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Xiong S, Liu F, Sun J, Gao S, Wong CCL, Tu P, Wang Y. Abrogation of USP9X Is a Potential Strategy to Decrease PEG10 Levels and Impede Tumor Progression in Cutaneous T-Cell Lymphoma. J Invest Dermatol 2024:S0022-202X(24)00307-5. [PMID: 38677662 DOI: 10.1016/j.jid.2024.02.039] [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: 10/19/2023] [Revised: 01/30/2024] [Accepted: 02/26/2024] [Indexed: 04/29/2024]
Abstract
Advanced-stage cutaneous T-cell lymphomas (CTCLs) are notorious for their highly aggressive behavior, resistance to conventional treatments, and poor prognosis, particularly when large-cell transformation occurs. PEG10 has been recently proposed as a potent driver for large-cell transformation in CTCL. However, the targeting of PEG10 continues to present a formidable clinical challenge that has yet to be addressed. In this study, we report an important post-translational regulatory mechanism of PEG10 in CTCL. USP9X, a deubiquitinase, interacted with and deubiquitinated PEG10, thereby stabilizing PEG10. Knockdown of USP9X or pharmacological targeting of USP9X resulted in a prominent downregulation of PEG10 and its downstream pathway in CTCL. Moreover, USP9X inhibition conferred tumor cell growth disadvantage and enhanced apoptosis in vitro, an effect that occurred in part through its regulation on PEG10. Furthermore, we demonstrated that inhibition of USP9X obviously restrained CTCL tumor growth in vivo and that high expression of USP9X is associated with poor survival in patients with CTCL. Collectively, our findings uncover USP9X as a key post-translational regulator in the stabilization of PEG10 and suggest that targeting PEG10 stabilization through USP9X inhibition may represent a promising therapeutic strategy for advanced-stage CTCL.
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Affiliation(s)
- Shan Xiong
- Department of Dermatology and Venereology, Peking University First Hospital, Beijing, China; Beijing Key Laboratory of Molecular Diagnosis on Dermatoses, Beijing, China; National Clinical Research Center for Skin and Immune Diseases, Beijing, China
| | - Fengjie Liu
- Department of Dermatology and Venereology, Peking University First Hospital, Beijing, China; Beijing Key Laboratory of Molecular Diagnosis on Dermatoses, Beijing, China; National Clinical Research Center for Skin and Immune Diseases, Beijing, China
| | - Jingru Sun
- Department of Dermatology and Venereology, Peking University First Hospital, Beijing, China; Beijing Key Laboratory of Molecular Diagnosis on Dermatoses, Beijing, China; National Clinical Research Center for Skin and Immune Diseases, Beijing, China
| | - Shuaixin Gao
- Department of Human Sciences & James Comprehensive Cancer Center, The Ohio State University, Columbus, Ohio, USA; James Comprehensive Cancer Center, The Ohio State University, Columbus, Ohio, USA
| | - Catherine C L Wong
- Clinical Research Institute, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Science & Peking Union Medical College, Beijing, China
| | - Ping Tu
- Department of Dermatology and Venereology, Peking University First Hospital, Beijing, China; Beijing Key Laboratory of Molecular Diagnosis on Dermatoses, Beijing, China; National Clinical Research Center for Skin and Immune Diseases, Beijing, China
| | - Yang Wang
- Department of Dermatology and Venereology, Peking University First Hospital, Beijing, China; Beijing Key Laboratory of Molecular Diagnosis on Dermatoses, Beijing, China; National Clinical Research Center for Skin and Immune Diseases, Beijing, China.
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2
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Oska S, Barash A, D'Sa H, Pui J, Hristov A, Sundram UN. Verrucous Plaques in a Young Woman: Answer. Am J Dermatopathol 2024; 46:132. [PMID: 38275241 DOI: 10.1097/dad.0000000000002609] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2024]
Affiliation(s)
- Sandra Oska
- Department of Dermatology, Henry Ford Hospital, Detroit, MI
| | | | - Helen D'Sa
- Middlebelt Dermatology, Farmington Hills, MI
| | - John Pui
- Department of Anatomic Pathology, Corewell Health East, Farmington Hills, MI
| | - Alexandra Hristov
- Department of Pathology
- Department of Dermatology, Michigan Medicine, Ann Arbor, MI; and
| | - Uma N Sundram
- Department of Anatomic Pathology, Corewell Health East, Royal Oak, MI
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3
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Keskin N, Temel B, Adışen E, Aksakal AB, Acar E, Erdem Ö. Clinical, histopathological and immunohistochemical evaluation of ultraviolet A1 treatment in early-stage mycosis fungoides. PHOTODERMATOLOGY, PHOTOIMMUNOLOGY & PHOTOMEDICINE 2024; 40:e12951. [PMID: 38288765 DOI: 10.1111/phpp.12951] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/07/2023] [Revised: 01/04/2024] [Accepted: 01/15/2024] [Indexed: 02/01/2024]
Abstract
BACKGROUND/PURPOSE Mycosis fungoides (MF) is the most common variant of cutaneous T-cell lymphomas primarily involving the skin. Early-stage MF is characterised by non-specific skin lesions and non-diagnostic biopsies. While skin-focused treatments, such as PUVA and narrowband UVB (nbUVB), are the most frequently recommended treatments, the UVA1 efficacy has been researched in recent years. The purpose of this study was to evaluate the clinical, histopathological and immunohistochemical aspects of UVA1 treatment in patients with early-stage MF. METHODS The modified severity weighted assessment scale (mSWAT) was used for total skin body scoring before and after treatment. Skin punch biopsies were taken from the patients before and after treatment. UVA1 therapy was performed five times each week. RESULTS This study included 26 patients with early-stage MF. The total number of UVA1 sessions varied between 15 and 34. Complete response was observed in 8 (30.8%) of 26 patients (30.8%). The median mSWAT score decreased statistically significantly from 7.1 to 2.0 after treatment (p < .001). Histopathological complete response was observed in 2 (9.5%) of 21 patients. A statistically significant decrease in dermal interstitial infiltrate was observed on histopathological examination after treatment (p = .039). Epidermal CD4/CD8 levels decreased statistically significantly higher from a median of 2.5-1.2 in the complete clinical response group after treatment (p = .043). CONCLUSION According to our results, UVA1 treatment has an effect on early-stage MF in terms of clinical, histopathological and immunohistochemistry.
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Affiliation(s)
- Nuray Keskin
- Dermatology Department, Yenimahalle Training and Research Hospital, Ankara, Turkey
| | - Berkay Temel
- Dermatology Department, Ankara Training and Research Hospital, Ankara, Turkey
| | - Esra Adışen
- Dermatology Department, Gazi University Faculty of Medicine, Ankara, Turkey
| | | | - Elif Acar
- Pathology Department, Ömer Halisdemir University Training and Research Hospital, Niğde, Turkey
| | - Özlem Erdem
- Pathology Department, Gazi University Faculty of Medicine, Ankara, Turkey
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4
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Ikuno Y, Kokubu H, Yamaguchi A, Takahashi T, Kato T, Fujimoto N. Isolated Verrucous Mycosis Fungoides with an Etiological Clue. Indian J Dermatol 2023; 68:728. [PMID: 38371579 PMCID: PMC10868967 DOI: 10.4103/ijd.ijd_575_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/20/2024] Open
Affiliation(s)
- Yasuaki Ikuno
- From the Department of Dermatology, Shiga University of Medical Science, Setatsukinowa, Otsu, Shiga, Japan E-mail:
| | - Hiraku Kokubu
- From the Department of Dermatology, Shiga University of Medical Science, Setatsukinowa, Otsu, Shiga, Japan E-mail:
| | - Akihiko Yamaguchi
- From the Department of Dermatology, Shiga University of Medical Science, Setatsukinowa, Otsu, Shiga, Japan E-mail:
| | - Toshifumi Takahashi
- From the Department of Dermatology, Shiga University of Medical Science, Setatsukinowa, Otsu, Shiga, Japan E-mail:
| | - Takeshi Kato
- From the Department of Dermatology, Shiga University of Medical Science, Setatsukinowa, Otsu, Shiga, Japan E-mail:
| | - Noriki Fujimoto
- From the Department of Dermatology, Shiga University of Medical Science, Setatsukinowa, Otsu, Shiga, Japan E-mail:
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5
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Baykal C, Polat Ekinci A. Annular skin tumors and lymphoproliferative diseases. Clin Dermatol 2023; 41:692-711. [PMID: 37586571 DOI: 10.1016/j.clindermatol.2023.08.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/18/2023]
Abstract
Determining the shape of a skin lesion may provide a diagnostic clue in dermatology practice, more commonly for inflammatory diseases but also for skin tumors. The annular formation may develop by diverse mechanisms in skin tumors. Annular lesions may occur from the onset of the tumor as sparing the central area or depression and/or ulceration in the center of the tumor or outward expansion of the primary lesion. Clustering of multiple papulonodular lesions sparing the central area or relatively independent processes acting on the central and peripheral components of the tumor may also result in an annular appearance. We have explored a wide variety of benign and malignant skin tumors and lymphoproliferative diseases forming an annular shape.
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Affiliation(s)
- Can Baykal
- Department of Dermatology and Venereology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Algün Polat Ekinci
- Department of Dermatology and Venereology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey.
