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Feng X, Xie Y, Li F, Wang L. Follicular mycosis fungoides: Clinicohistopathologic features and outcomes in a series of 12 Chinese cases. Indian J Dermatol Venereol Leprol 2024; 90:68-77. [PMID: 37317772 DOI: 10.25259/ijdvl_1003_2021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2021] [Accepted: 01/01/2023] [Indexed: 06/16/2023]
Abstract
Background Follicular mycosis fungoides is a distinct variant of mycosis fungoides with a broad clinical spectrum. Recently, many studies have indicated that follicular mycosis fungoides should be divided into different subtypes with disparate prognoses. Objective To define the clinicohistopathologic features and outcomes of follicular mycosis fungoides and to identify risk factors that may be related to the prognosis of Chinese patients with follicular mycosis fungoides. Materials and methods We conducted a single-centre retrospective study and reviewed the clinical, histopathologic and immunophenotypic data of 12 patients diagnosed with follicular mycosis fungoides between 2009 and 2020 in the Department of Dermatology of West China Hospital of Sichuan university. Results A total of 12 patients (seven males and five females) with a mean age of 30 ± 14 years (age range 16-55 years) were included. Scalp and face were the most common involved sites (100%). Follicular papules, acneiform lesions, plaques, and nodules, were the main clinical presentations. Histopathological findings were consistent with the classic manifestations of follicular mycosis fungoides, including folliculotropism, perifollicular and intrafollicular lymphocytic infiltrates and mucinous degeneration. Interferon α-1b was the most common treatment. Four patients died of follicular mycosis fungoides in three years. Notably, immunohistochemical analysis revealed a decreased number of CD20+ cells in the deceased patients. Limitations This is a retrospective evaluation with a small number of cases; further prospective studies are warranted to support our inferences. Conclusion Our patients were much younger than in previous studies. The observed difference in this cohort may be explained by race, in addition to the limited number of cases. A decreased number of B cells might be associated with a poor prognosis, and more studies are necessary to discover the role of B cells in follicular mycosis fungoides as well as in mycosis fungoides.
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Affiliation(s)
- Xiwei Feng
- Department of Dermatology, West China School of Medicine/West China Hospital of Sichuan University (WCSM/WCH), Sichuan University, Chengdu, Sichuan, China
| | - Yao Xie
- Department of Dermatology, West China School of Medicine/West China Hospital of Sichuan University (WCSM/WCH), Sichuan University, Chengdu, Sichuan, China
| | - Fan Li
- Department of Dermatology, West China School of Medicine/West China Hospital of Sichuan University (WCSM/WCH), Sichuan University, Chengdu, Sichuan, China
| | - Lin Wang
- Department of Dermatology, West China School of Medicine/West China Hospital of Sichuan University (WCSM/WCH), Sichuan University, Chengdu, Sichuan, China
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Charli-Joseph Y, Kashani-Sabet M, McCalmont TH, Kornak J, Allen I, Ai WZ, LeBoit PE, Pincus LB. Association of a Proposed New Staging System for Folliculotropic Mycosis Fungoides With Prognostic Variables in a US Cohort. JAMA Dermatol 2021; 157:157-165. [PMID: 33295938 DOI: 10.1001/jamadermatol.2020.4372] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Importance A new cutaneous staging system for folliculotropic mycosis fungoides (FMF) has been purported to better estimate survival compared with the staging system for conventional mycosis fungoides. Objective To analyze predictive variables associated with survival and evaluate the effectiveness of the newly proposed staging system for estimating overall survival and disease-specific survival (DSS) in a US cohort. Design, Setting, and Participants This cohort study assessed 195 patients with FMF in the dermatopathology database of the University of California, San Francisco from January 1, 1990, to April 31, 2012, for eligibility. A total of 153 patients were excluded for the following reasons: (1) alternative diagnoses were favored ranging from benign dermatitides to other forms of cutaneous lymphoma; (2) technical problems with slides; and (3) lack of follow-up information. Data were analyzed from January 1, 2018, to August 31, 2020. Main Outcomes and Measures Kaplan-Meier curves were used to estimate overall survival and DSS for the entire cohort. Possible predictive variables associated with survival were evaluated using Cox proportional hazards regression modeling. Each variable was examined separately, followed by a multiple-variable model. Kaplan-Meier curves were used to estimate overall survival and DSS by subdividing the cohort into early- and advanced-stage cutaneous disease. Results Forty-two patients were included in the analysis (mean age at diagnosis, 55 [range, 8-89] years; 31 men [74%]). For the entire cohort, the estimated 5-year overall survival rate was 89% (95% CI, 79%-99%); 10-year rate, 78% (95% CI, 63%-92%); and 15-year rate, 58% (95% CI, 31%-85%). Estimated 5- and 10-year DSS rates were 89% (95% CI, 79%-99%); 15-year rate, 80% (95% CI, 61%-99%). For overall survival in the multiple-variable Cox proportional hazards regression model, only age was statistically significant (hazard ratio [HR] per 10-year age increase, 3.1; 95% CI, 1.4-7.2; P = .008), whereas for DSS, only cutaneous disease was statistically significant (HR, 11.4; 95% CI, 1.3-103.0; P = .03). When stage stratified, the 5-year estimated overall survival rate for early-stage disease was 96% (95% CI, 89%-103%); 10-year rate, 82% (95% CI, 65%-98%); and 15-year rate, 65% (95% CI, 33%-97%). For advanced-stage disease, the estimated 5- and 10-year overall survival rates were 70% (95% CI, 41%-98%); the 15-year rate, 53% (95% CI, 16%-89%). For early-stage cutaneous disease, the estimated 5-, 10- and 15-year DSS rates were all 96% (95% CI, 89%-103%). For advanced-stage cutaneous disease, the estimated 5- and 10-year DSS rates were 70% (95% CI, 41%-98%); the 15-year rate, 53% (95% CI, 16%-89%). Conclusions and Relevance Cox proportional hazards regression modeling demonstrated cutaneous stage to be the only statistically significant predictive variable associated with DSS. Subdividing FMF into early and advanced cutaneous stages was associated with effective estimation of survival in this cohort. Thus, findings suggest that FMF is a heterogeneous disease with early and advanced cutaneous stages; that the new staging system is effective in estimating survival in a US cohort; and that the poor prognosis initially associated with FMF only applies to the advanced cutaneous stage.
