.6; P = .009). LIMITATIONS A single center, retrospective design. CONCLUSION Head and neck involvement of MF was associated with a poor prognosis.
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32
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Rubio-Gonzalez B, Frieden IJ, McCalmont TH, Dorsey M, Funk T, Pincus LB. Folliculotropic mycosis fungoides driven by DOCK8 immunodeficiency syndrome. Pediatr Dermatol 2021; 38:229-232. [PMID: 33099799 DOI: 10.1111/pde.14424] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
DOCK8 immunodeficiency syndrome (DIDS) represents a rare primary immunodeficiency associated with cutaneous viral infections, allergy, and increased risk of malignancy. We report a case of folliculotropic mycosis fungoides with spontaneous resolution occurring in a patient with DIDS.
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Affiliation(s)
- Belen Rubio-Gonzalez
- Department of Pathology, University of California San Francisco, San Francisco, CA, USA
| | - Ilona J Frieden
- Department of Dermatology, University of California San Francisco, San Francisco, CA, USA
| | - Timothy H McCalmont
- Department of Pathology, University of California San Francisco, San Francisco, CA, USA.,Department of Dermatology, University of California San Francisco, San Francisco, CA, USA
| | - Morna Dorsey
- Division of Pediatric Allergy, Immunology and Bone Marrow Transplantation, Benioff Children's Hospital, University of California San Francisco, San Francisco, CA, USA
| | - Tracy Funk
- Department of Dermatology, Oregon Health and Science University, Portland, OR, USA
| | - Laura B Pincus
- Department of Pathology, University of California San Francisco, San Francisco, CA, USA.,Department of Dermatology, University of California San Francisco, San Francisco, CA, USA
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33
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Lu CW, Lu LY, Yen H, Sun PL, Huang YL. Juvenile folliculotropic mycosis fungoides mimicking tinea capitis: A case report and literature review. DERMATOL SIN 2021. [DOI: 10.4103/ds.ds_15_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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35
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Valencia Ocampo O, Julio L, Zapata V, Correa L, Vasco C, Correa S, Velásquez-Lopera M. Micosis fungoide en niños y adolescentes: descripción de una serie de 23 casos. ACTAS DERMO-SIFILIOGRAFICAS 2020; 111:149-156. [DOI: 10.1016/j.ad.2019.04.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2018] [Revised: 04/25/2019] [Accepted: 04/26/2019] [Indexed: 10/26/2022] Open
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36
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Wu JH, Cohen BA, Sweren RJ. Mycosis fungoides in pediatric patients: Clinical features, diagnostic challenges, and advances in therapeutic management. Pediatr Dermatol 2020; 37:18-28. [PMID: 31630432 DOI: 10.1111/pde.14026] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Mycosis fungoides (MF) is the most common primary cutaneous lymphoma in pediatric patients. Given the indolent nature of MF, symptoms often present in childhood but may not be diagnosed as MF until adulthood. Delayed diagnosis is associated with poor long-term prognosis. Thus, increased clinician recognition and accurate diagnosis of early-stage MF in pediatric patients is critically important. In this review, we summarize the clinical features of the most common pediatric MF subtypes and highlight important differences between pediatric and adult MF. Moreover, we reviewed all pediatric MF case series published between 2008 and 2018 to analyze treatment modalities and identify emerging therapies. As treatment of pediatric MF is complex, selection of therapy varies significantly depending upon the specific clinical characteristics, disease severity, and patients' preferences.
