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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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Prag Naveh H, Amitay-Laish I, Zidan O, Leshem YA, Sherman S, Noyman Y, Taieb J, Didkovsky E, Hodak E. Real-life experience with chlormethine gel for early-stage mycosis fungoides with emphasis on types and management of cutaneous side-effects . J DERMATOL TREAT 2021; 33:2364-2370. [PMID: 34427536 DOI: 10.1080/09546634.2021.1967266] [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] [Indexed: 10/20/2022]
Abstract
BACKGROUND Real-life efficacy data on the recently approved once daily application of chlormethine gel (CG) for mycosis fungoides (MF) is limited, and detailed characterization of the side effects and their management are strikingly sparse. OBJECTIVE To evaluate the efficacy and particularly the side effect profile of CG in early-stage MF patients in a real-life setting. METHODS We performed a single-center retrospective analysis of 66 early-stage MF adult patients treated with CG in 2016-2019. RESULTS Treatment with a once-daily application (52%), or at lower frequencies (48%), in some with topical corticosteroids (TCS) (40%), resulted in an overall response rate of 50%, with no significant difference between stage IA and IB. Cutaneous side effects (56%) included irritant or allergic contact dermatitis (36%, mostly mild/moderate and manageable by reducing application frequency and/or adding TCS or interrupting treatment), unmasking effect (9%), hyperpigmentation (14%), and pruritus (9%). Withdrawal due to side effects occurred in 19.6% of patients (15% for contact dermatitis). CONCLUSION In real-life management, flexible regimens of CG sometimes with TCS, show efficacy in early-stage MF and may reduce the rate of contact dermatitis, the main treatment-limiting side effect. Practical recommendations with emphasis of the types, time of appearance, and management of side effects are provided.
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Affiliation(s)
- Hadas Prag Naveh
- Division of Dermatology, Rabin Medical Center - Beilinson Hospital, Petach Tikva, Israel
| | - Iris Amitay-Laish
- Division of Dermatology, Rabin Medical Center - Beilinson Hospital, Petach Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Omri Zidan
- Division of Dermatology, Rabin Medical Center - Beilinson Hospital, Petach Tikva, Israel
| | - Yael A Leshem
- Division of Dermatology, Rabin Medical Center - Beilinson Hospital, Petach Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Shany Sherman
- Division of Dermatology, Rabin Medical Center - Beilinson Hospital, Petach Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Yehonatan Noyman
- Division of Dermatology, Rabin Medical Center - Beilinson Hospital, Petach Tikva, Israel
| | - Joseph Taieb
- Division of Dermatology, Rabin Medical Center - Beilinson Hospital, Petach Tikva, Israel
| | - Elena Didkovsky
- Institute of Pathology, Rabin Medical Center - Beilinson Hospital, Petach Tikva, Israel
| | - Emmilia Hodak
- Division of Dermatology, Rabin Medical Center - Beilinson Hospital, Petach Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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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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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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Friedland R, David M, Feinmesser M, Fenig-Nakar S, Hodak E. Idiopathic guttate hypomelanosis-like lesions in patients with mycosis fungoides: a new adverse effect of phototherapy. J Eur Acad Dermatol Venereol 2010; 24:1026-30. [PMID: 20180893 DOI: 10.1111/j.1468-3083.2010.03571.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND Idiopathic guttate hypomelanosis (IGH) is a common pigmentary disorder, the aetiology and pathogenesis of which are largely unknown. The appearance of IGH-like lesions during phototherapy has been reported previously in only one patient. OBJECTIVE To describe the clinical and histological features of phototherapy-induced IGH-like lesions, their relation to ultraviolet dosimetry and the course of this eruption in patients with mycosis fungoides (MF). METHODS The files of all patients with MF who underwent phototherapy in our centre from 1992 to 2008 were searched to identify those in whom IGH-like lesions appeared during treatment. Results Among 87 patients with early-stage MF who underwent phototherapy, seven acquired IGH-like lesions during monotherapy with narrow-band ultraviolet B (NB-UVB; four patients) or psoralen and ultraviolet A (PUVA; three patients). All but one had a light complexion. The lesions appeared in areas exposed to ultraviolet light, and not exclusively on the skin previously involved by the disease. The mean number of exposures until appearance of the lesions was 92 for NB-UVB and 137 for PUVA. Biopsy study showed a decreased number of melanocytes. Phototherapy was discontinued in four patients, of whom three showed a partial or complete disappearance of the IGH-lesions. The other three patients are still receiving phototherapy, with no change in their IGH-like lesions. CONCLUSIONS Phototherapy may induce an eruption bearing similar clinical and histopathological features to IGH. The eruption is rare, appears to emerge only after prolonged therapy and seems to be reversible upon discontinuation of phototherapy. IGH-like eruption should be added to the list of side-effects of phototherapy.
