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Peters K, Onajin O, Ruiz de Luzuriaga A, Lullo J, Shea CR. An Asymptomatic Case of Invisible Mycosis Fungoides. Am J Dermatopathol 2023; 45:409-410. [PMID: 37130207 DOI: 10.1097/dad.0000000000002445] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/04/2023]
Abstract
ABSTRACT Mycosis fungoides has previously been reported in 'invisible' form, when biopsy of normal-appearing skin in the background of undifferentiated chronic pruritus demonstrated histopathologic findings of the malignancy. Asymptomatic cases have been reported more infrequently on biopsies of individual skin lesions. We present a case of invisible and asymptomatic mycosis fungoides, confirmed with immunohistochemical and T-cell receptor gene rearrangement studies, diagnosed on a re-excision specimen of an atypical melanocytic nevus. The case highlights the importance of alert examination of all tissue specimens for evidence of unrelated pathologic findings.
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Affiliation(s)
- Kristopher Peters
- Department of Dermatology, Cascade Eye and Skin Centers, University Place, WA; and
| | - Oluwakemi Onajin
- Section of Dermatology, Department of Medicine, The University of Chicago, Chicago, IL
| | | | - Jenna Lullo
- Section of Dermatology, Department of Medicine, The University of Chicago, Chicago, IL
| | - Christopher R Shea
- Section of Dermatology, Department of Medicine, The University of Chicago, Chicago, IL
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Fahmy LM, Kwinta BD, Schreidah CM, Ferris LK, Geskin LJ. Topical Mechlorethamine for the Treatment of Psoriasis: A Report of Two Cases and Literature Review. Dermatol Ther (Heidelb) 2023; 13:617-627. [PMID: 36543971 PMCID: PMC9884718 DOI: 10.1007/s13555-022-00871-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2022] [Accepted: 11/29/2022] [Indexed: 12/24/2022] Open
Abstract
INTRODUCTION Psoriasis is a common inflammatory skin disease that significantly impacts patients' psychosocial wellbeing. Despite increasingly effective treatment options, the recurrence of plaques after discontinuation of therapy in many patients highlights the need for additional therapies. METHODS We report two cases of patients with concurrent psoriasis and mycosis fungoides who were treated with topical mechlorethamine (MCH). A literature review was performed by searching PubMed using the keywords psoriasis, mechlorethamine, chlormethine, and nitrogen mustard. RESULTS Both patients had significant improvement in their psoriasis following treatment with topical MCH gel, which was well tolerated and maintained clearance after 1 and 3 years of follow-up. Seven prospective cohort studies investigating the use of topical MCH were identified through literature review. Out of five studies reporting clinical outcomes by patient, 68 of 77 patients (88%) experienced an improvement in their psoriasis, with 47 of 77 (61%) achieving complete or near-complete clearance. The remaining two studies reported clinical outcomes by lesion, demonstrating improvement in 40 of 45 lesions (88%) and complete or near-complete clearance in 32 of 42 lesions (76%). Contact dermatitis was the most frequent adverse effect, observed in 56 of 125 patients (45%). CONCLUSIONS Topical MCH may be an option for patients with psoriasis who fail or have incomplete responses to other treatments. Published studies are limited by lack of standardized treatment regimens and well-defined outcome measures, highlighting the need for prospective clinical trials to better understand the utility of this topical agent in psoriasis.
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Affiliation(s)
- Lauren M Fahmy
- Columbia University Vagelos College of Physicians and Surgeons, New York, NY, USA
| | - Bradley D Kwinta
- Columbia University Vagelos College of Physicians and Surgeons, New York, NY, USA
| | - Celine M Schreidah
- Columbia University Vagelos College of Physicians and Surgeons, New York, NY, USA
| | - Laura K Ferris
- Department of Dermatology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Larisa J Geskin
- Department of Dermatology, Columbia University Irving Medical Center, New York, NY, USA.
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Cutaneous T-Cell Lymphoma Skin Microbiome Is Characterized by Shifts in Certain Commensal Bacteria but not Viruses when Compared with Healthy Controls. J Invest Dermatol 2020; 141:1604-1608. [PMID: 33212154 DOI: 10.1016/j.jid.2020.10.021] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2020] [Revised: 10/02/2020] [Accepted: 10/14/2020] [Indexed: 11/21/2022]
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‘Could it be mycosis fungoides?’: an approach to diagnosing patch stage mycosis fungoides. J Hematop 2015. [DOI: 10.1007/s12308-015-0247-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
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Abstract
INTRODUCTION Pruritus without visible dermatoses may be the first manifestation of hematological malignancies such as Hodgkin disease, chronic lymphocytic leukemia and mycosis fungoides (MF) and may precede the definitive diagnosis by weeks to years. CASE REPORT We present a case of 'invisible' MF associated with chronic generalized pruritus in an elderly patient. CONCLUSION Our case highlights the importance of performing skin biopsies in patients with chronic unexplained pruritus, especially in the absence of cutaneous lesions. This can prompt the clinician to consider possible underlying malignancy, such as 'invisible' MF.