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Affiliation(s)
- Julie H Wu
- Memorial Sloan Kettering Cancer Center, New York, New York
| | - Bernard A Cohen
- Department of Dermatology, Johns Hopkins University School of Medicine, Baltimore, Maryland.,Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Ronald J Sweren
- Department of Dermatology, Johns Hopkins University School of Medicine, Baltimore, Maryland
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37
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Sidiropoulou P, Nikolaou V, Marinos L, Voudouri D, Komini E, Economidi A, Rigopoulos D, Stratigos A. The different faces of mycosis fungoides: results of a single‐center study. Int J Dermatol 2019; 59:314-320. [DOI: 10.1111/ijd.14735] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2019] [Revised: 10/21/2019] [Accepted: 11/05/2019] [Indexed: 12/13/2022]
Affiliation(s)
- Polytimi Sidiropoulou
- 1st Department of Dermatology‐Venereology Faculty of Medicine National and Kapodistrian University of Athens Cutaneous Lymphoma Clinic, “A. Sygros” Hospital for Skin & Venereal Diseases Athens Greece
| | - Vasiliki Nikolaou
- 1st Department of Dermatology‐Venereology Faculty of Medicine National and Kapodistrian University of Athens Cutaneous Lymphoma Clinic, “A. Sygros” Hospital for Skin & Venereal Diseases Athens Greece
| | - Leonidas Marinos
- Hematopathology Department “Evangelismos” General Hospital Athens Greece
| | - Dimitra Voudouri
- 1st Department of Dermatology‐Venereology Faculty of Medicine National and Kapodistrian University of Athens Cutaneous Lymphoma Clinic, “A. Sygros” Hospital for Skin & Venereal Diseases Athens Greece
| | - Elena Komini
- 1st Department of Dermatology‐Venereology Faculty of Medicine National and Kapodistrian University of Athens Cutaneous Lymphoma Clinic, “A. Sygros” Hospital for Skin & Venereal Diseases Athens Greece
| | - Afroditi Economidi
- 1st Department of Dermatology‐Venereology Faculty of Medicine National and Kapodistrian University of Athens Cutaneous Lymphoma Clinic, “A. Sygros” Hospital for Skin & Venereal Diseases Athens Greece
| | - Dimitris Rigopoulos
- 1st Department of Dermatology‐Venereology Faculty of Medicine National and Kapodistrian University of Athens Cutaneous Lymphoma Clinic, “A. Sygros” Hospital for Skin & Venereal Diseases Athens Greece
| | - Alexander Stratigos
- 1st Department of Dermatology‐Venereology Faculty of Medicine National and Kapodistrian University of Athens Cutaneous Lymphoma Clinic, “A. Sygros” Hospital for Skin & Venereal Diseases Athens Greece
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Nasimi M, Kamyab K, Aghahi T, Fahim S, Ghandi N. Childhood mycosis fungoides: A clinicopathologic study of 30 cases from Iran. Australas J Dermatol 2019; 61:e259-e261. [DOI: 10.1111/ajd.13192] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Maryam Nasimi
- Department of Dermatology Autoimmune Bullous Disease Research Centre Razi Hospital Tehran University of Medical Sciences Tehran Iran
| | - Kambiz Kamyab
- Department of pathology Razi Hospital Tehran University of Medical Sciences Tehran Iran
| | - Tahereh Aghahi
- Student of medicine Tehran University of Medical Sciences Tehran Iran
| | - Shabnam Fahim
- Department of Dermatology Pediatric Dermatology Fellowship Razi Hospital Tehran University of Medical Sciences Tehran Iran
| | - Narges Ghandi
- Department of Dermatology Autoimmune Bullous Disease Research Centre Razi Hospital Tehran University of Medical Sciences Tehran Iran
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Saleem MD, Oussedik E, Picardo M, Schoch JJ. Acquired disorders with hypopigmentation: A clinical approach to diagnosis and treatment. J Am Acad Dermatol 2018; 80:1233-1250.e10. [PMID: 30236514 DOI: 10.1016/j.jaad.2018.07.070] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2017] [Revised: 07/09/2018] [Accepted: 07/13/2018] [Indexed: 02/07/2023]
Abstract
Acquired hypopigmented skin changes are commonly encountered by dermatologists. Although hypopigmentation is often asymptomatic and benign, occasional serious and disabling conditions present with cutaneous hypopigmentation. A thorough history and physical examination, centered on disease distribution and morphologic findings, can aid in delineating the causes of acquired hypopigmented disorders. The second article in this 2-part continuing medical education series focuses on conditions with a hypopigmented phenotype. Early diagnosis and appropriate management of these disorders can improve a patient's quality of life, halt disease progression, and prevent irreversible disability.