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Affiliation(s)
- R Friedland
- Department of Dermatology, Rabin Medical Center, Beilinson Hospital, Petah Tiqwa, Israel
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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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Pujol RM, Gallardo F, Llistosella E, Blanco A, Bernadó L, Bordes R, Nomdedeu JF, Servitje O. Invisible mycosis fungoides: a diagnostic challenge. J Am Acad Dermatol 2002; 47:S168-71. [PMID: 12140452 DOI: 10.1067/mjd.2002.107231] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
We describe a 76-year-old woman who had persistent generalized pruritus as the only cutaneous manifestation of a cutaneous T-cell lymphoma (mycosis fungoides). No cutaneous lesions were observed throughout the patient's course. Skin biopsy specimens obtained from normal-looking pruritic skin revealed a discrete perivascular lymphocytic infiltrate in the upper dermis and focal intraepidermal clusters of atypical lymphoid cells (Pautrier's microabscesses). PCR analysis of TCR-gamma gene disclosed a monoclonal T-cell rearrangement. Sequencing of the PCR monoclonal product identified the J(8)V(2)C(2) TCR gene rearrangement. This observation illustrates the existence of a peculiar and exceedingly rare form of mycosis fungoides characterized only by persistent pruritus unresponsive to several therapeutic approaches. The diagnostic difficulties of this rare variant are stressed.
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Affiliation(s)
- Ramon M Pujol
- Department of Dermatology, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain.
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Affiliation(s)
- G S Wood
- Division of Dermatology, University of Wisconsin, Madison, USA
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Pujol RM, Gallardo F, Llistosella E, Blanco A, Bernadó L, Bordes R, Nomdedeu JF, Servitje O. Invisible mycosis fungoides: A diagnostic challenge. J Am Acad Dermatol 2000; 42:324-8. [PMID: 10640924 DOI: 10.1016/s0190-9622(00)90103-8] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
We describe a 76-year-old woman who presented persistent generalized pruritus as the only cutaneous manifestation of a cutaneous T-cell lymphoma (mycosis fungoides). No cutaneous lesions were observed throughout the patient's course. Skin biopsies obtained from normal-looking pruritic skin revealed a discrete perivascular lymphocytic infiltrate in the upper dermis and focal intraepidermal clusters of atypical lymphoid cells (Pautrier's microabscesses). PCR analysis of TCR-gamma gene disclosed a monoclonal T-cell rearrangement. Sequencing of the PCR monoclonal product identified the J(8)V(2)C(2) TCR gene rearrangement. This observation illustrates the existence of a peculiar and exceedingly rare form of mycosis fungoides characterized only by persistent pruritus unresponsive to several therapeutic approaches. The diagnostic difficulties of this rare variant are stressed.
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Affiliation(s)
- R M Pujol
- Hospital Princeps d'Espanya, Barcelona, Spain.
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Glusac EJ, Shapiro PE, McNiff JM. Cutaneous T-cell lymphoma. Refinement in the application of controversial histologic criteria. Dermatol Clin 1999; 17:601-14, ix. [PMID: 10410861 DOI: 10.1016/s0733-8635(05)70110-8] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The term cutaneous T-cell lymphoma was originally coined to encompass the spectrum of mycosis fungoides and Sézary syndrome. It has become increasingly evident that the histopathologic diagnosis of CTCL can be exceedingly challenging. A series of recent studies, however, have helped clarify the nature of the histologic findings in CTCL. Recently reported histologic data on mycosis fungoides, Sézary syndrome, and their variants is emphasized in this article, with special focus given to the findings in early lesions. A brief summary of lymphocyte immunophenotyping and the role of T-cell reception gene rearrangements in CTCL is included.
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Affiliation(s)
- E J Glusac
- Department of Dermatology, Yale Dermatopathology Laboratory, New Haven, Connecticut, USA
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Abstract
The foregoing underlines the advances which have been made in our understanding of cutaneous lymphoma and the areas where further research is needed. With a few noteable exceptions the aim of therapy in CTCL is palliative rather than curative and treatment success is measured in terms of disease-free interval. There is still no evidence that any chemotherapeutic regimen prolongs survival. A possible exception is the effect of photopheresis in Sézary syndrome but our own experience differs from that in the USA and underlines the need to identify patients with clonal disease when defining subjects for study. The combination of genotypic analysis and new treatment methods offers exciting new prospects in the management of patients with cutaneous lymphoma.
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Affiliation(s)
- R Russell-Jones
- Skin Tumour Unit, St John's Institute of Dermatology, St Thomas' Hospital, London, UK
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