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6
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Hu M, Pyatilova P, Altrichter S, Sheng C, Liu N, Terhorst-Molawi D, Lohse K, Ginter K, Puhl V, Maurer M, Metz M, Kolkhir P. In the skin lesions of patients with mycosis fungoides, the number of MRGPRX2-expressing cells is increased and correlates with mast cell numbers. Front Immunol 2023; 14:1197821. [PMID: 38022672 PMCID: PMC10646224 DOI: 10.3389/fimmu.2023.1197821] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Accepted: 09/28/2023] [Indexed: 12/01/2023] Open
Abstract
Background Mycosis fungoides (MF) is an indolent T-cell lymphoma that mainly affects the skin and presents with itch in more than half of the patients. Recently, the expression of Mas-related G protein-coupled receptor X2 (MRGPRX2), a receptor of mast cell (MC) responsible for the IgE-independent non-histaminergic itch, has been shown in lesional skin of patients with pruritic skin diseases, including chronic urticaria, prurigo, and mastocytosis. As of yet, limited knowledge exists regarding the MRGPRX2 expression in the skin of patients with MF. Objectives To investigate the number of MRGPRX2-expressing (MRGPRX2+) cells in the skin of patients with MF and its correlation with clinical and laboratory characteristics of the disease. Methods MRGPRX2 was analyzed in lesional and non-lesional skin of MF patients and healthy skin tissues by immunohistochemistry. Co-localization of MRGPRX2 with the MC marker tryptase was assessed by immunofluorescence. Public single-cell RNAseq data was reanalyzed to identify the MRGPRX2 expression on the distinct cell types. Results In lesional skin of MF patients, MRGPRX2+ cell number was higher than in non-lesional skin and healthy control skin (mean:15.12 vs. 6.84 vs. 5.51 cells/mm2, p=0.04), and correlated with MC numbers (r=0.73, p=0.02). MC was the primary cell type expressing MRGPRX2 in MF patients. The ratio of MRGPRX2+ MCs to MRGPRX2+ cells in lesional and non-lesional skin correlated with the severity of disease (r=0.71, p=0.02 and r=0.67, p=0.03, respectively). Conclusions Our findings point to the role of MRGPRX2 and MC in the pathogenesis of MF that should be investigated in further studies.
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Affiliation(s)
- Man Hu
- Institute of Allergology, Charité – Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
- Fraunhofer Institute for Translational Medicine and Pharmacology (ITMP), Immunology and Allergology, Berlin, Germany
| | - Polina Pyatilova
- Institute of Allergology, Charité – Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
- Fraunhofer Institute for Translational Medicine and Pharmacology (ITMP), Immunology and Allergology, Berlin, Germany
| | - Sabine Altrichter
- Institute of Allergology, Charité – Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
- Fraunhofer Institute for Translational Medicine and Pharmacology (ITMP), Immunology and Allergology, Berlin, Germany
- Departement for Dermatology and Venerology, Kepler University Hospital, Linz, Austria
| | | | - Nian Liu
- Institute of Allergology, Charité – Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
- Fraunhofer Institute for Translational Medicine and Pharmacology (ITMP), Immunology and Allergology, Berlin, Germany
| | - Dorothea Terhorst-Molawi
- Institute of Allergology, Charité – Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
- Fraunhofer Institute for Translational Medicine and Pharmacology (ITMP), Immunology and Allergology, Berlin, Germany
| | - Katharina Lohse
- Institute of Allergology, Charité – Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
- Fraunhofer Institute for Translational Medicine and Pharmacology (ITMP), Immunology and Allergology, Berlin, Germany
| | - Katharina Ginter
- Institute of Allergology, Charité – Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
- Fraunhofer Institute for Translational Medicine and Pharmacology (ITMP), Immunology and Allergology, Berlin, Germany
- Department of Dermatology, Heidelberg University, Heidelberg, Germany
| | - Viktoria Puhl
- Institute of Allergology, Charité – Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
- Fraunhofer Institute for Translational Medicine and Pharmacology (ITMP), Immunology and Allergology, Berlin, Germany
| | - Marcus Maurer
- Institute of Allergology, Charité – Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
- Fraunhofer Institute for Translational Medicine and Pharmacology (ITMP), Immunology and Allergology, Berlin, Germany
| | - Martin Metz
- Institute of Allergology, Charité – Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
- Fraunhofer Institute for Translational Medicine and Pharmacology (ITMP), Immunology and Allergology, Berlin, Germany
| | - Pavel Kolkhir
- Institute of Allergology, Charité – Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
- Fraunhofer Institute for Translational Medicine and Pharmacology (ITMP), Immunology and Allergology, Berlin, Germany
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7
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Baykal C, Ekinci AP. Annular skin tumors and lymphoproliferative diseases. Clin Dermatol 2023; 41:382-395. [PMID: 37421997 DOI: 10.1016/j.clindermatol.2023.07.007] [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: 07/10/2023]
Abstract
Determining the shape of the skin lesion may provide a diagnostic clue in dermatology practice, more commonly for inflammatory diseases but also for skin tumors. The annular formation may develop by diverse mechanisms in skin tumors. Annular lesions may occur from the onset of the tumor as sparing the central area or depression and/or ulceration in the center of the tumor or outward expansion of the primary lesion. Clustering of multiple papulonodular lesions sparing the central area or relatively independent processes acting on the central and peripheral components of the tumor may also result in an annular appearance. We have explored a wide variety of benign and malignant skin tumors and lymphoproliferative diseases forming an annular shape.
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Affiliation(s)
- Can Baykal
- Department of Dermatology and Venereology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Algün Polat Ekinci
- Department of Dermatology and Venereology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey.
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8
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Hristov AC, Tejasvi T, Wilcox RA. Cutaneous T-cell lymphomas: 2023 update on diagnosis, risk-stratification, and management. Am J Hematol 2023; 98:193-209. [PMID: 36226409 PMCID: PMC9772153 DOI: 10.1002/ajh.26760] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2022] [Accepted: 10/05/2022] [Indexed: 02/04/2023]
Abstract
DISEASE OVERVIEW Cutaneous T-cell lymphomas are a heterogenous group of T-cell neoplasms involving the skin, the majority of which may be classified as Mycosis Fungoides (MF) or Sézary Syndrome (SS). DIAGNOSIS The diagnosis of MF or SS requires the integration of clinical and histopathologic data. RISK-ADAPTED THERAPY TNMB (tumor, node, metastasis, blood) staging remains the most important prognostic factor in MF/SS and forms the basis for a "risk-adapted," multidisciplinary approach to treatment. For patients with disease limited to the skin, expectant management or skin-directed therapies is preferred, as both disease-specific and overall survival for these patients is favorable. In contrast, patients with advanced-stage disease with significant nodal, visceral or the blood involvement are generally approached with systemic therapies, including biologic-response modifiers, histone deacetylase inhibitors, or antibody-based strategies, in an escalating fashion. In highly-selected patients, allogeneic stem-cell transplantation may be considered, as this may be curative in some patients.
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Affiliation(s)
- Alexandra C. Hristov
- Departments of Pathology and Dermatology, 2800 Plymouth Road, Building 35, Ann Arbor, MI 48109-2800
| | - Trilokraj Tejasvi
- Department of Dermatology, 1910 Taubman Center, 1500 E Medical Center Dr, Ann Arbor, MI 48109
| | - Ryan A. Wilcox
- Correspondence to: Ryan Wilcox, MD, PhD, Division of Hematology/Oncology, Department of Internal Medicine, University of Michigan Rogel Cancer Center, 1500 E. Medical Center Drive, Room 4310 CC, Ann Arbor, MI 48109-5948, Phone: (734) 615-9799, Fax: (734) 936-7376,
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9
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Pereira LB, Sobreira NDP, Rocha VB. Case for diagnosis. Ichthyosiform mycosis fungoides. An Bras Dermatol 2022; 97:795-797. [PMID: 36109269 PMCID: PMC9582871 DOI: 10.1016/j.abd.2021.10.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2021] [Revised: 09/27/2021] [Accepted: 10/01/2021] [Indexed: 11/24/2022] Open
Affiliation(s)
- Luciana Baptista Pereira
- Dermatology Service, Faculty of Medicine, Hospital das Clínicas, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil.
| | - Natália de Paiva Sobreira
- Dermatology Service, Faculty of Medicine, Hospital das Clínicas, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil
| | - Vanessa Barreto Rocha
- Dermatology Service, Faculty of Medicine, Hospital das Clínicas, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil
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10
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Efficacy of narrowband UVB phototherapy in early-stage mycosis fungoides in Iranian patients. Lasers Med Sci 2022; 37:3231-3235. [PMID: 35838846 DOI: 10.1007/s10103-022-03611-2] [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: 12/13/2021] [Accepted: 07/08/2022] [Indexed: 10/17/2022]
Abstract
Narrowband UVB (NB-UVB) has been shown to be effective for the treatment of early mycosis fungoides (MF) in light-skinned patients, but the effect of NB-UVB on patients with darker skin phototypes needs further investigation. The aim of this study was to evaluate the effect of NB-UVB in the treatment of early-stage MF in Iranian patients. In this retrospective study, 24 patients with the diagnosis of early MF (9 stage AI, 15 stage IB) were enrolled. All patients were treated with NB-UVB phototherapy 2-3 times weekly. After achieving complete response, a maintenance treatment was recommended. The response rate, side effects, and recurrence rate in the follow-up period were assessed. The follow-up period was ranged 6 to 24 months. Ten patients (41.7%) had complete remission after a mean number of 42.9 treatment and mean cumulative dose of 58.11 J/cm2. Twelve patients (50%) had partial response, and 2 patients (8.3%) had no response. After discontinuation of maintenance treatment, 4 of 10 patients (40%) with complete remission relapsed within a mean of 5 months. Side effects were limited to erythema (12.5%) and hyperpigmentation (4%). NB-UVB is a safe and effective method for the treatment of early MF, but it seems that more treatment sessions and higher doses of NB-UVB are required for darker skin phototypes.