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Affiliation(s)
- Yann Charli-Joseph
- Cutaneous Hematopathology Clinic, Department of Dermatology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | | | - Timothy H McCalmont
- Dermatopathology Service, Departments of Pathology and Dermatology, University of California, San Francisco.,University of California, San Francisco Helen A. Diller Family Comprehensive Cancer Center
| | - John Kornak
- Department of Epidemiology and Biostatistics, University of California, San Francisco
| | - Isabel Allen
- Department of Epidemiology and Biostatistics, University of California, San Francisco
| | - Weiyun Z Ai
- Division of Hematology and Oncology, Department of Medicine, University of California, San Francisco
| | - Philip E LeBoit
- Dermatopathology Service, Departments of Pathology and Dermatology, University of California, San Francisco.,University of California, San Francisco Helen A. Diller Family Comprehensive Cancer Center
| | - Laura B Pincus
- Dermatopathology Service, Departments of Pathology and Dermatology, University of California, San Francisco
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Walker CJ, Martinez-Escala ME, Tan TL, Espinosa ML, Guitart J. High incidence of adnexotropism in cytotoxic cutaneous lymphomas. J Cutan Pathol 2021; 48:1231-1238. [PMID: 33759218 DOI: 10.1111/cup.14017] [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: 01/02/2021] [Revised: 02/28/2021] [Accepted: 03/15/2021] [Indexed: 12/01/2022]
Abstract
BACKGROUND Primary cutaneous gamma-delta T-cell lymphoma (PCγδTCL) and primary cutaneous aggressive epidermotropic T-cell lymphomas (PCAETCL) are rare aggressive cytotoxic cutaneous lymphomas (CyCL) often difficult to diagnose. Histopathologically, PCAETCL and PCγδTCL may resemble mycosis fungoides (MF) and the presence of adnexotropism in CyCL (CyCL) contributes to this diagnostic challenge, especially in the setting of atypical and double-negative phenotypes. METHODS In this retrospective study clinical data and histopathological section of 91 patients were analyzed for signs of clinical and histopathological signs adnexotropism. RESULTS Adnexotropism was identified in 48.4% (44/91) of cases, including PCAETCL (40.9%, 18/44), PCγδTCL and cytotoxic cutaneous lymphomas, not otherwise specified (CyCTCL, NOS) (43.2%, 19/44 and 15.9%, 7/44). Comparison between disease-related mortality with Kaplan-Meier survival analysis of non-adnexotropic vs adnexotropic CyCL did not show any significant difference between the two groups (P = 0.8). Clinically they present with patches, plaques, and tumors and commonly with ulceration, but follicular prominence or alopecia are rare. Clinical signs of adnexotropism such as alopecia and hypo- or anhidrosis were rarely seen. CONCLUSION Adnexotropism is a common finding in CyCL, especially in PCAETCL. Adnexotropic CyCL may be histopathologically difficult to distinguish from folliculotropic mycosis fungoides. A comprehensive IHC panel should be routinely performed in such cases.