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Affiliation(s)
- Mohammed D Saleem
- Department of Internal Medicine, University of Florida College of Medicine and University of Florida Health, Gainesville, Florida.
| | | | - Mauro Picardo
- Department of Dermatology and Pediatric Dermatology, Cutaneous Physiopathology and Integrated Center of Metabolomics Research, San Gallicano Dermatologic Institute, IRCCS, Rome, Italy
| | - Jennifer J Schoch
- Department of Dermatology, University of Florida, Gainesville, Florida; Department of Pediatrics, University of Florida, Gainesville, Florida
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41
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Boix-Vilanova J, Corral-Magaña O, Martin-Santiago A, Escalas J. Folliculotropic mycosis fungoides in a pediatric patient with response to psoralen-ultraviolet A phototherapy. PHOTODERMATOLOGY PHOTOIMMUNOLOGY & PHOTOMEDICINE 2018; 35:54-56. [DOI: 10.1111/phpp.12414] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/15/2018] [Revised: 06/11/2018] [Accepted: 07/03/2018] [Indexed: 11/26/2022]
Affiliation(s)
| | | | | | - Juan Escalas
- Dermatology Department; Hospital Universitari Son Espases; Palma Spain
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Amitay-Laish I, Reiter O, Prag-Naveh H, Kershenovich R, Hodak E. Retinoic acid receptor agonist as monotherapy for early-stage mycosis fungoides: does it work? J DERMATOL TREAT 2018; 30:258-263. [PMID: 29889596 DOI: 10.1080/09546634.2018.1487525] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
BACKGROUND Retinoids exert their biologic effects by binding to intracellular retinoic-acid receptors (RARs) and/or retinoid X receptors (RXRs). Early-stage mycosis fungoides (MF) has been effectively treated with bexarotene, an RXR-agonist, with overall response (OR) rates 54-67% and complete response (CR) rates 7-27%. Data on RAR-agonist monotherapy are limited. OBJECTIVE To analyze the effectiveness of RAR-agonist monotherapy for early-stage MF. METHODS Data on patients with early-stage MF treated with acitretin/isotretinoin monotherapy at a tertiary cutaneous lymphoma clinic in 2010-2017 were collected retrospectively from the medical files. RESULTS Thirty-five patients (26 males) of median age 50 years (range 8-83) with early-stage MF (IA 9, IB 26) underwent 37 treatment events: 25 acitretin and 12 isotretinoin at a median dosages of 0.3 mg/kg (range 0.2-0.9) and 0.2 mg/kg (range 0.1-0.7), respectively. Median time to maximal response was 6 months for both (range 1-10 for acitretin, 3-16 for isotretinoin); median treatment duration was 10 months (range 3-46) for acitretin, and 9 months (range 3-55) for isotretinoin. OR was 64% for acitretin and 80% for isotretinoin, and CR, 4% and 8%, respectively. Side-effect profiles were as previously reported for retinoids. CONCLUSIONS Early-stage MF patients may benefit from low dose RAR-agonist monotherapy, although the CR rate is low.