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Henn A, Michel L, Fite C, Deschamps L, Ortonne N, Ingen-Housz-Oro S, Marinho E, Beylot-Barry M, Bagot M, Laroche L, Crickx B, Maubec E. Sézary syndrome without erythroderma. J Am Acad Dermatol 2015; 72:1003-9.e1. [DOI: 10.1016/j.jaad.2014.11.015] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2014] [Revised: 11/10/2014] [Accepted: 11/11/2014] [Indexed: 10/23/2022]
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Abstract
Mycosis fungoides (MF) is a cutaneous T-cell lymphoma that usually manifests as patches and plaques with a propensity for nonphotoexposed areas. MF is a common mimicker of inflammatory and infectious skin diseases, because it can be manifested with a wide variety of clinical and pathologic presentations. These atypical presentations of MF may be difficult to diagnose, requiring a high level of suspicion and careful clinicopathologic correlation. Within this array of clinical presentations, the World Health Organization classification recognizes 3 MF variants: folliculotropic MF, pagetoid reticulosis, and granulomatous slack skin. These 3 variants, as well as hypopigmented MF, are addressed in this article.
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Affiliation(s)
- M Estela Martínez-Escala
- Department of Dermatology, Feinberg School of Medicine, Northwestern University, 676 North Saint Clair Street, Suite 1600, Chicago, IL 60611, USA; Department of Pathology, Feinberg School of Medicine, Northwestern University, 676 North Saint Clair Street, Suite 1600, Chicago, IL 60611, USA
| | - Belén Rubio González
- Dermatology Department, Hospital 12 de Octubre, Avda de Córdoba s/n, 28041 - Madrid, Spain
| | - Joan Guitart
- Department of Dermatology, Feinberg School of Medicine, Northwestern University, 676 North Saint Clair Street, Suite 1600, Chicago, IL 60611, USA; Department of Pathology, Feinberg School of Medicine, Northwestern University, 676 North Saint Clair Street, Suite 1600, Chicago, IL 60611, USA; Division of Hematology/Oncology Department, Robert H. Lurie Comprehensive Cancer Center, 675 North Saint Clair Street, Suite 19 100, Chicago, IL 60611, USA.
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Yamashita T, Abbade LPF, Marques MEA, Marques SA. Mycosis fungoides and Sézary syndrome: clinical, histopathological and immunohistochemical review and update. An Bras Dermatol 2012; 87:817-28; quiz 829-30. [PMID: 23197199 PMCID: PMC3699909 DOI: 10.1590/s0365-05962012000600001] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2011] [Accepted: 07/19/2011] [Indexed: 12/22/2022] Open
Abstract
This paper reviews the diagnostic and classificatory concepts of mycosis fungoides and Sézary syndrome in light of the latest normative publications. It describes the great variability of the clinical expression of mycosis fungoides in its early stages as well as the histopathological and immunohistochemical aspects that help with diagnosis. The diagnostic criteria required for characterizing Sézary syndrome and the staging system used for both mycosis fungoides and Sézary syndrome are described.
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Affiliation(s)
- Thamy Yamashita
- M.Sc.,PhD in Pathology, Department of Pathology, Botucatu School of
Medicine- Universidade Estadual Paulista "Julio de Mesquita Filho" (São
Paulo State University) (FMB-UNESP) - São Paulo (SP), Brazil
| | - Luciana Patricia Fernandes Abbade
- PhD - Assistant Professor, Department of Dermatology and Radiotherapy,
Botucatu School of Medicine - Universidade Estadual Paulista "Julio de Mesquita
Filho" (São Paulo State University) (FMB-UNESP) - São Paulo (SP),
Brazil
| | - Mariangela Esther Alencar Marques
- Professor, Department of Pathology, Botucatu School of Medicine -
Universidade Estadual Paulista "Julio de Mesquita Filho" (São Paulo
State University) (FMB-UNESP) - São Paulo (SP), Brazil
| | - Silvio Alencar Marques
- Professor - Department of Dermatology and Radiotherapy, Botucatu School
of Medicine - Universidade Estadual Paulista "Julio de Mesquita Filho"
(São Paulo State University) (FMB-UNESP) - São Paulo (SP), Brazil
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McClain CM, Cole MB, Robbins JB, Kantrow SM. Mycosis fungoides involving an acrochordon: a case report. J Cutan Pathol 2012; 39:1131-4. [PMID: 22994930 DOI: 10.1111/cup.12009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2012] [Revised: 06/14/2012] [Accepted: 06/24/2012] [Indexed: 11/26/2022]
Abstract
We present the case of a 77-year-old male undergoing treatment for mycosis fungoides (MF) who presented for removal of an acrochordon on his mid back. Histopathologic examination of the acrochordon revealed a dense, band-like lymphocytic inflammatory infiltrate in the dermis with epidermotropism of single lymphocytes and small nests of lymphocytes into the lower epidermis. Immunohistochemical staining characterized the dermal and epidermal lymphocytic population as CD3-positive T lymphocytes with a predominance of CD4-positive over CD8-positive lymphocytes. These findings were consistent with the patient's known MF and molecular identification of a clonal T-cell receptor gene rearrangement further supported the diagnosis. Our unusual case reports MF involving an acrochordon and provides evidence to support the importance of submitting acrochordons for histopathologic examination.