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Affiliation(s)
- Christina J Walker
- Department of Dermatology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | | | - Timothy L Tan
- Department of Dermatology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Maria L Espinosa
- Department of Dermatology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Joan Guitart
- Department of Dermatology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
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Abstract
BACKGROUND Folliculotropic mycosis fungoides (FMF) is a variant of cutaneous T-cell lymphoma that has clinical overlap with a variety of inflammatory follicular unit disorders. However, we describe distinctive presentations of FMF with acneiform features that can be diagnostically challenging, leading to diagnostic delay. OBJECTIVE To highlight the importance of histopathologic and immunohistochemical evaluation for diagnostic confirmation of presumed inflammatory follicular unit-based disorders that are unusual in presentation or unresponsive to standard therapies. METHODS A cross-sectional retrospective study of 5 consecutive patients with a histopathologic diagnosis of FMF was conducted. The clinical, histopathologic, immunophenotypic, and molecular genetic features of cases are presented. RESULTS We describe 5 patients with clinical and histopathologic presentations of FMF masquerading as hidradenitis suppurativa, furunculosis, or acne vulgaris (age range 34-66 years, 4:1 female to male). Clinical morphologies included open and closed comedones, inflammatory pustules, papules and nodules, follicular papules with keratotic plugging, cysts, and scarring involving the face, trunk, and intertriginous areas. All patients failed to respond to standard therapies, including topical and oral antibiotics, topical and oral retinoids, or topical corticosteroids, before receiving the diagnosis of FMF. Lesional skin biopsies showed a perifollicular CD4-positive T-lymphocytic infiltrate with pilotropism, intrafollicular mucin deposition, foreign-body granulomatous inflammation, acute inflammation, and follicular epithelial necrosis. None had concurrent systemic mycosis fungoides. LIMITATIONS Small retrospective cohort study. CONCLUSION We present these cases to expand the clinical and histopathologic spectrum of FMF that may strikingly resemble acneiform disorders and to highlight the importance of diagnostic reconsideration with histopathologic evaluation.
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Kalay Yildizhan I, Sanli H, Akay BN, Uzundere C, Okcu Heper A. Folliculotropic mycosis fungoides: Clinical characteristics, treatments, and long-term outcomes of 53 patients in a tertiary hospital. Dermatol Ther 2020; 33:e13585. [PMID: 32410323 DOI: 10.1111/dth.13585] [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: 03/03/2020] [Revised: 05/02/2020] [Accepted: 05/12/2020] [Indexed: 12/11/2022]
Abstract
Folliculotropic mycosis fungoides (FMF) is characterized by a broad clinical spectrum and worse prognosis compared to classical MF. This study aimed to evaluate the clinical characteristics, treatment modalities and long-term outcome and risk factors for progression and survival of FMF patients. We conducted a single-center retrospective study and reviewed 53 patients diagnosed with FMF between 1990 to 2019 in a referral center at Ankara University, Turkey. Regarding to stage at diagnosis, 24 patients (45.3%) had advanced-stage disease (≥IIB). Follicular papules was observed in 66% and alopecia in 49.1% of the cases. Forty-three patients (81.1%) suffered from pruritus. The majority of the patients (92.4%) had at least one systemic therapy. Complete remission was achieved in 24.5% of the patients. The median time of overall survival (OS) was 50 months (range 9-324 months) and 5-year and 10-year OS was 83% and 69%, respectively. Twenty-eight (52.3%) patients progressed to more advanced stages and seven (13.2%) patients died due to MF during the follow-up period. FMF is associated with a progressive course and in most patients, skin-directed therapies were found to be inefficient to control the disease and multiple systemic therapeutic agents were required to control the disease.
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Affiliation(s)
| | - Hatice Sanli
- Faculty of Medicine, Department of Dermatology, Ankara University, Ankara, Turkey
| | - Bengu N Akay
- Faculty of Medicine, Department of Dermatology, Ankara University, Ankara, Turkey
| | - Ceren Uzundere
- Faculty of Medicine, Department of Dermatology, Ankara University, Ankara, Turkey
| | - Aylin Okcu Heper
- Faculty of Medicine, Department of Pathology, Ankara University, Ankara, Turkey
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van Santen S, Jansen PM, Quint KD, Vermeer MH, Willemze R. Plaque stage folliculotropic mycosis fungoides: histopathologic features and prognostic factors in a series of 40 patients. J Cutan Pathol 2019; 47:241-250. [PMID: 31755567 PMCID: PMC7028105 DOI: 10.1111/cup.13615] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2019] [Revised: 10/24/2019] [Accepted: 11/19/2019] [Indexed: 02/03/2023]
Abstract
BACKGROUND Folliculotropic mycosis fungoides (FMF) is a distinct variant of mycosis fungoides. Recent studies recognized indolent and aggressive subgroups of FMF, but there is controversy how patients presenting with plaques should be classified. The present study describes the histopathologic features of 40 FMF plaques. The aim of the study was to identify risk factors for disease progression and poor outcome in this group. METHODS Clinical, histopathological, and immunophenotypical data from 40 patients with plaque stage FMF were reviewed and analysed for risk factors for disease progression and survival. RESULTS After a median follow-up of 80 months, disease progression occurred in 20 of 40 patients. Percentage of atypical cells, cell size, percentage of Ki-67+ cells, and co-existent interfollicular epidermotropism, but not the extent of perifollicular infiltrates, were associated with disease progression and reduced survival, while extensive follicular mucinosis was associated with increased survival. CONCLUSIONS This study underlines that FMF patients presenting with plaques represent a heterogeneous group and that a subgroup of these patients may have an indolent clinical course. It further shows that histological examination is a valuable tool to differentiate between indolent and aggressive disease.
