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Neinaa YMEH, El-Maadawy IH, Atteia IA, Mohamed DAEA. Cell adhesion molecule 1 expression in mycosis fungoides versus parapsoriasis versus inflammatory dermatosis: an immunohistochemical comparative study. Arch Dermatol Res 2023; 315:2403-2411. [PMID: 36943432 DOI: 10.1007/s00403-023-02600-x] [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: 11/29/2022] [Revised: 01/26/2023] [Accepted: 02/28/2023] [Indexed: 03/23/2023]
Abstract
Cell adhesion molecule 1 (CADM1) is one of the immunoglobulin super family adhesion molecules, that is proposed to contribute in the pathogenesis of various types of cutaneous T-cell lymphoma, including mycosis fungoides (MF). In this work, we decided to examine the immunohistochemical expression of CADM1 in MF specimens compared to premycotic parapsoriasis, benign inflammatory dermatosis and normal control skin specimens. 125 participants were enrolled (50 MF, 25 parapsoriasis, 25 inflammatory dermatosis, and 25 healthy controls). Patients were selected from the Outpatient Clinic of Dermatology and Venereology Department, Tanta University Hospitals. From all, 4 mm punch skin biopsies were taken and examined for CADM1 immunohistochemical expression. The current study revealed statistically significant upregulation of CADM1 expression in MF specimens in comparison to parapsoriasis, inflammatory dermatosis, and normal control specimens. Additionally, there was statistically significant positive correlation between CADM1 expression and progression of TNMB staging of MF disease. Therefore, it is possible to recommend CADM1 as a beneficial diagnostic immunohistochemical marker for differentiation between early stages of MF and both the premycotic parapsoriasis and benign inflammatory dermatosis. Moreover, it may be of value in early detection of neoplastic transformation of parapsoriasis as well as in assessment of MF progression.
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Affiliation(s)
- Yomna Mazid El-Hamd Neinaa
- Dermatology and Venereology Department, Faculty of Medicine, Tanta University, Tanta, Egypt.
- Dermatopathology Unit, Faculty of Medicine, Tanta University, Tanta, Egypt.
| | - Iman Hamed El-Maadawy
- Dermatology and Venereology Department, Faculty of Medicine, Tanta University, Tanta, Egypt
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2
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Wojewoda K, Gillstedt M, Englund H, Ali S, Lewerin C, Osmancevic A. Diagnostic Outcomes and Treatment Modalities in Patients with Mycosis Fungoides in West Sweden—A Retrospective Register-Based Study. Cancers (Basel) 2022; 14:cancers14194661. [PMID: 36230583 PMCID: PMC9563600 DOI: 10.3390/cancers14194661] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2022] [Revised: 09/12/2022] [Accepted: 09/20/2022] [Indexed: 11/21/2022] Open
Abstract
Simple Summary Mycosis fungoides (MF) is a rare and incurable disease, but there are a wide variety of treatment options. Since the condition is rare, only a few studies have been performed on this topic in Sweden. This study contributes to the knowledge of the epidemiological and clinical features and diagnostic findings in addition to the treatment modalities and responses in patients with diagnosed MF and/or followed up for a long period of time in Sweden. The results of this study can be used to improve clinical practice and stimulate future research. Abstract (1) Background: Mycosis fungoides (MF) is a variant of primary cutaneous T-cell lymphoma. The aim of this study was to describe the clinical features and epidemiological and diagnostic findings in addition to the treatment modalities and responses in patients with MF. Furthermore, comparisons between patients in the early stage and the advanced stage were evaluated. (2) Methods: A retrospective register-based study based on data collected from the primary cutaneous lymphoma register and medical records was performed at the Department of Dermatology and Venerology at Sahlgrenska University Hospital, Gothenburg, Sweden. (3) Results: Eighty-four patients with a median age of 55 years with MF were included. Most of the patients (n = 73) were diagnosed at the early stage of the disease (IA–IIA). Overall disease progression was seen in 12.5% (n = 9) of the patients. Nine (10.7%) patients were deceased, out of which four (4.8%) deaths were associated with MF-related causes. (4) Conclusions: This study contributes to the knowledge of the epidemiological and clinical features in addition to the diagnostic findings and treatment responses in patients with MF in Sweden.
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Affiliation(s)
- Karolina Wojewoda
- Department of Dermatology and Venereology, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, 413 46 Gothenburg, Sweden
- Department of Dermatology and Venereology, Sahlgrenska University Hospital, Region Västra Götaland, 413 46 Gothenburg, Sweden
- Correspondence:
| | - Martin Gillstedt
- Department of Dermatology and Venereology, Sahlgrenska University Hospital, Region Västra Götaland, 413 46 Gothenburg, Sweden
| | - Hanna Englund
- Department of Dermatology and Venereology, Sahlgrenska University Hospital, Region Västra Götaland, 413 46 Gothenburg, Sweden
| | - Shada Ali
- Department of Dermatology and Venereology, Sahlgrenska University Hospital, Region Västra Götaland, 413 46 Gothenburg, Sweden
| | - Catharina Lewerin
- Section of Hematology and Coagulation, Department of Internal Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, 413 46 Gothenburg, Sweden
| | - Amra Osmancevic
- Department of Dermatology and Venereology, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, 413 46 Gothenburg, Sweden
- Department of Dermatology and Venereology, Sahlgrenska University Hospital, Region Västra Götaland, 413 46 Gothenburg, Sweden
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3
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Hain C, Stadler R, Kalinowski J. Unraveling the Structural Variations of Early-Stage Mycosis Fungoides-CD3 Based Purification and Third Generation Sequencing as Novel Tools for the Genomic Landscape in CTCL. Cancers (Basel) 2022; 14:4466. [PMID: 36139626 PMCID: PMC9497107 DOI: 10.3390/cancers14184466] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Revised: 09/08/2022] [Accepted: 09/12/2022] [Indexed: 11/16/2022] Open
Abstract
Mycosis fungoides (MF) is the most common cutaneous T-cell lymphoma (CTCL). At present, knowledge of genetic changes in early-stage MF is insufficient. Additionally, low tumor cell fraction renders calling of copy-number variations as the predominant mutations in MF challenging, thereby impeding further investigations. We show that enrichment of T cells from a biopsy of a stage I MF patient greatly increases tumor fraction. This improvement enables accurate calling of recurrent MF copy-number variants such as ARID1A and CDKN2A deletion and STAT5 amplification, undetected in the unprocessed biopsy. Furthermore, we demonstrate that application of long-read nanopore sequencing is especially useful for the structural variant rich CTCL. We detect the structural variants underlying recurrent MF copy-number variants and show phasing of multiple breakpoints into complex structural variant haplotypes. Additionally, we record multiple occurrences of templated insertion structural variants in this sample. Taken together, this study suggests a workflow to make the early stages of MF accessible for genetic analysis, and indicates long-read sequencing as a major tool for genetic analysis for MF.