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11
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Stagg B, Ma J, Ibbetson J, James C, Ly H, Sidhu S. Two cases of granulomatous mycosis fungoides mimicking interstitial granulomatous dermatosis. Australas J Dermatol 2022; 63:359-364. [PMID: 35753024 DOI: 10.1111/ajd.13888] [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: 12/01/2021] [Revised: 05/22/2022] [Accepted: 06/05/2022] [Indexed: 11/28/2022]
Abstract
Two patients presented with erythematous papules within larger patches and thin plaques. Following biopsies, each case was initially thought to represent interstitial granulomatous dermatitis (IGD); however, clinicopathological correlation led to a diagnosis of granulomatous mycosis fungoides (GMF). Drawing upon the similarities between these cases, this report explores the clinical and histological manifestations of GMF, features distinguishing GMF from other granulomatous diseases like IGD and the prognostic significance of distinguishing GMF from classic mycosis fungoides. This report also shows that despite the potential for histological overlap between GMF and IGD, the existing literature does not reveal an epidemiological or pathophysiological link between these two conditions.
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Affiliation(s)
- Brendan Stagg
- SA Pathology, Royal Adelaide Hospital, Adelaide, Australia
| | - Joyce Ma
- Royal Adelaide Hospital, Adelaide, Australia
| | - Jan Ibbetson
- SA Pathology, Clinpath Pathology, Adelaide, Australia
| | | | - Hoang Ly
- Flinders Medical Centre, North Eastern Health Specialists, Adelaide, Australia
| | - Shireen Sidhu
- North Eastern Health Specialists, Royal Adelaide Hospital, Adelaide, Australia
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12
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André R, Ram-Wolff C, Bagot M. Clinical characteristics of Mycosis fungoides palmaris et plantaris: two cases and a systematic literature review. Eur J Dermatol 2022; 32:421-423. [PMID: 36065530 PMCID: PMC9660025 DOI: 10.1684/ejd.2021.4126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
- Raphaël André
- grid.8591.50000 0001 2322 4988Department of Dermatology, Geneva Hospitals, Geneva University, Geneva, Switzerland
| | - Caroline Ram-Wolff
- grid.462420.60000 0004 0638 4500Department of Dermatology, Saint-Louis Hospital, AP-HP, Paris University, Inserm U976, Paris, France
| | - Martine Bagot
- grid.462420.60000 0004 0638 4500Department of Dermatology, Saint-Louis Hospital, AP-HP, Paris University, Inserm U976, Paris, France
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13
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Pigmented Purpuric Dermatosis of the Hand: Clinicopathologic Analysis of Six Cases With Review of the Literature. Am J Dermatopathol 2022; 44:553-558. [PMID: 35503879 DOI: 10.1097/dad.0000000000002204] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
ABSTRACT Pigmented purpuric dermatosis (PPD) is a group of skin disorders characterized by red, brown, or golden macules and patches with cayenne pepper-like spots. Classic histopathologic features include a perivascular lymphocytic infiltrate with associated erythrocyte extravasation and hemosiderin deposition. Although PPD most commonly affects the lower extremities, upper extremity involvement has been infrequently reported. Cases involving the hands are particularly rare. We present 6 new cases of PPD involving the hand and review 17 previously reported cases in the literature. All cases in our series were unilateral and localized to the dorsum of the hand. PPD was considered clinically in only 2 of these cases. Histopathologic examination revealed hallmark features of PPD, namely a superficial perivascular lymphocytic infiltrate and extravasated erythrocytes. Previous reports of PPD involving the hand described concurrent involvement of other anatomic sites in most cases; only 4 cases (24%) were confined to the hands. Histopathologic descriptions of these reported cases were compatible with PPD. In sum, our series describes a unique and rare clinical presentation of PPD confined to the unilateral dorsal hand. Because of the unusual presentation, biopsy is often required for accurate diagnosis.
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14
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Zhang JH, Zhao J, Fan Y, Fu ZL, Zhang XC, Liu M, Zhao GY, Cen XN, Chen XQ, Ning J, Li X, Wang RF. Prognostic significance of pretreatment 18F-fluorodeoxyglucose positron emission tomography/computed tomography (PET/CT) in patients with primary T cell lymphomas. Nucl Med Commun 2022; 43:186-192. [PMID: 34783717 DOI: 10.1097/mnm.0000000000001504] [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: 11/26/2022]
Abstract
OBJECTIVE T cell lymphomas are associated with an aggressive worse prognosis. This study is designed to assess T cell lymphomas using 18F-FDG PET/CT. METHODS Sixty-four patients with newly diagnosed T cell lymphomas underwent PET/computed tomography (PET/CT) scans, 47 cases who were fully followed up were retrospectively reviewed and analyzed. Overall survival (OS) and progression-free survival (PFS) were recorded for prognosis. We measured the maximum standardized uptake value (SUVmax) in all cases, analyzed the correlation between SUVmax and survival and other clinicopathologic parameters. Kaplan-Meier log-rank tests were then used to compare the survival of high and low PET/CT parameter groups, and multivariate Cox proportional hazards regression analysis was carried out to identify predictors of OS and PFS. RESULTS With a median follow-up of 26.5 (range 0.7-117.5) months, the 1-, 2- and 3-year OS were 75.6, 61.7 and 49.2%, and PFS were 49.3, 39.9 and 29.9%, respectively in 47 patients. Among them, 33 cases progressed with a median time of 9.5 (0.7-115.0) months, and 26 patients died with a median survival time of 26.5 (0.7-117.5) months. Multivariate analysis showed the following independent prognostic factors for OS: age >60 years (P = 0.002), SUVmax >9.7 (P = 0.009) and extranodal involvement of more than one site (P = 0.018). In addition, lactate dehydrogenase level (P = 0.003) and B symptoms (P = 0.018) were independent risk factors for PFS. CONCLUSION Pretherapy SUVmax may serve as an independent predictor of outcome in patients with newly diagnosed T cell lymphomas.
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Affiliation(s)
- Jian-Hua Zhang
- Department of Nuclear Medicine, Peking University First Hospital
| | - Jing Zhao
- Department of Nuclear Medicine, Peking University First Hospital
- Department of Nuclear Medicine, Peking University International Hospital
| | - Yan Fan
- Department of Nuclear Medicine, Peking University First Hospital
| | - Zhan-Li Fu
- Department of Nuclear Medicine, Peking University First Hospital
| | - Xu-Chu Zhang
- Department of Nuclear Medicine, Peking University First Hospital
| | - Meng Liu
- Department of Nuclear Medicine, Peking University First Hospital
| | - Guang-Yu Zhao
- Department of Nuclear Medicine, Peking University First Hospital
| | - Xi-Nan Cen
- Department of Hematology, Peking University First Hospital, Beijing, China
| | - Xue-Qi Chen
- Department of Nuclear Medicine, Peking University First Hospital
| | - Jing Ning
- Division of Nuclear Medicine, Department of Biomedical Imaging and Image-guided Therapy, Vienna General Hospital, Medical University of Vienna, Vienna, Austria
| | - Xiang Li
- Division of Nuclear Medicine, Department of Biomedical Imaging and Image-guided Therapy, Vienna General Hospital, Medical University of Vienna, Vienna, Austria
| | - Rong-Fu Wang
- Department of Nuclear Medicine, Peking University First Hospital
- Department of Nuclear Medicine, Peking University International Hospital
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15
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Licht P, Mailänder V. Transcriptional Heterogeneity and the Microbiome of Cutaneous T-Cell Lymphoma. Cells 2022; 11:cells11030328. [PMID: 35159138 PMCID: PMC8834405 DOI: 10.3390/cells11030328] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Revised: 12/31/2021] [Accepted: 01/13/2022] [Indexed: 11/16/2022] Open
Abstract
Cutaneous T-Cell Lymphomas (CTCL) presents with substantial clinical variability and transcriptional heterogeneity. In the recent years, several studies paved the way to elucidate aetiology and pathogenesis of CTCL using sequencing methods. Several T-cell subtypes were suggested as the source of disease thereby explaining clinical and transcriptional heterogeneity of CTCL entities. Several differentially expressed pathways could explain disease progression. However, exogenous triggers in the skin microenvironment also seem to affect CTCL status. Especially Staphylococcus aureus was shown to contribute to disease progression. Only little is known about the complex microbiome patterns involved in CTCL and how microbial shifts might impact this malignancy. Nevertheless, first hints indicate that the microbiome might at least in part explain transcriptional heterogeneity and that microbial approaches could serve in diagnosis and prognosis. Shaping the microbiome could be a treatment option to maintain stable disease. Here, we review current knowledge of transcriptional heterogeneity of and microbial influences on CTCL. We discuss potential benefits of microbial applications and microbial directed therapies to aid patients with CTCL burden.
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Affiliation(s)
- Philipp Licht
- Dermatology Clinic, University Medical Center of the Johannes Gutenberg-University Mainz, Langenbeckstraße 1, 55131 Mainz, Germany;
| | - Volker Mailänder
- Dermatology Clinic, University Medical Center of the Johannes Gutenberg-University Mainz, Langenbeckstraße 1, 55131 Mainz, Germany;
- Max Planck Institute for Polymer Research, Ackermannweg 10, 55128 Mainz, Germany
- Correspondence:
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16
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Ba W, Yang HH, Wang W, Li C. CD8+ mycosis fungoides with ichthyosiform clinical presentation and angiocentric feature. J Cutan Pathol 2021; 49:487-490. [PMID: 34913182 DOI: 10.1111/cup.14188] [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: 08/02/2021] [Revised: 12/08/2021] [Accepted: 12/13/2021] [Indexed: 11/30/2022]
Abstract
Mycosis fungoides (MF) is characterized by epidermotropic atypical lymphocytes infiltrate with α/β T-helper memory immunophenotype (βF1+, CD3+, CD4+, CD45Ro+, and CD8-). Angiocentricity is always associated with aggressive behavior or poor outcome in primary or secondary cutaneous lymphomas. Rare cases of angiocentric MF with a T-cytotoxic immunophenotype (CD3+, CD4-, CD8+, TIA-1+) have been described. Here, we report a 27-year-old man diagnosed with MF, clinically presenting with ichthyosiform lesions on his trunk and limbs. Biopsy demonstrated a CD3+ and CD8+ atypical lymphocytic infiltrate with marked epidermotropism and angiocentricity. Awareness of this rare MF variant with unusual clinicopathological characteristics is important to avoid misdiagnosis.