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Affiliation(s)
- Iris Amitay-Laish
- a Department of Dermatology , Rabin Medical Center, Beilinson Hospital , Petach Tikva, Israel.,b Sackler Faculty of Medicine , Tel Aviv University , Tel Aviv , Israel
| | - Ofer Reiter
- a Department of Dermatology , Rabin Medical Center, Beilinson Hospital , Petach Tikva, Israel.,b Sackler Faculty of Medicine , Tel Aviv University , Tel Aviv , Israel
| | - Hadas Prag-Naveh
- a Department of Dermatology , Rabin Medical Center, Beilinson Hospital , Petach Tikva, Israel
| | - Ruben Kershenovich
- a Department of Dermatology , Rabin Medical Center, Beilinson Hospital , Petach Tikva, Israel
| | - Emmilia Hodak
- a Department of Dermatology , Rabin Medical Center, Beilinson Hospital , Petach Tikva, Israel.,b Sackler Faculty of Medicine , Tel Aviv University , Tel Aviv , Israel
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Rovaris M, Colato C, Girolomoni G. Pediatric CD8+/CD56+ mycosis fungoides with cytotoxic marker expression: A variant with indolent course. J Cutan Pathol 2018; 45:782-785. [DOI: 10.1111/cup.13317] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2018] [Revised: 06/14/2018] [Accepted: 06/28/2018] [Indexed: 12/19/2022]
Affiliation(s)
- Marco Rovaris
- Department of Medicine, Section of Dermatology and Venereology; University of Verona; Verona Italy
| | - Chiara Colato
- Department of Pathology and Diagnostics, Section of Pathology; University of Verona; Verona Italy
| | - Giampiero Girolomoni
- Department of Medicine, Section of Dermatology and Venereology; University of Verona; Verona Italy
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Juvenile-Onset Early-Stage Mycosis Fungoides-Associated Follicular Mucinosis: A Case Report. Am J Dermatopathol 2018; 40:e112-e114. [PMID: 29927752 DOI: 10.1097/dad.0000000000001114] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
We report a juvenile case of mycosis fungoides with prominent follicular mucinosis (FM). The patient was a 9-year old boy who presented with a 2-month history of enlarging alopecic patch with fine scales on the scalp. Dermatologic examination revealed orange-tan slightly palpable plaques with follicular prominence on his trunk. The patient and his family were not aware of these asymptomatic truncal plaques. Histopathologic examination of both-scalp and trunk-lesions revealed folliculotropic lymphocytic infiltration with mucin. Immunohistochemical study showed that lymphocytic infiltration was CD4 dominant. Flow cytometry analyses of peripheral blood were normal. Any abnormal populations and Sézary cells were not observed on blood smear. Polymerase chain reaction testing showed monoclonality for the T-cell receptor4-[Latin Small Letter Rams Horn] gene. Our patient had the clinical and histopathological diagnosis of follicular mycosis fungoides-associated follicular mucinosis.
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Mitteldorf C, Stadler R, Sander CA, Kempf W. Folliculotropic mycosis fungoides. J Dtsch Dermatol Ges 2018; 16:543-557. [DOI: 10.1111/ddg.13514] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2017] [Accepted: 11/28/2017] [Indexed: 01/02/2023]
Affiliation(s)
- Christina Mitteldorf
- Department of DermatologyVenereology and AllergologyHELIOS Medical Center Hildesheim Hildesheim Germany
- Department of DermatologyVenereology and AllergologyGöttingen University Medical Center Göttingen Germany
| | - Rudolf Stadler
- Department of DermatologyVenereologyAllergologyand PhlebologyMühlenkreisklinikenJohannes Wesling Medical Center Minden Germany
| | - Christian A. Sander
- Eduard Arning Department of Dermatology and AllergologyAsklepios Klinik St. Georg Hamburg Germany
| | - Werner Kempf
- Kempf und PfaltzDermatopathology Laboratory Zurich Switzerland
- Department of DermatologyVenereology and AllergologyZurich University Hospital Zurich Switzerland
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46
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Mitteldorf C, Stadler R, Sander CA, Kempf W. Die follikulotrope Mycosis fungoides. J Dtsch Dermatol Ges 2018; 16:544-559. [DOI: 10.1111/ddg.13514_g] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2017] [Accepted: 11/28/2017] [Indexed: 11/28/2022]
Affiliation(s)
- Christina Mitteldorf
- Klinik für DermatologieVenerologie und AllergologieHELIOS Klinikum Hildesheim
- Klinik für DermatologieVenerologie und Allergologie Göttingen
| | - Rudolf Stadler
- Universitätsklinik für DermatologieVenerologieAllergologie und PhlebologieMühlenkreisklinikenJohannes Wesling Klinikum Minden
| | - Christian A. Sander
- Eduard‐Arning‐Klinik für Dermatologie und AllergologieAsklepios Klinik St. Georg Hamburg
| | - Werner Kempf
- Kempf und Pfaltz histologische Diagnostik Zürich
- Universitätsspital ZürichKlinik für DermatologieVenerologie und Allergologie Zürich
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Abstract
This article focuses on cutaneous hematopoietic neoplasms that are more likely to be encountered in the pediatric age-group and includes both lymphoproliferative and histiocytic disorders. The cutaneous hematologic disorders in children have a different epidemiologic profile to what is seen during adulthood. Although mycosis fungoides is the most frequent form of cutaneous lymphoma in adults, it is very rare in children. Because lymphoblastic leukemias and lymphomas are more frequent in the pediatric setting, cutaneous leukemic infiltrates are relatively common in this age-group. Similarly, histiocytic disorders are more common in children, particularly Langerhans cell histiocytosis and juvenile xanthogranuloma. Notably, the histiocytic disorders have undergone significant modifications on their nomenclature in the basis of the molecular characteristics that are present in them. A summary of the most frequent cutaneous hematopoietic disorders in children will be discussed further in this review.