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Affiliation(s)
- Carsten Hain
- Center for Biotechnology (CeBiTec), Bielefeld University, 33615 Bielefeld, Germany
| | - Rudolf Stadler
- University Clinic for Dermatology, Johannes Wesling Medical Centre, UKRUB, University of Bochum, 32429 Minden, Germany
| | - Jörn Kalinowski
- Center for Biotechnology (CeBiTec), Bielefeld University, 33615 Bielefeld, Germany
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4
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Wechsler J, Ingen-Housz-Oro S, Deschamps L, Brunet-Possenti F, Deschamps J, Delfau MH, Calderaro J, Ortonne N. Prevalence of T-cell antigen losses in mycosis fungoides and CD30-positive cutaneous T-cell lymphoproliferations in a series of 153 patients. Pathology 2022; 54:729-737. [DOI: 10.1016/j.pathol.2022.02.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Revised: 01/28/2022] [Accepted: 02/09/2022] [Indexed: 10/18/2022]
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5
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Haque WS, Alam S, Kabir H, Chowdhury AA. Unilesional mycosis fungoides: a case report and review of literature. IMC JOURNAL OF MEDICAL SCIENCE 2021. [DOI: 10.55010/imcjms.16.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Mycosis fungoides (MF) is the commonest primary cutaneous T-cell lymphoma (CTCL). Classically MF is presented clinically as multilesional disease but occurrence of solitary lesion, though quite rare, is on the record. This rare variant of MF is clinically and histopathologically indistinguishable from classic MF. Due to the rarity of the presentation the clinician may miss the diagnosis and the pathologist may also be in diagnostic dilemma specially if not clinically oriented. Here we describe a case of unilesional/solitary MF (UMF) in a 59 years old male who was initially clinically diagnosed as inflammatory dermatosis and was treated accordingly without any appreciable clinical response for over 4 years. Unresponsiveness to empirical treatment led to biopsy which finally proved it to be UMF. The clinical, light microscopic and immunohistochemical features of UMF are briefly reviewed to create awareness among the clinicians and pathologists about this rare variant of MF.
IMC J Med Sci 2022; 16(1): 006
*Correspondence: Wasim Selimul Haque, Head, Department of Histopathology and Cytopathology, Jaber Al-Ahmed Armed Forces Hospital, Kuwait Armed, Forces, Subhan Cantonment, Kuwait. Email: audrirodelawasim@gmail.com
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Affiliation(s)
- Wasim Selimul Haque
- Department of Histopathology and Cytopathology, Jaber Al-Ahmed Armed Forces Hospital, Subhan Cantonment, Kuwait
| | - Shakibul Alam
- Department of Dermatology, Jaber Al-Ahmed Armed Forces Hospital, Subhan Cantonment, Kuwait
| | - Humayun Kabir
- Department of Dermatology, Jaber Al-Ahmed Armed Forces Hospital, Subhan Cantonment, Kuwait
| | - Al-Amin Chowdhury
- Department of Surgery, Jaber Al-Ahmed Armed Forces Hospital, Subhan Cantonment, Kuwait
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6
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Torres-Cabala CA. Diagnosis of T-cell lymphoid proliferations of the skin: putting all the pieces together. Mod Pathol 2020; 33:83-95. [PMID: 31664155 DOI: 10.1038/s41379-019-0397-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2019] [Revised: 09/29/2019] [Accepted: 10/15/2019] [Indexed: 11/09/2022]
Abstract
The spectrum of T-cell lymphoid proliferations of the skin varies from indolent to highly aggressive diseases and therefore an accurate pathological diagnosis is paramount. Integration of clinical, histopathological, immunohistochemical, and molecular findings is of crucial importance in the evaluation of these processes. In this article, we discuss selected situations where difficulty may arise for the pathologist evaluating this type of skin biopsies, such as: the diagnosis of early (patch stage) mycosis fungoides, the distinction of mycosis fungoides with large cell transformation from primary cutaneous anaplastic large cell lymphoma, the recognition of new histopathological patterns of lymphomatoid papulosis and the entities they mimic, the evaluation of primary cutaneous anaplastic large cell lymphoma with expression of markers suggestive of systemic origin (such as ALK), the awareness of the wide range of clinical and pathological presentations of hydroa vacciniforme-like EBV-positive T-cell lymphoproliferative disorders, the evaluation of cases of primary cutaneous γδ T-cell lymphoma showing predominantly epidermotropic pattern of growth, and the correct interpretation of findings seen in indolent proliferations such as primary cutaneous acral CD8-positive T-cell lymphoma and primary cutaneous small/medium size CD4 + T-cell lymphoproliferative disorder.
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Affiliation(s)
- Carlos A Torres-Cabala
- Departments of Pathology and Dermatology, The University of Texas - MD Anderson Cancer Center, 1515 Holcombe Blvd Unit 85, Houston, TX, 77030, USA.