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Affiliation(s)
- Colt M McClain
- Departments of Pathology, Microbiology and Immunology, Vanderbilt University Medical Center, Nashville, TN, USA
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Edinger JT, Lorenzo CR, Breneman DL, Swerdlow SH. Primary cutaneous marginal zone lymphoma with subclinical cutaneous involvement and biclonality. J Cutan Pathol 2011; 38:724-30. [DOI: 10.1111/j.1600-0560.2011.01726.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
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Dellavalle RP. Notice of inadvertent duplicate publication: (1) Penile paraffinoma: Self-injection with mineral oil; and (2) Invisible mycosis fungoides: a diagnostic challenge. J Am Acad Dermatol 2008; 59:350. [PMID: 18754136 DOI: 10.1016/j.jaad.2008.04.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Abstract
Mycosis fungoides (MF), a low-grade lymphoproliferative disorder, is the most common type of cutaneous T-cell lymphoma. Typically, neoplastic T cells localize to the skin and produce patches, plaques, tumours or erythroderma. Diagnosis of MF can be difficult due to highly variable presentations and the sometimes nonspecific nature of histological findings. Molecular biology has improved the diagnostic accuracy. Nevertheless, clinical experience is of substantial importance as MF can resemble a wide variety of skin diseases. We performed a literature review and found that MF can mimic >50 different clinical entities. We present a structured framework of clinical variations of classical, unusual and distinct forms of MF. Distinct subforms such as ichthyotic MF, adnexotropic (including syringotropic and folliculotropic) MF, MF with follicular mucinosis, granulomatous MF with granulomatous slack skin and papuloerythroderma of Ofuji are delineated in more detail.
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Affiliation(s)
- D Nashan
- Department of Dermatology, University of Freiburg, Hautstrasse 7, 79104 Freiburg, Germany.
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El-Darouti MA, Marzouk SA, Bosseila M, Zeid OA, El-Safouri O, Zayed A, El-Ramly A, Abdel-Halim MRE. Microscopic study of normal skin in cases of mycosis fungoides. Int J Dermatol 2006; 45:1043-6. [PMID: 16961506 DOI: 10.1111/j.1365-4632.2006.02686.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND During therapy of patients with mycosis fungoides (MF) at the Department of Dermatology, Kasr El-Aini Hospital, follow-up biopsies are routinely taken every 2 months. It was noticed that lesions of MF might become clinically normal during treatment, and yet still show microscopical evidence of MF. This finding raised the possibility that clinically normal skin in MF could be microscopically involved. AIM The aim of our work was to evaluate the degree of histopathological involvement of normal-looking skin in patients with MF. PATIENTS AND METHODS Thirty patients with stage IB were biopsied from their normal skin. Two biopsies were taken: one proximal (2 cm) and the other distal (> 5 cm) from any visible lesion. Ten normal controls were included in the study. All specimens were stained with H&E and examined microscopically. The microscopical diagnosis was confirmed by immunophenotyping. RESULTS Epidermotropism was detected in 21 (70%) of the proximal skin biopsies and 14 (47%) of the distal skin biopsies, whereas no biopsy from the control group showed epidermotropism. All the proximal skin biopsies showed dermal infiltrate and 90% of the biopsies from the distal normal skin showed dermal infiltrate (mostly superficial perivascular). CONCLUSION Normal skin in patients with MF could be affected microscopically and this may raise questions regarding the credibility of the current staging classification of MF, and may necessitate taking biopsies from normal skin before starting topical treatment. During MF treatment, biopsies from cured lesions are required before starting withdrawal.
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Abstract
Cutaneous lymphomas represent a heterogeneous group of T-, NK- and B-cell neoplasms, with mycosis fungoides (MF) being the most common subtype. MF has a plethora of clinicopathological manifestations. Many variants of this lymphoma differ substantially from the 'classical' Alibert-Bazin disease and are therefore sometimes referred to as 'atypical' forms of the disease. This review addresses the whole clinicopathological spectrum of mycosis fungoides with respect to epidemiology, clinical, histopathological, immunophenotypic and genotypic features and the clinical course and prognosis of its variants: classical, erythrodermic, follicular, syringotropic, bullous/vesicular, granulomatous, poikilodermic, hypo- and hyperpigmented, unilesional, palmoplantar, hyperkeratotic/verrucous, vegetating/papillomatous, ichthyosiform, pigmented purpura-like, pustular and mucosal involvement in MF.
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Affiliation(s)
- D V Kazakov
- Sikl's Department of Pathology, Charles University, Medical Faculty Hospital, Alej Svobody 80, Pilsen 30460, Czech Republic
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Gallardo F, Pujol RM. Diagnóstico y tratamiento de los linfomas cutáneos de células T primarios. ACTAS DERMO-SIFILIOGRAFICAS 2004. [DOI: 10.1016/s0001-7310(04)76864-7] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
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La dermatología española fuera de españa, 2000. ACTAS DERMO-SIFILIOGRAFICAS 2002. [DOI: 10.1016/s0001-7310(02)79224-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
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