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Affiliation(s)
- Suzanne van Santen
- Department of Dermatology, Leiden University Medical Center, Leiden, The Netherlands
| | - Patty M Jansen
- Department of Clinical Pathology, Leiden University Medical Center, Leiden, The Netherlands
| | - Koen D Quint
- Department of Dermatology, Leiden University Medical Center, Leiden, The Netherlands
| | - Maarten H Vermeer
- Department of Dermatology, Leiden University Medical Center, Leiden, The Netherlands
| | - Rein Willemze
- Department of Dermatology, Leiden University Medical Center, Leiden, The Netherlands
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7
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Kalay Yildizhan I, Sanli H, Akay BN, Sürgün E, Heper A. CD8 + cytotoxic mycosis fungoides: a retrospective analysis of clinical features and follow-up results of 29 patients. Int J Dermatol 2019; 59:127-133. [PMID: 31633200 DOI: 10.1111/ijd.14689] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2019] [Revised: 09/14/2019] [Accepted: 09/20/2019] [Indexed: 11/26/2022]
Abstract
BACKGROUND AND OBJECTIVE Less than 5% of cases of mycosis fungoides (MF) present with a cytotoxic/suppressor CD8+ phenotype. This study aimed to evaluate the clinical characteristics, treatment modalities, and clinical course in CD8+ MF patients. METHODS In a retrospective analysis of 353 MF patients in a referral center at Ankara University, Turkey, 29 patients that were diagnosed with CD8+ MF were included in the study. RESULTS CD8+ MF cases constituted 8.2% of all MF patients. The age at the time of diagnosis ranged between 6 and 81 years with a median value of 46 years. The female-to-male ratio was 1.41. Patients presented with erythematous scaly (69%), hyperpigmented (58.6%), poikilodermic (17.2%), and hypopigmented (17.2 %) patches/plaques. The most common sites of involvement were the trunk and lower extremities. The most common comorbidity was hypertension (24.1%, n: 7) with 13 patients (44.8%) having a history of at least one autoimmune disease. At the time of diagnosis, 93.2% of the patients had early-stage disease, and 6.8% of the patients had advanced stage. The mean follow-up period was 6.68 ± 6.04 years (range 1-28 years). Most of the patients were treated with skin-directed therapies. Complete remission was achieved in 17 (58.6%) patients, eight (27.6%) patients had partial remission, and four (13.8%) patients had stable disease. CONCLUSIONS We concluded that CD8+ MF is associated with an indolent course and in most patients, skin-directed therapies were found to be efficient to control the disease.
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Affiliation(s)
| | - Hatice Sanli
- Department of Dermatology, Faculty of Medicine, Ankara University, Ankara, Turkey
| | - Bengu N Akay
- Department of Dermatology, Faculty of Medicine, Ankara University, Ankara, Turkey
| | - Ece Sürgün
- Department of Dermatology, Faculty of Medicine, Ankara University, Ankara, Turkey
| | - Aylin Heper
- Department of Pathology, Faculty of Medicine, Ankara University, Ankara, Turkey
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Uribe-Bojanini E, Santa-Vélez C, Rueda-Cadena X, Morales S. Severe and Lethal Presentation of Folliculotropic Mycosis Fungoides. ACTAS DERMO-SIFILIOGRAFICAS 2019. [DOI: 10.1016/j.adengl.2019.04.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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Jaque A, Mereniuk A, Walsh S, Shear NH, Sade S, Zagorski B, Alhusayen R. Influence of the phenotype on mycosis fungoides prognosis, a retrospective cohort study of 160 patients. Int J Dermatol 2019; 58:933-939. [DOI: 10.1111/ijd.14391] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2018] [Revised: 01/01/2019] [Accepted: 01/17/2019] [Indexed: 11/29/2022]
Affiliation(s)
- Alejandra Jaque
- Division of Dermatology Department of Medicine Sunnybrook Health Sciences Centre Toronto Canada
| | - Alexandra Mereniuk
- Division of Dermatology Department of Medicine Sunnybrook Health Sciences Centre Toronto Canada
| | - Scott Walsh
- Division of Dermatology Department of Medicine Sunnybrook Health Sciences Centre Toronto Canada
| | - Neil H. Shear
- Division of Dermatology Department of Medicine Sunnybrook Health Sciences Centre Toronto Canada
| | - Shachar Sade
- Department of Pathology Sunnybrook Health Sciences Centre Toronto Canada
| | - Brandon Zagorski
- University of Toronto Institute for Health Policy Management and Evaluation Toronto Canada
| | - Raed Alhusayen
- Division of Dermatology Department of Medicine Sunnybrook Health Sciences Centre Toronto Canada