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7
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The Use of Central Pathology Review With Digital Slide Scanning in Advanced-stage Mycosis Fungoides and Sézary Syndrome: A Multi-institutional and International Pathology Study. Am J Surg Pathol 2019. [PMID: 29543675 DOI: 10.1097/pas.0000000000001041] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
This pathology PILOT study aims to define the role and feasibility of centralized pathology review in a cohort of 75 patients from different centers in the United States and Europe using digital slide scanning. The pathologic material from 75 patients who had been diagnosed with mycosis fungoides/Sézary syndrome and were clinically staged as IIb or above was retrieved from 11 participating centers. Each pathology reviewer was provided with the pathologic diagnosis (by the referring pathologist), and the following list of histopathologic criteria (presence or absence) from the initial report: epidermotropism, folliculotropism (FT), large cell transformation, syringotropism, and granulomas. Patients with advance stage were selected for this study as this is a population where there is significant variability in the diagnosis of pathologic prognostic and predictive biomarkers. The slides were digitally scanned with an Aperio scanner and consensus review of cases occurred when major or minor discrepancies between the referral diagnosis and central pathology review occurred. Among the 75 cases, 70 (93.3%) had a final consensus diagnosis between the 3 central review pathologists. The overall agreement between the consensus review and the referring pathologist was 60%. The overall agreement was also higher between the reviewers and consensus review, compared with the referring pathologist and consensus. 65.3% of cases had some type of discrepancy (major or minor) between the outside and consensus review. Major discrepancies were seen in 34 of 73 cases (46.6%; 73 cases indicated a yes or no response). Minor discrepancies were seen in 32 of 75 (42.7%) of cases. Most of the major discrepancies were accounted by a difference in interpretation in the presence or absence of large cell transformation or FT. Most minor discrepancies were explained by a different interpretation in the expression of CD30. We found digital slide scanning to be a beneficial, reliable, and practical for a methodical approach to perform central pathology review in the context of a large clinical prospective study.
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Manso R, Martínez-Magunacelaya N, Eraña-Tomás I, Monsalvez V, Rodríguez-Peralto JL, Ortiz-Romero PL, Santonja C, Cristóbal I, Piris MA, Rodríguez-Pinilla SM. Mycosis fungoides progression could be regulated by microRNAs. PLoS One 2018; 13:e0198477. [PMID: 29894486 PMCID: PMC5997347 DOI: 10.1371/journal.pone.0198477] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2018] [Accepted: 05/18/2018] [Indexed: 12/26/2022] Open
Abstract
Differentiating early mycosis fungoides (MF) from inflammatory dermatitis is a challenge. We compare the differential expression profile of early-stage MF samples and benign inflammatory dermatoses using microRNA (miRNA) arrays. 114 miRNAs were found to be dysregulated between these entities. The seven most differentially expressed miRNAs between these two conditions were further analyzed using RT-PCR in two series comprising 38 samples of early MFs and 18 samples of inflammatory dermatitis. A series of 51 paraffin-embedded samples belonging to paired stages of 16 MF patients was also analyzed. MiRNAs 26a, 222, 181a and 146a were differentially expressed between tumoral and inflammatory conditions. Two of these miRNAs (miRNA-181a and miRNA-146a) were significantly deregulated between early and advanced MF stages. Bioinformatic analysis showed FOXP3 expression to be regulated by these miRNAs. Immunohistochemistry revealed the level of FOXP3 expression to be lower in tumoral MFs than in plaque lesions in paraffin-embedded tissue. A functional study confirmed that both miRNAs diminished FOXP3 expression when overexpressed in CTCL cells. The data presented here suggest that the analysis of a restricted number of miRNAs (26a, 222, 181a and 146a) could be sufficient to differentiate tumoral from reactive conditions. Moreover, these miRNAs seem to be involved in MF progression.
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Affiliation(s)
- Rebeca Manso
- Pathology Department, Fundación Jiménez Díaz, UAM, Madrid, CIBERONC, Madrid, Spain
| | | | | | - Verónica Monsalvez
- Hospital Universitario 12 de Octubre, Dermatology Department, Madrid, Spain
| | | | | | - Carlos Santonja
- Pathology Department, Fundación Jiménez Díaz, UAM, Madrid, CIBERONC, Madrid, Spain
| | - Ion Cristóbal
- Translational Oncology Division, Oncohealth Institute, IIS-Fundación Jiménez Díaz, UAM, Madrid, Spain
| | - Miguel A. Piris
- Pathology Department, Fundación Jiménez Díaz, UAM, Madrid, CIBERONC, Madrid, Spain
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9
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‘Could it be mycosis fungoides?’: an approach to diagnosing patch stage mycosis fungoides. J Hematop 2015. [DOI: 10.1007/s12308-015-0247-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
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10
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Horna P, Kurant D, Sokol L, Sotomayor EM, Moscinski L, Glass LF. Flow cytometric identification of immunophenotypically aberrant T-cell clusters on skin shave biopsy specimens from patients with mycosis fungoides. Am J Clin Pathol 2015; 143:785-96. [PMID: 25972320 DOI: 10.1309/ajcpwe2hbfcgdids] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
OBJECTIVES To assess the ability of flow cytometry (FC) to detect putative neoplastic T-cell subsets on skin shave biopsy (SSB) specimens from patients with mycosis fungoides (MF) and to study the immunophenotype of skin-infiltrating tumor cells in MF. METHODS SSB specimens from patients with suspected MF were bisected and submitted for both FC and routine histopathology. Six-dimensional gating strategies were applied to identify putative neoplastic cells, independently from their expected immunophenotype. RESULTS Aberrant T cells were detected by FC in 18 of 33 SBB specimens, of which all had clinicomorphologic features of MF. Of the remaining 15 SSB specimens, six had clinicomorphologic features of MF and nine were diagnosed with benign inflammatory dermatoses. Unexpectedly, CD26 was aberrantly overexpressed in 11 (73%) and lost in three (20%) of 15 SSB specimens from patients with MF where this antigen was evaluated. Other detected aberrancies included CD3 dim- (13/18 [72%]), CD7 dim- (15/18 [83%]), and CD4-/CD8- (3/18 [17%]). CONCLUSIONS FC is capable of identifying putative neoplastic cells on SSB specimens from patients with MF. Bright homogeneous CD26 expression is a common and previously undescribed immunophenotypic aberrancy on MF skin infiltrates.