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Affiliation(s)
- Wei Ba
- Department of Dermatology, Chinese PLA General Hospital & Medical School, Beijing, China
| | - Henry Hongyu Yang
- Department of Pathology, St. Vincent Evansville Medical Center, Evansville, Indiana, USA
| | - Wenjuan Wang
- Department of Dermatology, Chinese PLA General Hospital & Medical School, Beijing, China
| | - Chengxin Li
- Department of Dermatology, Chinese PLA General Hospital & Medical School, Beijing, China
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17
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Nofal A, Alakad R, Ehab R, Essam R. Mycosis fungoides bullosa: An unusual presentation of a rare entity. JAAD Case Rep 2021; 18:82-88. [PMID: 34869813 PMCID: PMC8626627 DOI: 10.1016/j.jdcr.2021.10.019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Affiliation(s)
- Ahmad Nofal
- Dermatology, Venereology and Andrology Department, Faculty of Medicine, Zagazig University, Zagazig, Egypt
- Interactive Dermatology Research Foundation, Cairo, Egypt
| | - Rania Alakad
- Dermatology, Venereology and Andrology Department, Faculty of Medicine, Zagazig University, Zagazig, Egypt
- Interactive Dermatology Research Foundation, Cairo, Egypt
| | - Rana Ehab
- Dermatology, Venereology and Andrology Department, Faculty of Medicine, Zagazig University, Zagazig, Egypt
| | - Reham Essam
- Dermatology, Venereology and Andrology Department, Faculty of Medicine, Zagazig University, Zagazig, Egypt
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18
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Kim DJ, Truong SV, Paik A, Kraus C, Harris RM, Barr RJ, Linden KG, Smith J. A case of acanthosis nigricans-like mycosis fungoides. JAAD Case Rep 2021; 16:144-148. [PMID: 34621939 PMCID: PMC8484728 DOI: 10.1016/j.jdcr.2021.08.032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Affiliation(s)
- Dong Joo Kim
- Department of Dermatology, University of California, Irvine, Irvine, California
| | - Sam Van Truong
- Department of Dermatology, University of California, Irvine, Irvine, California
| | - Aimee Paik
- Department of Dermatology, University of California, Irvine, Irvine, California
| | - Christina Kraus
- Department of Dermatology, University of California, Irvine, Irvine, California
| | - Ronald M Harris
- Department of Dermatology, University of California, Irvine, Irvine, California
| | - Ronald J Barr
- Department of Dermatology, University of California, Irvine, Irvine, California.,Laguna Pathology Medical Group, Laguna Beach, California
| | - Kenneth G Linden
- Department of Dermatology, University of California, Irvine, Irvine, California.,The Chao Family Comprehensive Cancer Center, University of California, Irvine, Irvine, California
| | - Janellen Smith
- Department of Dermatology, University of California, Irvine, Irvine, California.,The Chao Family Comprehensive Cancer Center, University of California, Irvine, Irvine, California
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19
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Hristov AC, Tejasvi T, Wilcox RA. Cutaneous T-cell lymphomas: 2021 update on diagnosis, risk-stratification, and management. Am J Hematol 2021; 96:1313-1328. [PMID: 34297414 PMCID: PMC8486344 DOI: 10.1002/ajh.26299] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Revised: 07/20/2021] [Accepted: 07/21/2021] [Indexed: 11/08/2022]
Abstract
DISEASE OVERVIEW Cutaneous T-cell lymphomas are a heterogenous group of T-cell neoplasms involving the skin, the majority of which may be classified as Mycosis Fungoides (MF) or Sézary Syndrome (SS). DIAGNOSIS The diagnosis of MF or SS requires the integration of clinical and histopathologic data. RISK-ADAPTED THERAPY TNMB (tumor, node, metastasis, blood) staging remains the most important prognostic factor in MF/SS and forms the basis for a "risk-adapted," multi-disciplinary approach to treatment. For patients with disease limited to the skin, expectant management or skin-directed therapies is preferred, as both disease-specific and overall survival for these patients is favorable. In contrast, patients with advanced-stage disease with significant nodal, visceral or blood involvement are generally approached with systemic therapies, including biologic-response modifiers, histone deacetylase inhibitors, or antibody-based strategies, in an escalating fashion. In highly-selected patients, allogeneic stem-cell transplantation may be considered, as this may be curative in some patients.
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Affiliation(s)
- Alexandra C. Hristov
- Departments of Pathology and Dermatology, North Campus Research Complex, Ann Arbor, Michigan, USA
| | - Trilokraj Tejasvi
- Director Cutaneous Lymphoma program, Department of Dermatology, A. Alfred Taubman Health Care Center, Ann Arbor, Michigan, USA
| | - Ryan A. Wilcox
- Division of Hematology/Oncology, Department of Internal Medicine, University of Michigan Rogel Cancer Center, Ann Arbor, Michigan, USA
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20
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Tambe SA, Zambare US, Nayak CS. Folliculotropic Mycosis Fungoides. Indian Dermatol Online J 2021; 12:178-180. [PMID: 33768049 PMCID: PMC7982027 DOI: 10.4103/idoj.idoj_289_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Revised: 08/07/2020] [Accepted: 09/24/2020] [Indexed: 11/04/2022] Open
Affiliation(s)
- Swagata A Tambe
- Department of Skin & V.D., TNMC & BYL Nair Ch. Hospital, Mumbai, Maharashtra, India
| | - Uddhao S Zambare
- Department of Skin & V.D., TNMC & BYL Nair Ch. Hospital, Mumbai, Maharashtra, India
| | - Chitra S Nayak
- Department of Skin & V.D., TNMC & BYL Nair Ch. Hospital, Mumbai, Maharashtra, India
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21
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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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22
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Hignett E, Seminario-Vidal L, Shulman K, Sami N. Cutaneous T-cell lymphoma mimicking palmoplantar pustular psoriasis: A rare variant. Australas J Dermatol 2021; 62:e280-e282. [PMID: 33386610 DOI: 10.1111/ajd.13544] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2020] [Revised: 11/21/2020] [Accepted: 11/28/2020] [Indexed: 11/30/2022]
Abstract
The development of pustular cutaneous T-cell lymphoma (CTCL) on the palms and soles is rare. Without confirmatory biopsy and molecular studies, CTCL can be misdiagnosed as many benign inflammatory skin diseases. We present a case of cutaneous T-cell lymphoma (CTCL) that mimicked palmoplantar pustular psoriasis, a rarely reported manifestation of the disease. We stress the importance of biopsy to confirm diagnoses, especially when preliminary diagnoses do not respond to empiric treatment.