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Uribe-Bojanini E, Santa-Vélez C, Rueda-Cadena X, Morales SD. Severe and Lethal Presentation of Folliculotropic Mycosis Fungoides. ACTAS DERMO-SIFILIOGRAFICAS 2019; 110:412-414. [PMID: 30642565 DOI: 10.1016/j.ad.2018.02.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2017] [Revised: 01/25/2018] [Accepted: 02/10/2018] [Indexed: 10/27/2022] Open
Affiliation(s)
| | - C Santa-Vélez
- Universidad CES, Medellín, Colombia; Instituto Nacional de Cancerología, Bogotá, Colombia
| | | | - S D Morales
- Instituto Nacional de Cancerología, Bogotá, Colombia
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Mitteldorf C, Stadler R, Sander CA, Kempf W. Folliculotropic mycosis fungoides. J Dtsch Dermatol Ges 2018; 16:543-557. [DOI: 10.1111/ddg.13514] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2017] [Accepted: 11/28/2017] [Indexed: 01/02/2023]
Affiliation(s)
- Christina Mitteldorf
- Department of DermatologyVenereology and AllergologyHELIOS Medical Center Hildesheim Hildesheim Germany
- Department of DermatologyVenereology and AllergologyGöttingen University Medical Center Göttingen Germany
| | - Rudolf Stadler
- Department of DermatologyVenereologyAllergologyand PhlebologyMühlenkreisklinikenJohannes Wesling Medical Center Minden Germany
| | - Christian A. Sander
- Eduard Arning Department of Dermatology and AllergologyAsklepios Klinik St. Georg Hamburg Germany
| | - Werner Kempf
- Kempf und PfaltzDermatopathology Laboratory Zurich Switzerland
- Department of DermatologyVenereology and AllergologyZurich University Hospital Zurich Switzerland
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12
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Mitteldorf C, Stadler R, Sander CA, Kempf W. Die follikulotrope Mycosis fungoides. J Dtsch Dermatol Ges 2018; 16:544-559. [DOI: 10.1111/ddg.13514_g] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2017] [Accepted: 11/28/2017] [Indexed: 11/28/2022]
Affiliation(s)
- Christina Mitteldorf
- Klinik für DermatologieVenerologie und AllergologieHELIOS Klinikum Hildesheim
- Klinik für DermatologieVenerologie und Allergologie Göttingen
| | - Rudolf Stadler
- Universitätsklinik für DermatologieVenerologieAllergologie und PhlebologieMühlenkreisklinikenJohannes Wesling Klinikum Minden
| | - Christian A. Sander
- Eduard‐Arning‐Klinik für Dermatologie und AllergologieAsklepios Klinik St. Georg Hamburg
| | - Werner Kempf
- Kempf und Pfaltz histologische Diagnostik Zürich
- Universitätsspital ZürichKlinik für DermatologieVenerologie und Allergologie Zürich
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Deonizio JMD, Guitart J, Yazdan P, Mulinari-Brenner F, Sotto MN, Sanches JA. Immune privilege disruption in folliculotropic mycosis fungoides: investigation of major histocompatibility complex antigen expression. Int J Dermatol 2018; 57:675-680. [PMID: 29603194 DOI: 10.1111/ijd.13967] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2017] [Revised: 01/31/2018] [Accepted: 02/24/2018] [Indexed: 11/29/2022]
Abstract
BACKGROUND Folliculotropic mycosis fungoides (FMF) is a cutaneous T-cell lymphoma mainly affecting the hair follicle, which seems to represent a place of immune privilege phenomenon. OBJECTIVES To explore a possible role of immune privilege (IP) in FMF analyzing the major histocompatibility complex (MHC) expression. METHODS Immunohistochemistry for HLA-G and MHC-II was performed to formalin-fixed paraffin-embedded cutaneous skin biopsies of FMF patients (n = 43), conventional mycosis fungoides (CMF; n = 13), alopecia areata (AA; n = 13), and normal scalp skin (NS; n = 12). RESULTS HLA-G expression was lower in FMF (34%: 14/41) and CMF (18%: 2/11) groups compared to alopecia areata (92%:11/12) and normal scalp skin group (100%: 12/12). MHC-II expression in hair follicle was greater in the FMF group (18/42: 43%) compared to AA (0%) and NS (0%). HLA-G and MHC-II expression in cellular infiltrate had no difference among FMF and CMF groups and was different compared to the AA group. CONCLUSIONS Our data support the hypothesis of disruption of immune privilege based on the lower expression of HLA-G and higher expression of MHC-II in the follicular epithelium in mycosis fungoides compared to alopecia areata and normal scalp skin. The lack of difference between FMF and CMF groups did not support the role of these molecules as a driver of folliculotropism. The expression of MHC molecules seems to be different between neoplastic and inflammatory infiltrates. The definitive significance of expression of the MHC molecules remains unclear, and more studies are necessary to fully understand the role of these molecules in cutaneous lymphomas.