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Affiliation(s)
- Pedro Horna
- Department of Hematopathology and Laboratory Medicine, H. Lee Moffitt Cancer Center, Tampa, FL
| | - Danielle Kurant
- The Department of Pathology and Cell Biology, University of South Florida, Tampa
| | - Lubomir Sokol
- Department of Malignant Hematology, H. Lee Moffitt Cancer Center, Tampa, FL
| | | | - Lynn Moscinski
- Department of Hematopathology and Laboratory Medicine, H. Lee Moffitt Cancer Center, Tampa, FL
| | - L. Frank Glass
- Department of Dermatology, H. Lee Moffitt Cancer Center, Tampa, FL
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11
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Vandergriff T, Nezafati KA, Susa J, Karai L, Sanguinetti A, Hynan LS, Ambruzs JM, Oliver DH, Pandya AG. Defining early mycosis fungoides: validation of a diagnostic algorithm proposed by the International Society for Cutaneous Lymphomas. J Cutan Pathol 2015; 42:318-28. [PMID: 25721994 DOI: 10.1111/cup.12470] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2014] [Revised: 02/11/2015] [Accepted: 02/21/2015] [Indexed: 12/01/2022]
Abstract
BACKGROUND Mycosis fungoides (MF) is the most common subtype of cutaneous T-cell lymphoma and is often difficult to diagnose. Early-stage disease is particularly challenging and requires clinical and histopathologic correlation to make an accurate diagnosis. In order to facilitate the diagnosis of early MF, an algorithm has been proposed by the International Society for Cutaneous Lymphomas (ISCL) whereby clinical and histopathologic characteristics as well as immunohistochemistry and T-cell receptor gene rearrangement studies may be applied to suspected cases of MF. The diagnostic utility of this algorithm has not yet been validated. We sought to determine the validity of the proposed algorithm via an investigator-blinded, retrospective, case-control study. METHODS A total of 34 cases were randomly selected from the database of a clinic for cutaneous T-cell lymphomas and included patients with MF and patients with clinicopathologic mimics. The proposed diagnostic algorithm was systematically applied to the entire cohort. Each case was assigned a composite score based on the parameters in the proposed algorithm. RESULTS Among the 24 cases of MF, 21 cases achieved four or more points through application of the algorithm. Among the 10 cases of MF mimics, only four achieved four or more points. This difference was significant (Fisher's exact test, p = 0.009). The sensitivity of the 4-point threshold for a diagnosis of MF was 87.5% and the specificity was 60%. CONCLUSIONS The diagnostic algorithm proposed by the ISCL is a statistically valid method for defining cases of early MF and distinguishing these cases from other benign dermatoses. However, the clinical utility of the algorithm may be limited by its low specificity. Further refinement of the algorithm may improve its accuracy.
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Affiliation(s)
- Travis Vandergriff
- Department of Dermatology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Kaveh A Nezafati
- Department of Dermatology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Joseph Susa
- Department of Dermatology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Laszlo Karai
- Department of Dermatology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Amy Sanguinetti
- Veterans Affairs Hospital, Sierra Nevada Health Care System, Reno, NV, USA
| | - Linda S Hynan
- Department of Clinical Science, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Josephine M Ambruzs
- Department of Pathology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Dwight H Oliver
- Department of Pathology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Amit G Pandya
- Department of Dermatology, University of Texas Southwestern Medical Center, Dallas, TX, USA
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12
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Sandlund JT, Perkins SL. Uncommon non-Hodgkin lymphomas of childhood: pathological diagnosis, clinical features and treatment approaches. Br J Haematol 2015; 169:631-46. [PMID: 25851546 DOI: 10.1111/bjh.13359] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
We provide a review of the pathological and clinical features for uncommon B-cell and T-cell lymphomas of childhood with a specific focus on advances in treatment approaches and outcomes. There is clearly a need for prospective investigation of both the clinical and biological features of the uncommon non-Hodgkin lymphoma subtypes in childhood. These results should lead to more uniform and more effective treatment approaches.
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Affiliation(s)
- John T Sandlund
- Department of Oncology, St Jude Children's Research Hospital, Memphis, TN, USA
| | - Sherrie L Perkins
- Department of Pathology, University of Utah and ARUP Laboratories, Salt Lake City, UT, USA
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13
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Hsi AC, Lee SJ, Rosman IS, Carson KR, Kelley A, Viele V, Pang X, Musiek A, Schaffer A. Expression of helper T cell master regulators in inflammatory dermatoses and primary cutaneous T-cell lymphomas: Diagnostic implications. J Am Acad Dermatol 2015; 72:159-67. [DOI: 10.1016/j.jaad.2014.09.022] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2014] [Revised: 08/30/2014] [Accepted: 09/09/2014] [Indexed: 12/13/2022]
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14
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Çetinözman F, Jansen PM, Willemze R. Expression of programmed death-1 in skin biopsies of benign inflammatory vs. lymphomatous erythroderma. Br J Dermatol 2014; 171:499-504. [PMID: 24601935 DOI: 10.1111/bjd.12934] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/17/2014] [Indexed: 12/31/2022]
Abstract
BACKGROUND Histological differentiation between Sézary syndrome (SS) and erythrodermic inflammatory dermatoses (EID) can be very difficult. Recent studies show that programmed death-1 (PD-1) is strongly expressed by the neoplastic cells in skin biopsies of SS, while similar studies in EID are lacking. OBJECTIVES To determine whether the number and distribution of PD-1(+) T cells could be used as an adjunct in the differentiation between SS and EID. METHODS Expression of PD-1 and a panel of T-cell markers was investigated in skin biopsies from 30 patients with various types of EID (12 idiopathic, 10 atopic, six psoriatic and two paraneoplastic) and 25 patients with SS. RESULTS Expression of PD-1 by > 50% of the infiltrating T cells was observed in 23 of 25 (92%) SS cases and in only four of 30 (13%) EID cases. PD-1 is expressed by neoplastic CD4(+) T cells in SS, while in contrast, PD-1 was predominantly expressed by dermal and epidermal CD8(+) T cells in EID. Expression of CD7 by ≤ 20% of the infiltrating T cells was observed only in SS (13 of 24; 54%), and not in any of the 30 cases of EID. CONCLUSIONS While PD-1 is expressed by CD4(+) neoplastic T cells in SS, our results suggest that PD-1 is expressed mainly by activated dermal and epidermal CD8(+) T cells in EID. Expression of PD-1 by > 50% of CD4(+) T cells and expression of CD7 by ≤ 20% of the infiltrating T cells strongly support a diagnosis of SS in skin biopsies of patients with erythroderma.