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Affiliation(s)
- Emma Hignett
- University of Central Florida College of Medicine, Orlando, FL, USA
| | - Lucia Seminario-Vidal
- H. Lee Moffitt Cancer and Research Center, Cutaneous Oncology Program, Tampa, FL, USA
| | - Kenneth Shulman
- H. Lee Moffitt Cancer and Research Center, Cutaneous Oncology Program, Tampa, FL, USA
| | - Naveed Sami
- Department of Dermatology, University of Central Florida College of Medicine, Orlando, FL, USA
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23
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Apalla Z, Lallas A, Katodritou E, Fotiadou C, Lazaridou E, Bobos M. Dermoscopy of poikilodermatous mycosis fungoides: A case escaping diagnosis for three decades. PHOTODERMATOLOGY PHOTOIMMUNOLOGY & PHOTOMEDICINE 2020; 37:250-252. [PMID: 33336431 DOI: 10.1111/phpp.12644] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/16/2020] [Revised: 11/13/2020] [Accepted: 12/13/2020] [Indexed: 11/30/2022]
Affiliation(s)
- Zoe Apalla
- Second Dermatology Department, Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Aimilios Lallas
- First Dermatology Department, Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Eirini Katodritou
- Hematology Department, "Theagenio" Cancer Hospital, Thessaloniki, Greece
| | - Christina Fotiadou
- Second Dermatology Department, Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Elizabeth Lazaridou
- Second Dermatology Department, Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Mattheos Bobos
- Microdiagnostics Private Pathology Laboratory, Thessaloniki, Greece
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24
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Brouwer IJ, Out-Luiting JJ, Vermeer MH, Tensen CP. Cucurbitacin E and I target the JAK/STAT pathway and induce apoptosis in Sézary cells. Biochem Biophys Rep 2020; 24:100832. [PMID: 33102814 PMCID: PMC7569298 DOI: 10.1016/j.bbrep.2020.100832] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Revised: 09/21/2020] [Accepted: 10/02/2020] [Indexed: 02/08/2023] Open
Abstract
Cutaneous T-cell lymphomas and leukemias (CTCLs) are a heterogeneous group of extranodal non-Hodgkin's lymphomas. These are characterized by an accumulation of malignant CD4+ T-lymphocytes in the skin, lymph nodes, and peripheral blood. Novel treatment options are needed for patients who progress to advanced stage disease. Cucurbitacin I has previously shown promising results in Sézary syndrome (Sz). A plethora of cucurbitacins, however, have not yet been tested in CTCL. Herein, we investigated the effect of cucurbitacin E and I in two CTCL cell lines. We show that both cucurbitacins decrease viability and cause apoptosis in these cell lines, although HuT-78 was more affected than SeAx (IC50 of 17.38 versus 22.01 μM for cucurbitacin E and 13.36 versus 24.47 μM for cucurbitacin I). Moreover, both cucurbitacins decrease viability of primary cells of a Sz patient (56.46% for cucurbitacin E and 59.07% for cucurbitacin I). Furthermore, while JAK2 inhibition leads to decreased viability in SeAx cells (IC50 of 9.98 and 29.15 μM for AZD1480 and ruxolitinib respectively), both JAK1 and JAK3 do not. This suggests that JAK2 has a preferential role in promoting survival. Western blotting in SeAx cells revealed that both cucurbitacins inhibit STAT3 activation (P < 0.0001), while only cucurbitacin I inhibits STAT5 activation (P = 0.05). This suggests that STAT3 plays a preferential role in the mechanism of action of these cucurbitacins. Nevertheless, a role of STAT5 and JAK2 cannot be excluded and should be explored further. This knowledge could contribute to the development of effective therapies for CTCL and other malignancies involving dysfunction of the JAK/STAT pathway. Cucurbitacin E and I decrease viability and cause apoptosis in Sézary cell lines Both cucurbitacins decrease viability of primary cells of a Sézary patient STAT3 appears to play a role in the mechanism of action of cucurbitacin E and I
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Affiliation(s)
- Isabella J Brouwer
- Department of Dermatology, Leiden University Medical Center, Leiden, the Netherlands
| | - Jacoba J Out-Luiting
- Department of Dermatology, Leiden University Medical Center, Leiden, the Netherlands
| | - Maarten H Vermeer
- Department of Dermatology, Leiden University Medical Center, Leiden, the Netherlands
| | - Cornelis P Tensen
- Department of Dermatology, Leiden University Medical Center, Leiden, the Netherlands
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25
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[Mycosis fungoides bullosa: A rare clinical presentation]. Ann Dermatol Venereol 2020; 147:760-763. [PMID: 32532519 DOI: 10.1016/j.annder.2020.04.017] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2019] [Revised: 01/17/2020] [Accepted: 04/21/2020] [Indexed: 11/20/2022]
Abstract
INTRODUCTION Mycosis fungoides (MF) is the most common form of cutaneous lymphoma and usually manifests as erythematous and scaly patches or plaques. Its phenotypic or histologic presentation can be heterogeneous. Herein we report a very rare form of MF bullosa. PATIENTS AND METHODS A 73-year-old man presented with a 4-month history of erythematous, scaly and itchy plaques on the trunk, as well as blistering lesions present for 2 months and which appeared on the trunk and lower limbs, both on patches of MF and on apparently healthy skin. Histopathology confirmed the diagnosis of bullous mycosis fungoides. Gene rearrangement of TCR showed a monoclonal profile in the skin. The hypothesis of bullous pemphigoid was ruled out by additional exams. Our patient was successively treated with combined interferon, bexarotene and methotrexate, followed by vorinostat, resulting in partial remission. DISCUSSION Cases of bullous MF are very rare. In the literature, the clinical presentation is heterogeneous, with tense or flaccid bullae that can occur on unaffected skin or on erythematous plaques. The bullae generally appear after the plaques. The histologic blister site may be subepidermal or, more rarely, intra-epidermal. The exact mechanism of blister formation is not clear. Its treatment is poorly codified but follows the usual treatment of MF in its classical form. CONCLUSION Bullous MF is a very rare entity that can mimic autoimmune blistering disease, and this diagnosis must therefore be ruled out.
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26
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Alsayyah A. Is it mycosis fungoides? A comprehensive guide to reaching the diagnosis and avoiding common pitfalls. Ann Diagn Pathol 2020; 47:151546. [PMID: 32554312 DOI: 10.1016/j.anndiagpath.2020.151546] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2020] [Revised: 05/07/2020] [Accepted: 05/19/2020] [Indexed: 12/14/2022]
Abstract
Mycosis Fungoides (MF) is known as 'the great mimicker' due to its capacity to emulate several dermatoses, both in the clinic and on histology. This often leads to the diagnosis being missed or delayed, which consequently leads to poorer prognosis. For a timely diagnosis, it is crucial that the physician is aware of the various clinical and histological presentations of MF, as well as the proper diagnostic protocols. In the current review, we concisely encapsulate all the variants of MF as well has the conditions it mimics clinically and histologically. Through this, we aim to provide clinicians with a holistic picture of MF and help them determine when to suspect this disease and steps to take in order to nail the diagnosis.
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Affiliation(s)
- Ahmed Alsayyah
- Department of Pathology, College of Medicine, Imam Abdulrahman Bin Faisal University, Post Box No. 1982, Dammam 31441, Saudi Arabia.
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27
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Rohmer E, Mitcov M, Cribier B, Lipsker D, Lenormand C. [Clinical heterogeneity of poikilodermatous mycosis fungoides: A retrospective study of 12 cases]. Ann Dermatol Venereol 2020; 147:418-428. [PMID: 32229035 DOI: 10.1016/j.annder.2020.02.007] [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: 04/19/2019] [Revised: 01/08/2020] [Accepted: 02/05/2020] [Indexed: 11/28/2022]
Abstract
INTRODUCTION Poikilodermatous mycosis fungoides is a rare and indolent clinical variant of mycosis fungoides (MF). It can be difficult to distinguish from poikilodermatous parapsoriasis, a group of chronical dermatoses that may sometimes progress to MF. We aimed to specify the clinical, histopathological and developmental features of these entities by means of a retrospective study of 12 cases followed in our center. PATIENTS AND METHODS We identified cases of poikiloderma for which a diagnosis of MF or parapsoriasis was made by the physician. Photographs and histological slides were reviewed, and a final diagnosis of MF was made if the International Society for Cutaneous Lymphoma criteria for the diagnosis of early MF were fulfilled. RESULTS Twelve patients were included, 10 of whom met of the MF criteria. 5 patients had large poikilodermatous patches or thin, well-defined plaques ; 3 patients had the same lesions associated with classical MF lesions ; finally, 4 patients had widespread ill-defined erythematous lesions in a net-like pattern, described as parakeratosis variegata, including 3 MF. 2 patients with well-defined lesions (one associated with classical MF lesions) progressed to the tumoral stage whereas none of the patients with parakeratosis variegata presented such progression. A total of 5 patients had a high skin phototype (IV and V). Two patients had squamous cell carcinoma on poikilodermatous lesions. DISCUSSION Our study suggests that poikilodermatous MF covers a heterogeneous clinical spectrum comprising on one hand a presentation of delimited lesions sharing classical MF risk of progression, and on the other, an entity similar to parakeratosis variegata, an entity overlooked in the French nomenclature, which was particularly benign in our small series, raising the question of its affiliation to the MF group. This question merits further investigation in a larger-scale study.
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Affiliation(s)
- E Rohmer
- Clinique dermatologique, université de Strasbourg et hôpitaux universitaires de Strasbourg, 1, place de l'Hôpital, 67091 Strasbourg cedex, France.
| | - M Mitcov
- Clinique dermatologique, université de Strasbourg et hôpitaux universitaires de Strasbourg, 1, place de l'Hôpital, 67091 Strasbourg cedex, France
| | - B Cribier
- Clinique dermatologique, université de Strasbourg et hôpitaux universitaires de Strasbourg, 1, place de l'Hôpital, 67091 Strasbourg cedex, France
| | - D Lipsker
- Clinique dermatologique, université de Strasbourg et hôpitaux universitaires de Strasbourg, 1, place de l'Hôpital, 67091 Strasbourg cedex, France
| | - C Lenormand
- Clinique dermatologique, université de Strasbourg et hôpitaux universitaires de Strasbourg, 1, place de l'Hôpital, 67091 Strasbourg cedex, France
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28
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Amorim GM, Quintella DC, Niemeyer-Corbellini JP, Ferreira LC, Ramos-E-Silva M, Cuzzi T. Validation of an algorithm based on clinical, histopathological and immunohistochemical data for the diagnosis of early-stage mycosis fungoides. An Bras Dermatol 2020; 95:326-331. [PMID: 32317132 PMCID: PMC8074686 DOI: 10.1016/j.abd.2020.01.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2019] [Accepted: 01/05/2020] [Indexed: 12/27/2022] Open
Abstract
Background Diagnosis of mycosis fungoides is challenging due to the non-specificity of clinical and histopathological findings. The literature indicates an average delay of 4–6 years for a conclusive diagnosis. Refinement of the histopathological criteria for the diagnosis of patients in early stages of the disease is considered of interest. Objectives To study the histopathological aspects of early-stage mycosis fungoides and the applicability, in a retrospective form, of the diagnostic algorithm proposed by Pimpinelli et al. Methods Observational, retrospective, transversal study based on revision of histopathological exams of patients with suspected mycosis fungoides. Medical records were reviewed, and complementary immunohistochemistry performed. Results Sixty-seven patients were included. The most frequent histopathological features were superficial perivascular lymphoid infiltrate (71.6%), epidermotropism (68.7%), lymphocytic atypia (63.8%), hyperkeratosis (62.7%) and acanthosis (62.7%). Forty-three patients scored 4 points at the algorithm, by clinical and histological evaluation. Immunohistochemistry was performed on 23 of the 24 patients with less than 4 points. Of those 23, 22 scored 1 point, allowing a total of 61 patients (91%) with the diagnosis of early-stage mycosis fungoides. Study limitations Its retrospective character, reduced sample size and incomplete application of the algorithm. Conclusions Application of the Pimpinelli et al. algorithm, even in an incomplete form, increased the percentage of cases diagnosed as mycosis fungoides. Routine application of the algorithm may contribute to earlier and specific management and improvement of the patients’ outcome.