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Affiliation(s)
- Janyana M D Deonizio
- Department of Dermatology, University of São Paulo Medical School, São Paulo, Brazil
| | - Joan Guitart
- Department of Dermatopathology, Northwestern University, Chicago, USA
| | - Pedram Yazdan
- Department of Dermatopathology, Northwestern University, Chicago, USA
| | | | - Mirian N Sotto
- Department of Dermatology, University of São Paulo Medical School, São Paulo, Brazil
| | - José A Sanches
- Department of Dermatology, University of São Paulo Medical School, São Paulo, Brazil
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15
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van Santen S, Vermeer MH, Willemze R. Classification and recommended treatment options for folliculotropic mycosis fungoides. Expert Opin Orphan Drugs 2017. [DOI: 10.1080/21678707.2018.1406796] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Suzanne van Santen
- Department of Dermatology, Leiden University Medical Center, Leiden, The Netherlands
| | - Maarten H. Vermeer
- Department of Dermatology, Leiden University Medical Center, Leiden, The Netherlands
| | - Rein Willemze
- Department of Dermatology, Leiden University Medical Center, Leiden, The Netherlands
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16
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Clinical characteristics, risk factors and long-term outcome of 114 patients with folliculotropic mycosis fungoides. Arch Dermatol Res 2017; 309:453-459. [PMID: 28516243 DOI: 10.1007/s00403-017-1744-1] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2016] [Revised: 04/24/2017] [Accepted: 05/03/2017] [Indexed: 10/19/2022]
Abstract
Folliculotropic mycosis fungoides (FMF) is a distinct variant of mycosis fungoides (MF) where atypical T-cells invade the hair follicles. The objective was to assess the clinical features, risk factors for progression, long-term outcome and response to treatment modalities in a large cohort of FMF patients. We, therefore, conducted a single-center retrospective study, reviewing 114 patients with FMF seen from 1987 to 2015 at the cutaneous T-cell lymphoma clinic of the MD Anderson Cancer Center. The mean age at diagnosis of FMF was 57.1 ± 13.5 years. The male to female ratio was 1.2:1. MF stage IA (n = 50, 43.9%) was the most common diagnosed stage, followed equally by stages IB and IIB (n = 23, 20.2%, respectively). Eighty-six patients (75.4%) suffered from pruritus. Concomitant hair loss was observed in 37 (32.5%) subjects. The median number of different treatment modalities used per patient was 4 (range 1-12). Low-dose radiation was beneficial in clearing therapy refractory lesions. The overall survival was influenced by several factors, including advanced age (>65), late stages and the presence of large cell transformation (LCT). Thirty-three of 113 patients (29.2%) progressed to more advanced stages and 26 (23.0%) died, with the cause of death being MF in 11 (9.7%) subjects. In conclusion, patients with FMF have a worse overall 10-year survival rate compared with other MF variants. Several factors, including stage, advanced age and the presence of LCT impact survival. Multiple different treatment approaches may be needed to achieve a good clinical response and to prevent disease progression.
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17
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van Santen S, van Doorn R, Neelis KJ, Daniëls LA, Horváth B, Bruijn MS, Sanders CJG, van Rossum MM, de Haas ERM, Veraart JCJM, Bekkenk MW, Vermeer MH, Willemze R. Recommendations for treatment in folliculotropic mycosis fungoides: report of the Dutch Cutaneous Lymphoma Group. Br J Dermatol 2017; 177:223-228. [PMID: 28132406 DOI: 10.1111/bjd.15355] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/18/2017] [Indexed: 01/02/2023]
Abstract
BACKGROUND Folliculotropic mycosis fungoides (FMF) is an aggressive variant of mycosis fungoides (MF) and generally less responsive to standard skin-directed therapies (SDTs). Recent studies distinguished indolent (early-stage FMF) and more aggressive (advanced-stage FMF) subgroups. The optimal treatment for both subgroups remains to be defined. OBJECTIVES To evaluate initial treatment results in patients with early- and advanced-stage FMF. METHODS A study was undertaken of 203 patients (84 early-stage, 102 advanced-stage, 17 extracutaneous FMF) included in the Dutch Cutaneous Lymphoma Registry between 1985 and 2014. Type and results of initial treatment were retrieved from the Dutch Registry. Main outcomes were complete remission (CR); sustained complete remission; partial remission (PR), > 50% improvement; and overall response (OR; CR + PR). RESULTS Patients with early-stage FMF were treated with nonaggressive SDTs in 67 of 84 cases resulting, respectively, in CR and OR of 28% and 83% for monotherapy topical steroids, 0% and 83% for ultraviolet B (UVB), and 30% and 88% for psoralen plus ultraviolet A (PUVA). In patients with advanced-stage FMF these SDTs were less effective (combined CR and OR 10% and 52%, respectively). In patients with advanced-stage FMF local radiotherapy (CR 63%; OR 100%), total skin electron beam irradiation (CR 59%; OR 100%) and PUVA combined with local radiotherapy (CR 5%, OR 75%) were most effective. CONCLUSIONS The results of the present study demonstrate that not all patients with FMF should be treated aggressively. Patients with early-stage FMF may benefit very well from standard SDTs also used in early-stage classic MF and have an excellent prognosis.