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Affiliation(s)
- F Çetinözman
- Department of Dermatology, Leiden University Medical Center, PO Box 9600, Leiden, 2300 RC, the Netherlands
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15
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Abstract
This article is a comprehensive review of mycosis fungoides (MF), the most common type of cutaneous T-cell lymphoma. The first portion of the article introduces epidemiologic features of MF. Next, the clinical presentation is described, followed by the microscopic features. This article addresses how to establish a diagnosis of MF and includes a discussion of the utility of ancillary testing, such as immunohistochemistry and T-cell clonality testing. The differential diagnosis is also discussed, with attention to how to distinguish MF from histopathologic mimics. The final section of the article discusses prognosis and risk of disease progression in MF.
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Affiliation(s)
- Laura B Pincus
- Departments of Dermatology and Pathology, Section of Dermatopathology, University of California, San Francisco, 1701 Divisadero Street, Suite 280, San Francisco, CA 94115, USA.
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Abstract
OBJECTIVES The objectives of this study are to review prior publications of survival for patients with mycosis fungoides (MF), to perform some analyses on the consolidated data, and then to consider the implications of the results. METHODS The data for this study comprise 18 survival curves derived from seven prior publications of long-term survival in relatively large series of patients with MF. Altogether, the study uses results from over 5,000 patients. To examine fatality, the study uses hazard functions derived from the survival curves. RESULTS The analyses demonstrate significant variability in survival between different groups who have studied MF, and the results document that for most patients the diagnosis of MF has little impact on fatality. CONCLUSIONS Although MF is considered a cutaneous lymphoma, that is, a malignancy, it may be time to reconsider low stages of MF as precursors to malignancy analogous to the precursors to malignancies of other types or organs.
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Abstract
Primary cutaneous γδ T-cell lymphomas (PCGD-TCLs) are considered a subgroup of aggressive cytotoxic T-cell lymphomas (CTCLs). We have taken advantage of a new, commercially available antibody that recognizes the T-cell receptor-γ (TCR-γ) subunit of the TCR in paraffin-embedded tissue. We have analyzed a series of 146 primary cutaneous T-cell lymphomas received for consultation or a second opinion in the CNIO Pathology Department. Cases were classified according to the World Health Organization 2008 classification as mycosis fungoides (MF; n=96), PCGD-TCLs (n=5), pagetoid reticulosis (n=6), CD30(+) primary cutaneous anaplastic large cell lymphomas (n=5), primary cutaneous CD8 aggressive epidermotropic CTCLs (n=3), primary cutaneous CTCL, not otherwise specified (n=4), and extranodal nasal-type NK/T-cell lymphomas primarily affecting the skin or subcutaneous tissue (n=11). Sixteen cases of the newly named lymphomatoid papulosis type D (LyP-D; n=16) were also included. In those cases positive for TCR-γ, a further panel of 13 antibodies was used for analysis, including TIA-1, granzyme B, and perforin. Clinical and follow-up data were recorded in all cases. Twelve cases (8.2%) were positive for TCR-γ, including 5 PCGD-TCLs, 2 MFs, and 5 LyP-Ds. All 5 PCGD-TCL patients and 1 MF patient died of the disease, whereas the other MF patient and all those with LyP-D were alive. All cases expressed cytotoxic markers, were frequently CD3(+)/CD8(+), and tended to lose CD5 and CD7 expressions. Eight of 12 and 5 of 11 cases were CD30(+) and CD56(+), respectively. Interestingly, 5/12 TCR-γ-positive cases also expressed TCR-BF1. All cases analyzed were negative for Epstein-Barr virus-encoded RNA. In conclusion, TCR-γ expression seems to be rare and is confined to cytotoxic primary cutaneous TCLs. Nevertheless, its expression is not exclusive to PCGD-TCLs, as TCR-γ protein can be found in other CTCLs. Moreover, its expression does not seem to be associated with bad prognosis by itself, as it can be found in cases with good and bad outcomes.
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Deonizio JM, Guitart J. The Role of Molecular Analysis in Cutaneous Lymphomas. ACTA ACUST UNITED AC 2012; 31:234-40. [DOI: 10.1016/j.sder.2012.08.006] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2012] [Accepted: 08/21/2012] [Indexed: 11/16/2022]
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McClain CM, Cole MB, Robbins JB, Kantrow SM. Mycosis fungoides involving an acrochordon: a case report. J Cutan Pathol 2012; 39:1131-4. [PMID: 22994930 DOI: 10.1111/cup.12009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2012] [Revised: 06/14/2012] [Accepted: 06/24/2012] [Indexed: 11/26/2022]
Abstract
We present the case of a 77-year-old male undergoing treatment for mycosis fungoides (MF) who presented for removal of an acrochordon on his mid back. Histopathologic examination of the acrochordon revealed a dense, band-like lymphocytic inflammatory infiltrate in the dermis with epidermotropism of single lymphocytes and small nests of lymphocytes into the lower epidermis. Immunohistochemical staining characterized the dermal and epidermal lymphocytic population as CD3-positive T lymphocytes with a predominance of CD4-positive over CD8-positive lymphocytes. These findings were consistent with the patient's known MF and molecular identification of a clonal T-cell receptor gene rearrangement further supported the diagnosis. Our unusual case reports MF involving an acrochordon and provides evidence to support the importance of submitting acrochordons for histopathologic examination.