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Affiliation(s)
- Gustavo Moreira Amorim
- Postgraduate Program in Anatomical Pathology, Faculdade de Medicina, Universidade Federal do Rio de Janeiro, Rio de Janeiro, RJ, Brazil.
| | - Daniele Carvalho Quintella
- Department of Pathology, Faculdade de Medicina, Universidade Federal do Rio de Janeiro, Rio de Janeiro, RJ, Brazil
| | | | - Luiz Claudio Ferreira
- Instituto Nacional de Infectologia, Fundação Oswaldo Cruz, Rio de Janeiro, RJ, Brazil
| | - Marcia Ramos-E-Silva
- Discipline of Dermatology, Departamento de Clínica Médica, Faculdade de Medicina, Universidade Federal do Rio de Janeiro, Rio de Janeiro, RJ, Brazil
| | - Tullia Cuzzi
- Postgraduate Program in Anatomical Pathology, Faculdade de Medicina, Universidade Federal do Rio de Janeiro, Rio de Janeiro, RJ, Brazil; Department of Pathology, Faculdade de Medicina, Universidade Federal do Rio de Janeiro, Rio de Janeiro, RJ, Brazil; Instituto Nacional de Infectologia, Fundação Oswaldo Cruz, Rio de Janeiro, RJ, Brazil
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29
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Ortiz-Romero PL, Servitje O, Estrach MT, Izu-Belloso RM, Fernández-de-Misa R, Gallardo F, López-Martínez N, Pérez-Mitru A. Cost of early-stage mycosis fungoides treatments in Spain. CLINICOECONOMICS AND OUTCOMES RESEARCH 2020; 12:91-105. [PMID: 32104021 PMCID: PMC7024769 DOI: 10.2147/ceor.s233376] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2019] [Accepted: 12/18/2019] [Indexed: 11/23/2022] Open
Abstract
AIM To identify the most common therapeutic options for the treatment of early-stage mycosis fungoides in Spain, quantify their associated healthcare resource use and costs. METHODS After reviewing the literature, a panel of 6 Spanish clinical dermatologists validated the treatments and healthcare resource use through a structured questionnaire. Individual responses were collected, analyzed and presented into a face-to-face meeting in order to reach a consensus. Cost categories considered were: drug acquisition and administration, photo/radiotherapy session and maintenance, clinical follow-up visits and laboratory tests. Costs were expressed in euros from 2018. The Spanish National Health System perspective was considered, taking into account direct health costs and time horizons of 1, 3 and 6 months. RESULTS Costs for the skin-directed treatments (SDT) assessed at 1, 3 and 6 months, were: Topical carmustine [€6,593.36, €19,780.09 and €27,592.78]; Phototherapy with psoralens and ultraviolet A light (PUVA) [€1,098.68, €2,999.99 and €3,187.60]; Narrow-band ultraviolet B phototherapy [€1,657.47, €4,842.10 and €4,842.10]; Total skin electron beam therapy (TSEBT) [€6,796.45, €7,913.34 and €7,913.34]. Cost for topical corticosteroids, being considered an adjuvant option, were €17.16, €51.49 and €102.97. Costs for the assessed systemic treatments alone or in combination with SDT at 1, 3 and 6 months, were: Systemic retinoids [€2,026.03, €5,206.63 and €7,426.42]; Systemic retinoids + PUVA phototherapy [€3,066.50, €8,271.26 and €10,046.58]; Interferon alfa + PUVA phototherapy [€1,541.09, €5,167.57 and €6,404.55]. CONCLUSION According to the Spanish clinical practice, phototherapies in monotherapy were the treatments with the lowest associated costs regardless of the time horizon considered. TSEBT turned out as the treatment with the highest associated costs when considering 1 month. However, while considering 3 and 6 months the treatment with the highest associated costs was topical carmustine. The results of this analysis may provide critical information to measure the disease burden, to detect unmet medical needs and to advocate towards better treatments for this rare disease.
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Affiliation(s)
- Pablo Luis Ortiz-Romero
- Dermatology Department, Hospital 12 de Octubre, Institute I+12, Medical School, University Complutense, CIBERONC, Madrid, Spain
| | - Octavio Servitje
- Dermatology Department, Hospital Universitari de Bellvitge, IDIBELL, L’Hospitalet de Llobregat, Barcelona, Spain
| | - María Teresa Estrach
- Dermatology Department, Hospital Clínic, IDIBAPS, Universitat de Barcelona, Barcelona, Spain
| | | | - Ricardo Fernández-de-Misa
- Department of Dermatology and Research Unit, Hospital Universitario Nuestra Señora de Candelaria, Santa Cruz de Tenerife, Spain
| | - Fernando Gallardo
- Dermatology Department, Parc de Salut Mar-Hospital del Mar, Barcelona, Spain
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Molina GE, Danesh MJ, Foreman RK, Kroshinsky D. A 78-Year-Old Female with a Diffuse Pruritic Rash and Palmoplantar Desquamation. Dermatopathology (Basel) 2020; 6:241-245. [PMID: 32083061 PMCID: PMC7011743 DOI: 10.1159/000503745] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2019] [Accepted: 09/29/2019] [Indexed: 12/04/2022] Open
Abstract
Mycosis fungoides, the most common cutaneous T-cell lymphoma, is known to exhibit varied clinical presentations and mimic many other dermatoses. This morphological heterogeneity can often lead to initial misdiagnoses resulting in significant delays from symptom onset to diagnosis. We report a case of mycosis fungoides imitating clinical and histopathological features of erythema annulare centrifugum.
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Affiliation(s)
| | - Melissa J Danesh
- Harvard Combined Dermatology Residency Program, Boston, Massachusetts, USA.,Department of Dermatology, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Ruth K Foreman
- Department of Pathology, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Daniela Kroshinsky
- Department of Dermatology, Massachusetts General Hospital, Boston, Massachusetts, USA
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31
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El Sherif N, Elorfi AM, Bugrein O, Eldruki S. Clinical and epidemiological profile of libyan patients with mycosis fungoides: A prospective study. JOURNAL OF DERMATOLOGY & DERMATOLOGIC SURGERY 2020. [DOI: 10.4103/jdds.jdds_24_20] [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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32
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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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33
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Kamijo H, Sugaya M. Two distinct variants of mycosis fungoides (MF): Folliculotropic MF and erythrodermic MF. J Dermatol 2019; 46:1136-1140. [PMID: 31625194 DOI: 10.1111/1346-8138.15114] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2019] [Accepted: 09/18/2019] [Indexed: 11/30/2022]
Abstract
Mycosis fungoides (MF) is the most frequent type of cutaneous T-cell lymphoma. Folliculotropic MF (fMF) and erythrodermic MF (eMF) are two distinct variants of MF. Both variants have been considered aggressive and most cases are less responsive to standard skin-directed therapies than classical MF. We, however, experienced many cases with fMF or eMF who showed indolent clinical courses. In this article, we reviewed 10 cases with fMF and 13 cases with eMF who came to our department between 2005 and 2017. In patients with fMF, monotherapy with topical corticosteroid was effective in two cases (20%) and ultraviolet phototherapy with oral retinoid controlled disease activity in two cases (20%). Five patients with eMF (38%) responded well to ultraviolet phototherapy. In conclusion, patients with early fMF and a subgroup of eMF patients have an indolent disease course, as was proposed among the specialists. Skin-directed therapies are preferable rather than aggressive treatment in those cases.
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Affiliation(s)
- Hiroaki Kamijo
- Department of Dermatology, University of Tokyo Graduate School of Medicine, Tokyo, Japan
| | - Makoto Sugaya
- Department of Dermatology, University of Tokyo Graduate School of Medicine, Tokyo, Japan.,Department of Dermatology, International University of Health and Welfare, Chiba, Japan
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34
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Perandones González H, Sánchez Sambucety P, Rodríguez Prieto MÁ. Ichthyosiform pattern: an exceptional presentation of mycosis fungoides. Int J Dermatol 2019; 59:730-732. [PMID: 31498889 DOI: 10.1111/ijd.14636] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2019] [Revised: 06/27/2019] [Accepted: 08/08/2019] [Indexed: 11/28/2022]
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35
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Hristov AC, Tejasvi T, Wilcox RA. Mycosis fungoides and Sézary syndrome: 2019 update on diagnosis, risk-stratification, and management. Am J Hematol 2019; 94:1027-1041. [PMID: 31313347 DOI: 10.1002/ajh.25577] [Citation(s) in RCA: 66] [Impact Index Per Article: 13.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2019] [Revised: 07/09/2019] [Accepted: 07/10/2019] [Indexed: 01/04/2023]
Abstract
DISEASE OVERVIEW Cutaneous T-cell lymphomas (CTCL) are a heterogenous group of T-cell neoplasms involving the skin, the majority of which may be classified as Mycosis fungoides (MF) or Sézary syndrome (SS). DIAGNOSIS The diagnosis of MF or SS requires the integration of clinical and histopathologic data. RISK-ADAPTED THERAPY TNMB (tumor, node, metastasis, blood) staging remains the most important prognostic factor in MF/SS and forms the basis for a "risk-adapted," multi-disciplinary approach to treatment. For patients with disease limited to the skin, skin-directed therapies are preferred, as both disease-specific and overall survival for these patients is favorable. In contrast, patients with advanced-stage disease with significant nodal, visceral or blood involvement are generally approached with systemic therapies. These include biologic-response modifiers, histone deacetylase (HDAC) inhibitors, or antibody-based strategies, in an escalating fashion. In highly-selected patients, allogeneic stem-cell transplantation may be considered, as this may be curative in some patients.