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Affiliation(s)
- S van Santen
- Department of Dermatology, Leiden University Medical Center, the Netherlands
| | - R van Doorn
- Department of Dermatology, Leiden University Medical Center, the Netherlands
| | - K J Neelis
- Department of Clinical Oncology, Leiden University Medical Center, the Netherlands
| | - L A Daniëls
- Department of Clinical Oncology, Leiden University Medical Center, the Netherlands
| | - B Horváth
- Department of Dermatology, University Medical Center of Groningen, the Netherlands
| | - M S Bruijn
- Department of Dermatology, University Medical Center of Groningen, the Netherlands
| | - C J G Sanders
- Department of Dermatology, University Medical Center Utrecht, Utrecht, the Netherlands
| | - M M van Rossum
- Department of Dermatology, Radboud University Medical Center, Nijmegen, the Netherlands
| | - E R M de Haas
- Department of Dermatology, Erasmus Medical Center, Rotterdam, the Netherlands
| | - J C J M Veraart
- Department of Dermatology, Maastricht University Medical Center, the Netherlands
| | - M W Bekkenk
- Department of Dermatology, Academic Medical Center and Vrije University Medical Center, Amsterdam, the Netherlands
| | - M H Vermeer
- Department of Dermatology, Leiden University Medical Center, the Netherlands
| | - R Willemze
- Department of Dermatology, Leiden University Medical Center, the Netherlands
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18
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Baykal C, Atci T, Ozturk Sari S, Polat Ekinci A, Buyukbabani N. Vernachlässigte klinische Merkmale der follikulotropen Mycosis fungoides: eine große klinische Fallserie. J Dtsch Dermatol Ges 2017; 15:289-301. [PMID: 28252867 DOI: 10.1111/ddg.12976_g] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2015] [Accepted: 01/26/2016] [Indexed: 11/27/2022]
Abstract
HINTERGRUND UND ZIEL Als seltene Form der Mycosis fungoides (MF), ist die follikulotrope MF (FMF) durch ein breites Spektrum klinischer Symptome gekennzeichnet. Dazu gehören, neben den vorherrschenden follikulären Läsionen, auch viele atypische Manifestationen. Das Ziel der vorliegenden Studie war eine klinische Bewertung von FMF-Patienten, unter besonderer Berücksichtigung von vernachlässigten dermatologischen Merkmalen. PATIENTEN UND METHODIK Insgesamt wurden 27 FMF-Patienten aus dem 572 Patienten umfassenden MF-Register unserer Abteilung retrospektiv bezüglich ihrer Demographie sowie der klinischen Merkmale, Behandlungsformen, Nachsorge und Therapieergebnisse bewertet. ERGEBNISSE Neben den bekannten klinischen Symptomen der FMF fanden wir Lichen-spinulosus-artige Läsionen mit begleitender Hypopigmentierung (n = 3) und Alopezie (n = 2), infiltrierte/erhabene, erythematöse Plaques im Gesicht, die zunächst als Lupus tumidus angesehen wurden (n = 2), pseudotumorale Läsionen, die klinisch eine MF im Tumorstadium vortäuschten (n = 1), dauerhafte Exkoriationen (n = 1), erythematöse, Rosazea-artige Papeln im Gesicht (n = 1) sowie kuppelförmige, asymptomatische, mit Muzin gefüllte (in der Histologie) Papeln/Knoten (n = 2), die andere krankheitsbedingte Läsionen überlagerten. Es kamen mehrere Therapieansätze mit unterschiedlichem Ergebnis zur Anwendung. Acht (29,6 %) Patienten hatten FMF im Spätstadium. SCHLUSSFOLGERUNGEN Das Bewusstsein für vernachlässigte klinische Symptome kann wesentlich dazu beitragen, verspätete Diagnosen dieser aggressiven MF-Variante zu verringern.
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Affiliation(s)
- Can Baykal
- Department of Dermatology and Venereology, Istanbul Medical Faculty, Istanbul University, Istanbul, Türkei
| | - Tugba Atci
- Department of Dermatology and Venereology, Istanbul Medical Faculty, Istanbul University, Istanbul, Türkei
| | - Sule Ozturk Sari
- Department of Pathology, Istanbul Medical Faculty, Istanbul University, Istanbul, Türkei
| | - Algun Polat Ekinci
- Department of Dermatology and Venereology, Istanbul Medical Faculty, Istanbul University, Istanbul, Türkei
| | - Nesimi Buyukbabani
- Department of Pathology, Istanbul Medical Faculty, Istanbul University, Istanbul, Türkei
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19
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Baykal C, Atci T, Ozturk Sari S, Polat Ekinci A, Buyukbabani N. Underrecognized clinical features of folliculotropic mycosis fungoides: a large clinical series. J Dtsch Dermatol Ges 2017; 15:289-299. [DOI: 10.1111/ddg.12976] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2015] [Accepted: 01/26/2016] [Indexed: 11/28/2022]
Affiliation(s)
- Can Baykal
- Department of Dermatology and Venereology; Istanbul Medical Faculty, Istanbul University; Istanbul Turkey
| | - Tugba Atci
- Department of Dermatology and Venereology; Istanbul Medical Faculty, Istanbul University; Istanbul Turkey
| | - Sule Ozturk Sari
- Department of Pathology; Istanbul Medical Faculty, Istanbul University; Istanbul Turkey
| | - Algun Polat Ekinci
- Department of Dermatology and Venereology; Istanbul Medical Faculty, Istanbul University; Istanbul Turkey
| | - Nesimi Buyukbabani
- Department of Pathology; Istanbul Medical Faculty, Istanbul University; Istanbul Turkey
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20