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Affiliation(s)
- Colt M McClain
- Departments of Pathology, Microbiology and Immunology, Vanderbilt University Medical Center, Nashville, TN, USA
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Chisholm C, Cockerell CJ. Functions and uses of immunohistochemical stains in cutaneous infiltrates of hematopoietic origin: a review for the practicing dermatologist. J Cutan Med Surg 2011; 15:65-83. [PMID: 21477554 DOI: 10.2310/7750.2011.10024] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
BACKGROUND Immunohistochemical stains, particularly those for cutaneous lymphomas, have similar-sounding names, which may lead to confusion among dermatologists who are not well versed in the terminology of the tools used for pathologic diagnosis. Also aiding in this is the fact that some familiar stains are constantly investigated for novel utility in different tumors, and a plethora of new stains regularly emerge in the peer-reviewed literature. OBJECTIVE To review the major stains encountered in dermatopathologic reports for cutaneous lymphomas. A select number of other stains are reviewed that are either new and under investigation in several cutaneous processes or have a new use described in recent reports. METHODS The peer-reviewed literature was searched and analyzed for the accepted purposes of using these markers. RESULTS All pertinent findings for these immunostains are reported with the purpose of educating the dermatology community. CONCLUSION This review serves as a reference to clarify potentially confusing immunohistochemical stains.
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Affiliation(s)
- Cary Chisholm
- Department of Dermatology, University of Texas Southwestern Medical Center, Dallas, TX, USA.
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Bordignon M, Belloni-Fortina A, Pigozzi B, Saponeri A, Alaibac M. The role of immunohistochemical analysis in the diagnosis of parapsoriasis. Acta Histochem 2011; 113:92-5. [PMID: 20083298 DOI: 10.1016/j.acthis.2009.12.006] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2009] [Revised: 12/17/2009] [Accepted: 12/20/2009] [Indexed: 12/16/2022]
Abstract
Parapsoriasis is a chronic dermatosis whose biological distinction from early mycosis fungoides, the most frequent form of cutaneous T-cell lymphoma, is still not clearly defined. Two types of parapsoriasis have been delineated: large-plaque parapsoriasis and small-plaque parapsoriasis. The lack of clinical and histological features, which may allow distinguishing parapsoriasis from early mycosis fungoides has prompted several investigations to assess the role of immunohistochemistry in establishing a conclusive diagnosis of these conditions. However, the additional data obtained by immunohistochemical analysis concerning the CD4/CD8 ratio, the aberrant expression of T-cell antigens and the expression of proliferation markers has not generally helped establish a more definitive diagnosis. This review critically discusses these immunohistochemical markers and their use in diagnosis of parapsoriasis.
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Affiliation(s)
- Matteo Bordignon
- Unit of Dermatology, University of Padua, Via Cesare Battisti 206, Padua, Italy
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Kelemen K, White CR, Gatter K, Braziel RM, Fan G. Immunophenotypic correlation between skin biopsy and peripheral blood findings in mycosis fungoides. Am J Clin Pathol 2010; 134:739-48. [PMID: 20959657 DOI: 10.1309/ajcp7lrrlk8sluge] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
Abstract
In mycosis fungoides (MF) with blood involvement, T-cell immunophenotypes in skin and blood have not been compared. Our aim was to evaluate T-cell immunophenotypes in skin by immunohistochemical analysis and compare results with flow cytometric (FC) findings in blood. Of 20 patients with MF with blood involvement, the immunophenotype was discrepant in 11 (55%). Compared with FC findings in blood, immunohistochemical analysis of skin samples failed to detect partial deletion of CD2 (5/11 [45%]), CD3 (3/11 [27%]), and CD5 (3/11 [27%]) and overrepresented deletion of CD7 in 2 (18%) of 11 patients. In addition, CD8+ MF was missed by immunohistochemical analysis in 2 (18%) of 11 patients. Identical T-cell populations were demonstrated by T-cell gene polymerase chain reaction in skin and blood in 8 of the 11 patients who had a discrepant immunophenotype. Awareness of the limitations of immunohistochemical analysis of skin samples is of practical value for pathologists interpreting skin biopsies in MF patients. In addition, our findings suggest CD8+ MF to be more common than previously reported.
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Zhang B, Beck AH, Taube JM, Kohler S, Seo K, Zwerner J, Viakhereva N, Sundram U, Kim YH, Schrijver I, Arber DA, Zehnder JL. Combined use of PCR-based TCRG and TCRB clonality tests on paraffin-embedded skin tissue in the differential diagnosis of mycosis fungoides and inflammatory dermatoses. J Mol Diagn 2010; 12:320-7. [PMID: 20203005 DOI: 10.2353/jmoldx.2010.090123] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
The distinction between mycosis fungoides (MF) and inflammatory dermatoses (ID) by clinicopathologic criteria can be challenging. There is limited information regarding the performance characteristics and utility of TCRG and TCRB clonality assays in diagnosis of MF and ID from paraffin-embedded tissue sections. In this study, PCR tests were performed with both TCRG and TCRB BIOMED-2 clonality methods followed by capillary electrophoresis and Genescan analysis using DNA samples from 35 MF and 96 ID patients with 69 and 133 paraffin-embedded specimens, respectively. Performance characteristics were determined for each test individually and in combination. TCRG and TCRB tests demonstrated identical sensitivity (64%) and specificity (84%) when analyzed as individual assays. The positive predictive value, negative predictive value, and change of posttest MF probability over a range of MF pretest probabilities were obtained. These data were used to construct an algorithm for sequential use of TCRG and TCRB. As single tests, commercially available BIOMED-2 PCR-based TCRG and TCRB clonality tests on paraffin-embedded tissue have no significant difference in terms of sensitivity and specificity. Combined use of the two tests in patients with intermediate pretest probabilities as proposed in the algorithm could improve test utility.