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Affiliation(s)
- Alejandro A Gru
- 1 Department of Pathology, University of Virginia, Charlottesville, Virginia
| | - Louis P Dehner
- 2 Lauren V. Ackerman Laboratory of Surgical Pathology, St. Louis Children's Hospital and Dermatopathology, Washington University Medical Center, St. Louis, Missouri
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48
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Emge DA, Lewis DJ, Aung PP, Duvic M. How to Discern Folliculotropic Mycosis Fungoides From Follicular Mucinosis Using a Pediatric Case. J Cutan Med Surg 2018; 22:336-340. [DOI: 10.1177/1203475417752366] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Folliculotropic mycosis fungoides (FMF) is a variant of mycosis fungoides (MF) with folliculotropic, atypical lymphocytes that may or may not have mucin deposition surrounding the hair follicle. Follicular mucinosis (FM) is a primary or secondary finding in FMF, lupus, or collagen vascular diseases that is only a histological process of mucin deposition surrounding the hair follicles. We present a case of a 6-year-old boy who had features of both FMF and primary follicular mucinosis (PFM). The case reveals key insights on FMF with concurrent FM in pediatric patients and how to differentiate between FMF and PFM.
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Affiliation(s)
- Drew A. Emge
- Department of Internal Medicine, Baylor College of Medicine, Houston, TX, USA
| | - Daniel J. Lewis
- School of Medicine, Baylor College of Medicine, Houston, TX, USA
- Department of Dermatology, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Phyu P. Aung
- Department of Pathology, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Madeleine Duvic
- Department of Dermatology, University of Texas MD Anderson Cancer Center, Houston, TX, USA
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van Santen S, Vermeer MH, Willemze R. Classification and recommended treatment options for folliculotropic mycosis fungoides. Expert Opin Orphan Drugs 2017. [DOI: 10.1080/21678707.2018.1406796] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Suzanne van Santen
- Department of Dermatology, Leiden University Medical Center, Leiden, The Netherlands
| | - Maarten H. Vermeer
- Department of Dermatology, Leiden University Medical Center, Leiden, The Netherlands
| | - Rein Willemze
- Department of Dermatology, Leiden University Medical Center, Leiden, The Netherlands
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50
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Abstract
T-cell lymphoma, a collection of subtypes of Non-Hodgkin lymphoma, is a rare malignancy. The low prevalence of this disease has made it challenging to identify subtype-specific risk factors. Potential risk factors could enable us to identify high-risk patients and predict patient outcomes. Here, we report on the current epidemiologic and prognostic factors data associated with the individual subtypes both of peripheral T-cell lymphoma (PTCL) and cutaneous T-cell lymphoma (CTCL) found in large cohort and case studies. Additionally, with recent findings, as well as updates in the new World Health Organization (WHO) classification of lymphoid neoplasms, we consider what this could do to change our approach to this group of diseases.
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