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Affiliation(s)
- Alexandra C. Hristov
- Departments of Pathology and DermatologyUniversity of Michigan Ann Arbor Michigan
| | | | - Ryan A. Wilcox
- Division of Hematology/Oncology, Department of Internal MedicineUniversity of Michigan Rogel Cancer Center Ann Arbor Michigan
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36
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37
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Waldman RA, Finch J, Grant-Kels JM, Stevenson C, Whitaker-Worth D. Skin diseases of the breast and nipple. J Am Acad Dermatol 2019; 80:1467-1481. [DOI: 10.1016/j.jaad.2018.08.066] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2018] [Revised: 08/03/2018] [Accepted: 08/06/2018] [Indexed: 12/31/2022]
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38
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Gantchev J, Martínez Villarreal A, Xie P, Lefrançois P, Gunn S, Netchiporouk E, Sasseville D, Litvinov IV. The Ectopic Expression of Meiosis Regulatory Genes in Cutaneous T-Cell Lymphomas (CTCL). Front Oncol 2019; 9:429. [PMID: 31214493 PMCID: PMC6554469 DOI: 10.3389/fonc.2019.00429] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2019] [Accepted: 05/07/2019] [Indexed: 01/12/2023] Open
Abstract
Cancer testis (CT) antigens, under normal circumstances are uniquely expressed in testicular germ cells. Recent research has shown that meiosis-specific CT (meiCT) antigens are ectopically expressed in cutaneous T-cell lymphoma (CTCL) and may contribute to increased genomic instability. The aberrant activation of meiosis genes in a mitotic cell is now recognized as a distinctive process, “meiomitosis.” We have previously demonstrated the ectopic expression of several meiCT antigens in nine patient-derived CTCL cell lines and in expanded peripheral T lymphocytes isolated from Sézary Syndrome patients. In this study we analyzed the transcriptional expression of meiCT genes in Sézary Syndrome patients and healthy controls using publicly-available RNA sequencing (RNA-Seq) data. We corroborated our in silico analysis by examining the expression of 5 meiCT proteins in formalin-fixed, paraffin-embedded (FFPE) lesional samples from CTCL patients. Our results show significant differential gene expression of STAG3, SGO2, SYCP3, and DMC1 in a cohort of Sézary Syndrome patients when compared to healthy controls. Additionally, our study demonstrates a heterogenous expression of meiCT genes involved in initiation (STRA8), sister chromatin cohesion (STAG3, SGO2), homologous chromosome synapsis (SYCP3) and homologous recombination (DMC1) in atypical lymphocytes in FFPE samples. Our results further confirm the ectopic expression of meiCT genes in CTCL which indicates that CTCL malignant cells likely undergo the process of cancer meiomitosis, as opposed to a typical mitotic division. The ectopic expression of meiCT genes together with investigations into the functional mechanisms of cancer meiomitosis will help provide a foundation to develop novel diagnostic tests to distinguish CTCL from benign inflammatory dermatoses and may enable us to develop additional targeted therapies for patients with this malignancy.
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Affiliation(s)
| | | | - Pingxing Xie
- Division of Dermatology, McGill University, Montréal, QC, Canada
| | | | - Scott Gunn
- Division of Dermatology, McGill University, Montréal, QC, Canada
| | | | - Denis Sasseville
- Division of Dermatology, McGill University, Montréal, QC, Canada
| | - Ivan V Litvinov
- Division of Dermatology, McGill University, Montréal, QC, Canada
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39
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40
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Ito A, Sugita K, Ikeda A, Yamamoto O. CD4/CD8 Double-negative Mycosis Fungoides: A Case Report and Literature Review. Yonago Acta Med 2019. [PMID: 30962758 DOI: 10.33160/yam.2019.03.021] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Mycosis fungoides, the most common subtype of cutaneous T-cell lymphoma, displays a broad spectrum of clinical, histological and phenotypic variants with different prognostic impacts. The classic immunophenotype is CD3+/CD4+/CD45RO+memory T cells. CD4/CD8 double-negative mycosis fungoides is rare. Here we describe the clinicopathological features of CD4/CD8 double-negative mycosis fungoides in a 55-year-old female with a review of the literature. Although the CD4/CD8 double-negative phenotype appears to be associated with an unusual clinical presentation, it does not appear to confer prognostic significance.
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Affiliation(s)
- Ayako Ito
- Division of Dermatology, Department of Medicine of Sensory and Motor Organs, School of Medicine, Tottori University Faculty of Medicine, Yonago 683-8503, Japan
| | - Kazunari Sugita
- Division of Dermatology, Department of Medicine of Sensory and Motor Organs, School of Medicine, Tottori University Faculty of Medicine, Yonago 683-8503, Japan
| | - Ayano Ikeda
- Division of Dermatology, Department of Medicine of Sensory and Motor Organs, School of Medicine, Tottori University Faculty of Medicine, Yonago 683-8503, Japan
| | - Osamu Yamamoto
- Division of Dermatology, Department of Medicine of Sensory and Motor Organs, School of Medicine, Tottori University Faculty of Medicine, Yonago 683-8503, Japan
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41
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Gug G, Huang Q, Chiticariu E, Solovan C, Baudis M. DNA copy number imbalances in primary cutaneous lymphomas. J Eur Acad Dermatol Venereol 2019; 33:1062-1075. [PMID: 30659659 DOI: 10.1111/jdv.15442] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2018] [Accepted: 12/14/2018] [Indexed: 12/22/2022]
Abstract
BACKGROUND Cutaneous lymphomas (CL) represent a clinically defined group of extranodal non-Hodgkin lymphomas harbouring heterogeneous and incompletely delineated molecular aberrations. Over the past decades, molecular studies have identified several chromosomal aberrations, but the interpretation of individual genomic studies can be challenging. OBJECTIVE With a comprehensive meta-analysis, we aim to delineate genomic alterations for different types of CL and propose a more accurate classification in line with their various pathogenicity. METHODS We searched PubMed and ISI Web of Knowledge for publications from 1996 to 2016 reporting the investigation of CL for genome-wide copy number alterations, by means of comparative genomic hybridization techniques and whole-genome sequencing and whole-exome sequencing. We then extracted and remapped the available copy number variation (CNV) data from these publications with the same pipeline and performed clustering and visualisation to aggregate samples of similar CNV profiles. RESULTS For 449 samples from 22 publications, CNV data were accessible for sample based meta-analysis. Our findings illustrate structural and numerical chromosomal imbalance patterns. Most frequent CNAs were linked to oncogenes or tumour suppressor genes with important roles in the course of the disease. CONCLUSION Summary profiles for genomic imbalances, generated from case-specific data, identified complex genomic imbalances, which could discriminate between different subtypes of CL and promise a more accurate classification. The collected data presented in this study are publicly available through the 'Progenetix' online repository.
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Affiliation(s)
- G Gug
- University of Medicine and Pharmacy "Victor Babeș", Timișoara, România
| | - Q Huang
- Institute of Molecular Life Sciences, University of Zurich, Zurich, Switzerland.,Swiss Institute of Bioinformatics, Zurich, Switzerland
| | - E Chiticariu
- University of Medicine and Pharmacy "Victor Babeș", Timișoara, România
| | - C Solovan
- University of Medicine and Pharmacy "Victor Babeș", Timișoara, România.,Emergency City Hospital, University Clinic of Dermatology and Venereology, Timișoara, România
| | - M Baudis
- Institute of Molecular Life Sciences, University of Zurich, Zurich, Switzerland.,Swiss Institute of Bioinformatics, Zurich, Switzerland
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42
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Yonan YA, Cumsky HJL, Costello CM, Maly CJ, Rosenthal AC, Reeder CB, Rule WG, Pittelkow MR, Craig FE, DiCaudo DJ, Mangold AR. Syringotropic and folliculotropic mycosis fungoides with mycosis fungoides-associated vasculopathic ulcers. JAAD Case Rep 2019; 5:231-233. [PMID: 30834284 PMCID: PMC6384313 DOI: 10.1016/j.jdcr.2019.01.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Affiliation(s)
- Yousif A Yonan
- Department of Dermatology, Mayo Clinic, Scottsdale, Arizona
| | - Helen J L Cumsky
- Department of Dermatology, Mayo Clinic, Scottsdale, Arizona.,Case Western Reserve University School of Medicine, Cleveland, Ohio
| | | | - Connor J Maly
- Department of Dermatology, Mayo Clinic, Scottsdale, Arizona.,Georgetown University School of Medicine, Washington, DC
| | | | - Craig B Reeder
- Department of Hematology, Mayo Clinic, Scottsdale, Arizona
| | - William G Rule
- Department of Radiation Oncology, Mayo Clinic, Scottsdale, Arizona
| | | | - Fiona E Craig
- Department of Pathology, Mayo Clinic, Scottsdale, Arizona
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43
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Kim SR, Lewis JM, Cyrenne BM, Monico PF, Mirza FN, Carlson KR, Foss FM, Girardi M. BET inhibition in advanced cutaneous T cell lymphoma is synergistically potentiated by BCL2 inhibition or HDAC inhibition. Oncotarget 2018; 9:29193-29207. [PMID: 30018745 PMCID: PMC6044378 DOI: 10.18632/oncotarget.25670] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2018] [Accepted: 06/06/2018] [Indexed: 12/31/2022] Open
Abstract
While several systemic therapies are approved for cutaneous T cell lymphoma (CTCL), a non-Hodgkin lymphoma of skin-homing T cells that may involve lymph nodes and peripheral blood in advanced stages, relapses are common. Mutational analysis of CTCL cells has revealed frequent amplification of the MYC oncogene, and bromodomain and extraterminal (BET) protein inhibitors have been shown to repress MYC expression in various malignancies. Towards a potential novel therapy, we thus sought to examine the effect of BET inhibition on CTCL cells in vitro. Each of the four tested BET inhibitors (JQ1, ABBV-075, I-BET762, CPI-0610) consistently induced dose-dependent decreases in viability of isolated patient-derived CTCL cells and established CTCL cell lines (MyLa, Sez4, HH, Hut78). This effect was synergistically potentiated by combination of BET inhibition with BCL2 inhibition (e.g. venetoclax) or histone deacetylase (HDAC) inhibition (e.g. vorinostat or romidepsin). There was also a marked increase in caspase 3/7 activation when JQ1 was combined with either vorinostat or romidepsin, confirming that the observed synergies are due in major part to induction of apoptosis. Furthermore, MYC and BCL2 expression were each synergistically repressed when CTCL cells were treated with JQ1 plus HDAC inhibitors, suggesting cooperative activities at the level of epigenetic regulation. Taken together, these data indicate that targeting BET proteins in CTCL represents a promising novel therapeutic strategy that may be substantially potentiated by combination with BCL2 or HDAC inhibition.