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Affiliation(s)
- Bing Zhang
- Department of Pathology, L235, Stanford University Medical Center, Stanford, CA 94305, USA
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Furmanczyk PS, Wolgamot GM, Kussick SJ, Sabath DE, Olerud JE, Argenyi ZB. Diagnosis of mycosis fungoides with different algorithmic approaches. J Cutan Pathol 2010; 37:8-14. [DOI: 10.1111/j.1600-0560.2009.01289.x] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Abstract
The major differential diagnosis for a primary cutaneous T-cell lymphoproliferative disorder with CD30 (Ki-1) positivity includes primary cutaneous anaplastic large cell lymphoma, lymphomatoid papulosis, pagetoid reticulosis and transformed mycosis fungoides (MF). Little is known, however, about CD30 expression in nontransformed MF, whether it simply reflects the proliferative fraction and if either CD30 staining or the proliferative fraction are of prognostic significance. Therefore, 47 nontransformed MF biopsies were stained for CD30 and Ki-67. The proportions of positive cells were determined and correlated with each other as well as with age, stage at diagnosis, maximum stage and survival. All cases had at least rare dermal CD30-positive cells. Higher percentages of dermal CD30 and Ki-67-positive cells were associated with a higher stage at diagnosis, and together with epidermal CD30, associated with a higher maximum stage. The proportion of CD30 and Ki-67-positive cells did not correlate with each other. Survivals were shorter if the dermal CD30 or epidermal or dermal Ki-67% were greater than the median (4.7%, 14%, 13%) and in patients of greater than or equal to 60 years of age or with a high stage. Dermal Ki-67 as a continuous variable was an independent prognostic indicator (P<0.001), as were dermal Ki-67 (P=0.004) and dermal CD30 (P=0.027) when analyzed as dichotomous variables but not stage. Therefore, CD30 expression is not restricted to transformed MF but higher levels of dermal CD30 expression and, even more so, dermal Ki-67 levels are independent adverse prognostic indicators.
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Affolter VK, Gross TL, Moore PF. Indolent cutaneous T-cell lymphoma presenting as cutaneous lymphocytosis in dogs. Vet Dermatol 2009; 20:577-85. [DOI: 10.1111/j.1365-3164.2009.00833.x] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Garcia-Herrera A, Colomo L, Camós M, Carreras J, Balague O, Martinez A, Lopéz-Guillermo A, Estrach T, Campo E. Primary Cutaneous Small/Medium CD4+ T-Cell Lymphomas: A Heterogeneous Group of Tumors With Different Clinicopathologic Features and Outcome. J Clin Oncol 2008; 26:3364-71. [DOI: 10.1200/jco.2008.16.1307] [Citation(s) in RCA: 131] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Purpose To define the clinical and pathologic characteristics of primary cutaneous small/medium CD4+ T-cell lymphoma (PCSM-TCL) and identify parameters of prognostic significance. Patients and Methods We have investigated 24 patients with primary cutaneous lymphomas composed of small/medium mature T-cells with a βF1, CD3, CD4+ and/or noncytotoxic, CD8– and CD30– phenotype. The proliferation index and CD8+ infiltrating cells were quantified with an automated image analysis system. Results Sixteen patients presenting with solitary or localized plaques or small nodules (< 3 cm) had an indolent course. Only three patients experienced repeated cutaneous relapses, and none of them died as a result of the disease after 1 to 168 months (median, 17 months) of follow-up. The tumors had a low proliferation (median Ki-67, 9% ± 5%) and an intense infiltrate of reactive CD8+ (median, 20% ± 11.7%). Five patients presenting with rapidly evolving large tumors or nodules (≥ 5 cm) had an aggressive disease and died with extracutaneous dissemination 18 to 36 months after diagnosis (median, 23 months). These tumors had a significantly higher proliferation (median Ki-67, 22% ± 11.3%; P < .05) and lower number of infiltrating CD8+ (median, 1% ± 3%; P < .05) than the previous group. A third group of three patients had a peculiar clinical presentation with multifocal relapsing lesions without extracutaneous dissemination after a long period of follow-up ranging from 41 to 92 months. Histologically, these cases had an intense infiltrate of eosinophils. Conclusion PCSM-TCL is a heterogeneous group of tumors with differentiated clinical and pathological characteristics with impact in the outcome of the patients.
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Affiliation(s)
- Adriana Garcia-Herrera
- From the Hematopathology Section, Department of Pathology, Department of Hematology, and Dermatology, Hospital Clínic, Institut d'Investigacions Biomediques August Pi i Sunyer, University of Barcelona, Barcelona, Spain
| | - Luis Colomo
- From the Hematopathology Section, Department of Pathology, Department of Hematology, and Dermatology, Hospital Clínic, Institut d'Investigacions Biomediques August Pi i Sunyer, University of Barcelona, Barcelona, Spain
| | - Mireia Camós
- From the Hematopathology Section, Department of Pathology, Department of Hematology, and Dermatology, Hospital Clínic, Institut d'Investigacions Biomediques August Pi i Sunyer, University of Barcelona, Barcelona, Spain
| | - Joaquín Carreras
- From the Hematopathology Section, Department of Pathology, Department of Hematology, and Dermatology, Hospital Clínic, Institut d'Investigacions Biomediques August Pi i Sunyer, University of Barcelona, Barcelona, Spain
| | - Olga Balague
- From the Hematopathology Section, Department of Pathology, Department of Hematology, and Dermatology, Hospital Clínic, Institut d'Investigacions Biomediques August Pi i Sunyer, University of Barcelona, Barcelona, Spain
| | - Antonio Martinez
- From the Hematopathology Section, Department of Pathology, Department of Hematology, and Dermatology, Hospital Clínic, Institut d'Investigacions Biomediques August Pi i Sunyer, University of Barcelona, Barcelona, Spain
| | - Armando Lopéz-Guillermo
- From the Hematopathology Section, Department of Pathology, Department of Hematology, and Dermatology, Hospital Clínic, Institut d'Investigacions Biomediques August Pi i Sunyer, University of Barcelona, Barcelona, Spain
| | - Teresa Estrach
- From the Hematopathology Section, Department of Pathology, Department of Hematology, and Dermatology, Hospital Clínic, Institut d'Investigacions Biomediques August Pi i Sunyer, University of Barcelona, Barcelona, Spain
| | - Elias Campo
- From the Hematopathology Section, Department of Pathology, Department of Hematology, and Dermatology, Hospital Clínic, Institut d'Investigacions Biomediques August Pi i Sunyer, University of Barcelona, Barcelona, Spain
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Abstract
Mycosis fungoides and Sézary syndrome are the most common of the cutaneous T-cell lymphomas, which are a heterogeneous group of neoplasms that affect the skin as a primary site. Although the aetiologies of mycosis fungoides and Sézary syndrome are unknown, important insights have been gained in the immunological and genetic perturbations that are associated with these diseases. Unlike some B-cell lymphomas, cutaneous T-cell lymphomas as a group are rarely if ever curable and hence need chronic-disease management. New approaches to treatments are being investigated and include biological and cytotoxic drugs, phototherapy, and monoclonal antibodies that are directed towards novel molecular targets. New molecular technologies such as complementary-DNA microarray have the potential to increase the accuracy of diagnosis and provide important prognostic information. Treatments can be combined to greatly improve clinical outcome without substantially increasing toxic effects in advanced disease that is otherwise difficult to treat. Although present treatment strategies are generally not curative, there is hope that experimental treatments, particularly immunotherapy, might eventually reverse or suppress the abnormalities of mycosis fungoides and Sézary syndrome to the point at which they become non-life-threatening, chronic diseases.