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Ehsani AH, Azizpour A, Noormohammadpoor P, Seirafi H, Farnaghi F, Kamyab-Hesari K, Sharifi M, Nasimi M. Folliculotropic Mycosis Fungoides: Clinical and Histologic Features in Five Patients. Indian J Dermatol 2016; 61:554-8. [PMID: 27688448 PMCID: PMC5029244 DOI: 10.4103/0019-5154.190124] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND Alopecia can be a manifestation of mycosis fungoides (MF); however, the prevalence is unknown. AIMS We sought to describe the clinicopathologic presentation of alopecia in patients with diagnosis of MF. METHODS A retrospective analysis of patients with biopsy-proven MF, who were evaluated at our cancer center from 2002 to 2012, was performed to identify patients with alopecia. RESULTS Five patients with alopecia were identified from reviewing of 157 patients with MF. The male:female ratio was 3:2, and the mean age of patients was 42.8 years. Two of these patients showed patchy hair loss on scalp which was clinically identical to alopecia areata. In remaining three patients, hair loss was seen in areas of MF lesions, and epidermal changes consisted of patch- and plaque-type lesions of MF, tumors, and follicular lesions (follicular MF) were also present. In two of these patients, lymphadenopathy without any visceral involvement was detected. CONCLUSIONS Alopecia was observed in 5 (3.18%) patients with MF, which makes it a rare finding, which included alopecia areata-like patchy loss in 2 and alopecia within MF lesions in 3.
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Affiliation(s)
- Amir Hooshang Ehsani
- Department of Dermatology, Razi Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Arghavan Azizpour
- Department of Dermatology, Razi Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Pedram Noormohammadpoor
- Department of Dermatology, Razi Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Hasan Seirafi
- Department of Dermatology, Razi Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Farshad Farnaghi
- Department of Dermatology, Razi Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Kambiz Kamyab-Hesari
- Department of Dermatopatology, Razi Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Mehdi Sharifi
- Department of Emergency Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Maryam Nasimi
- Department of Dermatology, Razi Hospital, Tehran University of Medical Sciences, Tehran, Iran
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21
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Hodak E, Amitay-Laish I, Atzmony L, Prag-Naveh H, Yanichkin N, Barzilai A, Kershenovich R, Feinmesser M. New insights into folliculotropic mycosis fungoides (FMF): A single-center experience. J Am Acad Dermatol 2016; 75:347-55. [DOI: 10.1016/j.jaad.2016.03.009] [Citation(s) in RCA: 67] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2016] [Revised: 02/29/2016] [Accepted: 03/10/2016] [Indexed: 12/22/2022]
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22
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Deonizio JMD, Ascef RD, Sanches JA. Folliculotropic mycosis fungoides: clinical and epidemiological evaluation in a single center in Brazil. Int J Dermatol 2015; 55:e256-61. [DOI: 10.1111/ijd.13149] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2015] [Revised: 06/29/2015] [Accepted: 07/29/2015] [Indexed: 01/04/2023]
Affiliation(s)
| | - Rogers Diego Ascef
- Department of Dermatology; University of São Paulo Medical School; São Paulo Brazil
| | - José Antonio Sanches
- Department of Dermatology; University of São Paulo Medical School; São Paulo Brazil
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23
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Brown DN, Wieser I, Wang C, Dabaja BS, Duvic M. Leonine facies (LF) and mycosis fungoides (MF): A single-center study and systematic review of the literature. J Am Acad Dermatol 2015; 73:976-86. [DOI: 10.1016/j.jaad.2015.09.017] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2015] [Revised: 09/08/2015] [Accepted: 09/10/2015] [Indexed: 11/15/2022]
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24
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Heisig M, Maj J, Szepietowski JC, Reich A. Durable remission of folliculotropic mycosis fungoides achieved with a combined topical treatment with cytarabine and carmustine. Dermatol Ther 2015; 29:15-8. [PMID: 26278921 DOI: 10.1111/dth.12272] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Folliculotropic mycosis fungoides (MF) is an uncommon subtype of MF which has a more aggressive natural history and is more resistant to treatment than other forms of MF. In this article, an innovative method of treatment is presented. We describe a successful use of topical cytarabine combined with topical carmustine in a patient with a folliculotropic MF. Based on our patient history we suggest this method as an effective therapy option for patients with folliculotropic MF unresponsive to other forms of treatment.
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Affiliation(s)
- Monika Heisig
- Department of Dermatology, Venereology and Allergology, Wroclaw Medical University, Wroclaw, Poland
| | - Joanna Maj
- Department of Dermatology, Venereology and Allergology, Wroclaw Medical University, Wroclaw, Poland
| | - Jacek C Szepietowski
- Department of Dermatology, Venereology and Allergology, Wroclaw Medical University, Wroclaw, Poland
| | - Adam Reich
- Department of Dermatology, Venereology and Allergology, Wroclaw Medical University, Wroclaw, Poland
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