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Affiliation(s)
- Sa Rang Kim
- Department of Dermatology, Yale School of Medicine, New Haven, CT 06510, USA
| | - Julia M Lewis
- Department of Dermatology, Yale School of Medicine, New Haven, CT 06510, USA
| | - Benoit M Cyrenne
- Department of Dermatology, Yale School of Medicine, New Haven, CT 06510, USA
| | - Patrick F Monico
- Department of Dermatology, Yale School of Medicine, New Haven, CT 06510, USA
| | - Fatima N Mirza
- Department of Dermatology, Yale School of Medicine, New Haven, CT 06510, USA
| | - Kacie R Carlson
- Department of Dermatology, Yale School of Medicine, New Haven, CT 06510, USA
| | - Francine M Foss
- Department of Internal Medicine, Section of Medical Oncology, Yale School of Medicine, New Haven, CT 06510, USA
| | - Michael Girardi
- Department of Dermatology, Yale School of Medicine, New Haven, CT 06510, USA
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44
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Cutaneous lymphomas in Taiwan: A review of 118 cases from a medical center in southern Taiwan. DERMATOL SIN 2018. [DOI: 10.1016/j.dsi.2017.08.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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45
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Jang MS, Jang JY, Park JB, Kang DY, Lee JW, Lee TG, Hwangbo H, Suh KS. Folliculotropic Mycosis Fungoides in 20 Korean Cases: Clinical and Histopathologic Features and Response to Ultraviolet A-1 and/or Photodynamic Therapy. Ann Dermatol 2018; 30:192-201. [PMID: 29606817 PMCID: PMC5839891 DOI: 10.5021/ad.2018.30.2.192] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2017] [Revised: 10/11/2017] [Accepted: 10/25/2017] [Indexed: 11/17/2022] Open
Abstract
Background Folliculotropic mycosis fungoides (FMF) is a variant of mycosis fungoides (MF) that is characterized clinically by variable types of skin eruptions, including plaques, acneiform lesions, and alopecic patches. Histopathologically, FMF is characterized by folliculotropic infiltrates. Objective This study was conducted to scrutinize the clinical and histopathologic features of FMF in Koreans and the responses to phototherapy. Methods Twenty Koreans diagnosed with MF who had histopathologic evidence of folliculotropism were enrolled. Results Eighteen patients had head-and-neck-region infiltration, while five had solitary lesion. In all patients, the atypical lymphocytic infiltrate had a perifollicular distribution. Twelve patients were treated with ultraviolet A (UVA)-1. Eleven of these 12 patients with early-stage FMF experienced >80% improvement (8: complete remission; 3: partial remission). Four patients, including 2 who relapsed after UVA-1, were treated with photodynamic therapy (PDT), reaching complete remission after PDT. Conclusion As FMF has variable clinical presentations, skin biopsy is required to confirm the diagnosis. And both UVA-1 and methyl aminolevulinate-PDT are clinically effective in treatment of early-stage FMF.
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Affiliation(s)
- Min Soo Jang
- Department of Dermatology, Kosin University College of Medicine, Busan, Korea
| | - Ji Yun Jang
- Department of Dermatology, Kosin University College of Medicine, Busan, Korea
| | - Jong Bin Park
- Department of Dermatology, Kosin University College of Medicine, Busan, Korea
| | - Dong Young Kang
- Department of Dermatology, Kosin University College of Medicine, Busan, Korea
| | - Jin Woo Lee
- Department of Dermatology, Kosin University College of Medicine, Busan, Korea
| | - Taek Geun Lee
- Department of Dermatology, Kosin University College of Medicine, Busan, Korea
| | - Hyun Hwangbo
- Department of Dermatology, Maryknoll Medical Center, Busan, Korea
| | - Kee Suck Suh
- Department of Dermatology, Kosin University College of Medicine, Busan, Korea
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46
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Lu YY, Wu CH, Lu CC, Hong CH. Hyperpigmentation as a peculiar presentation of mycosis fungoides. An Bras Dermatol 2017; 92:92-94. [PMID: 29267458 PMCID: PMC5726689 DOI: 10.1590/abd1806-4841.20175544] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2016] [Accepted: 04/16/2016] [Indexed: 11/21/2022] Open
Abstract
Hyperpigmented mycosis fungoides is an extremely rare subtype of mycosis
fungoides. It presents as multiple pigmented macules and patches without
poikilodermatous changes and characterized by a CD8+ phenotype on
immunohistochemistry. This report describes a typical case of hyperpigmented
mycosis fungoides in a 62-year-old woman, who presented with a 7-year history of
multiple hyperpigmented macules and patches on the trunk and right leg with
progression over this half a year. Histology and immunohistochemical staining of
skin samples confirmed the diagnosis of mycosis fungoides. She received psoralen
plus ultraviolet A (PUVA) therapy. After an 8-week treatment, the erythematous
changes cleared without recurrence during a 6-month follow-up period. An
intractable hyperpigmented patch should raise the clinical suspicion of mycosis
fungoides with sequential skin biopsy.
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Affiliation(s)
- Ying-Yi Lu
- Department of Dermatology, Kaohsiung Veterans General Hospital - Kaohsiung, Taiwan.,Graduate Institute of Medicine, College of Medicine, Kaohsiung Medical University - Kaohsiung, Taiwan.,Department of Cosmetic Applications and Management, Yuh-Ing Junior College of Health Care & Management - Kaohsiung, Taiwan
| | - Chieh-Hsin Wu
- Graduate Institute of Medicine, College of Medicine, Kaohsiung Medical University - Kaohsiung, Taiwan.,Division of Neurosurgery, Department of Surgery, Kaohsiung Medical University Hospital - Kaohsiung, Taiwan.,Department of Surgery, School of Medicine, College of Medicine, Kaohsiung Medical University - Kaohsiung, Taiwan
| | - Chun-Ching Lu
- Department of Orthopedics, Taipei Veterans General Hospital - Taipei, Taiwan
| | - Chien-Hui Hong
- Department of Dermatology, Kaohsiung Veterans General Hospital - Kaohsiung, Taiwan.,Department of Dermatology, National Yang-Ming University, College of Medicine - Taipei, Taiwan
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Abstract
Mycosis fungoides (MF) is the most common form of primary cutaneous lymphoma with a broad clinicopathological spectrum. Unusual histopathologic patterns of MF include lichenoid, interstitial, folliculotropic, spongiotic, granulomatous, and many others. Several cases of unusual lichenoid reaction characterized by a mixed lichenoid inflammatory infiltrate with prominent infiltration of the papillary dermis and epidermis by multinucleated giant cells were described under the name of "giant cell lichenoid dermatitis," most of them were considered to represent a drug eruption. Herein, we describe a 77-year-old woman with a 5-year history of MF displaying microscopic features of giant cell lichenoid dermatitis. Histology revealed a dense band-like lichenoid epidermotropic infiltrate composed of CD4 small to medium-sized lymphocytes with cerebriform nuclei with the presence of multinucleated giant cells in the papillary dermis, within the epidermis, and some hair follicles. Monoclonal TCR gene rearrangement was detected using PCR. To the best of our knowledge, this pattern was never described in MF.
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Wilcox RA. Cutaneous T-cell lymphoma: 2017 update on diagnosis, risk-stratification, and management. Am J Hematol 2017; 92:1085-1102. [PMID: 28872191 DOI: 10.1002/ajh.24876] [Citation(s) in RCA: 89] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2017] [Accepted: 07/27/2017] [Indexed: 12/12/2022]
Abstract
DISEASE OVERVIEW Cutaneous T-cell lymphomas are a heterogenous group of T-cell lymphoproliferative disorders involving the skin, the majority of which may be classified as Mycosis Fungoides (MF) or Sézary Syndrome (SS). DIAGNOSIS The diagnosis of MF or SS requires the integration of clinical and histopathologic data. RISK-ADAPTED THERAPY TNMB (tumor, node, metastasis, blood) staging remains the most important prognostic factor in MF/SS and forms the basis for a "risk-adapted," multi-disciplinary approach to treatment. For patients with disease limited to the skin, expectant management or skin-directed therapies is preferred, as both disease-specific and overall survival for these patients is favorable. In contrast, patients with advanced-stage disease with significant nodal, visceral or blood involvement are generally approached with biologic-response modifiers or histone deacetylase inhibitors prior to escalating therapy to include systemic, single-agent chemotherapy. In highly-selected patients, allogeneic stem-cell transplantation may be considered, as this may be curative in some patients.
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Affiliation(s)
- Ryan A. Wilcox
- Division of Hematology/Oncology; University of Michigan Comprehensive Cancer Center; Ann Arbor Michigan 48109-5948
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