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Affiliation(s)
- Sam T Hwang
- Dermatology Branch, Center for Cancer Research, National Cancer Institute, Bethesda, USA.
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Gambichler T, Bischoff S, Bechara FG, Altmeyer P, Kreuter A. Expression of proliferation markers and cell cycle regulators in T cell lymphoproliferative skin disorders. J Dermatol Sci 2007; 49:125-32. [PMID: 17826963 DOI: 10.1016/j.jdermsci.2007.07.011] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2007] [Revised: 06/03/2007] [Accepted: 07/27/2007] [Indexed: 10/22/2022]
Abstract
BACKGROUND Abnormal cell proliferation, which results from deregulation of the cell cycle, is fundamental in tumorigenesis. OBJECTIVES To investigate the expression of proliferation markers and cell cycle regulators in a range of T cell lymphoproliferative skin diseases. METHODS We studied skin specimens of 51 patients with parapsoriasis (PP), mycosis fungiodes (MF), or lymphomatoid papulosis (LyP). Immunohistochemistry was performed for Ki-67, proliferating cell nuclear antigen (PCNA), minichromosome maintenance protein 7 (MCM7), and p21. RESULTS MF with stage IIB-IV and LyP showed a significantly greater number of Ki-67-positive cells than PP (P=0.02 and 0.001) and MF I-IIA (P=0.019 and 0.003), respectively. MCM7 staining revealed significantly higher labeling indices for MF IIB-IV and LyP when compared to PP (P=0.002 and 0.04) and MF I-IIA (P=0.0005 and 0.01), respectively. Compared to PP and MF I-IIA, MF IIB-IV was associated with significantly higher labeling indices for PCNA (P=0.006 and 0.0004). p21 staining was significantly increased in MF IIB-IV and LyP when compared to PP (P=0.006 and 0.003) and MF I-IIA (P=0.003). However, p21 staining was all in all very weak. CONCLUSIONS Ki-67 and PCNA seem to be useful immunohistological parameters for the correlation with the clinical stage of MF. In the differentiation and prognostication of T cell lymphoproliferative skin disorders, MCM7 may serve as a novel biomarker which is, in contrast to Ki-67 and PCNA, stable throughout the cell cycle.
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Affiliation(s)
- Thilo Gambichler
- Department of Dermatology, Ruhr-University Bochum, Gudrunstrasse 56, 44791, Bochum, Germany.
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Gerami P, Guitart J. The Spectrum of Histopathologic and Immunohistochemical Findings in Folliculotropic Mycosis Fungoides. Am J Surg Pathol 2007; 31:1430-8. [PMID: 17721200 DOI: 10.1097/pas.0b013e3180439bdc] [Citation(s) in RCA: 67] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
BACKGROUND Since the original designation of folliculotropic mycosis fungoides (FMF) as a distinct entity, there has been an increasing appreciation of the broad clinical and histopathologic spectrum with which this disease can present. However, there have been few large histologic studies characterizing the various histopathologic patterns. OBJECTIVE In this study, we attempt to describe the histopathologic and immunohistochemical features of 47 biopsy specimens from 34 patients with FMF. METHODS We searched our lymphoma database for patients with FMF in which detailed histopathologic information and slides as well as clinical information was available for review. Additionally, immunohistochemical studies for CD4, CD8, and CD1a were performed in all cases in which the block was available. RESULTS In addition to the prototypical pattern of a folliculotropic lypmphoid infiltrate with or without mucinosis, the histologic features of follicular mycosis fungoides may include a granulomatous reaction, cystic and comedonal changes, an eosinophilic folliculitis pattern and basaloid folliculolymphoid hyperplasia as well as pustular changes, interface dermatitis and an interstitial dermatitislike pattern. Unlike conventional mycosis fungoides, eosinophils and plasma cells are conspicuous within the accompanying reactive infiltrate. We have also noted an exceedingly high number of Langerhans cells within the follicular epithelium. The CD4:CD8 ratio frequently is 10:1 or greater and the follicles show abundant CD1a positive cells. CONCLUSIONS FMF may present with a broad spectrum of histopathologic changes including interstitial, granulomatous, fibrotic and acneiform reactions that may lack the typical histologic attributes of a cutaneous T-cell lymphoma. Recognition of these myriad of histologic presentations can be of great diagnostic utility.
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Affiliation(s)
- Pedram Gerami
- Northwestern University and The Feinberg School of Medicine, Chicago, IL 60611, USA.
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