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Miller S, Vandergriff T, Woodworth Goff H, Xu J, Oliver D. Comparison of 2 T-Cell Receptor-γ Clonality Assays on Skin Biopsies Suspicious for Mycosis Fungoides. Am J Dermatopathol 2024:00000372-990000000-00301. [PMID: 38457687 DOI: 10.1097/dad.0000000000002654] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/10/2024]
Abstract
ABSTRACT PCR-based fragment analysis of the T-cell receptor (TCR) gene is used extensively in diagnostic labs to assess clonality in T-cell populations in multiple tissue sites. Of the numerous TCR assays that have been reported, studies assessing use on biopsies suspicious for mycosis fungoides specifically are lacking. We compared clonality findings from a previously run 2-tube/2-fluorochrome dye assay to a redesigned 1-tube/1-fluorochrome dye assay on formalin-fixed skin biopsies. Overall, the accuracy of the 2-tube assay was marginally better (75.7% vs. 71.4%), when using clinical history combined with histologic diagnosis as the gold standard. The 2-tube assay had better sensitivity (73.7% vs. 65.8%), while the 1-tube assay had superior specificity (93.8% vs. 87.5%). Clonality results were easier to interpret with the 1-tube assay. In nearly 19% of cases, a change of assays on the same biopsy resulted in a change of clonality interpretation. For laboratories that change TCR-γ clonality assays, follow-up biopsies for mycosis fungoides assessment may result in a change of diagnosis.
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Affiliation(s)
- Stan Miller
- Department of Pathology, UT Southwestern Medical Center, Dallas, TX; and
| | - Travis Vandergriff
- Department of Pathology, UT Southwestern Medical Center, Dallas, TX; and
- Department of Dermatology, UT Southwestern Medical Center, Dallas, TX
| | | | - Jing Xu
- Department of Pathology, UT Southwestern Medical Center, Dallas, TX; and
| | - Dwight Oliver
- Department of Pathology, UT Southwestern Medical Center, Dallas, TX; and
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Seçme M, Dodurga Y, Demirkan NÇ, Kaçar N, Günel NS, Açıkbaş İ. Determination of T-cell clonality and expression profiles of Toll-like receptors signaling pathway genes and related miRNAs in patients with mycosis fungoides. Gene 2024; 891:147825. [PMID: 37748629 DOI: 10.1016/j.gene.2023.147825] [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: 07/25/2023] [Revised: 09/18/2023] [Accepted: 09/22/2023] [Indexed: 09/27/2023]
Abstract
Cutaneous T-cell lymphomas (CTCL) encompass a group of diseases characterized by the presence of malignant clonal CD4+ T lymphocytes in the skin. Mycosis fungoides (MF) is the most prevalent form of CTCL, accounting for approximately 60 % of cutaneous T-cell lymphomas and 50 % of all primary cutaneous lymphomas. Despite ongoing research, the precise pathogenesis of MF remains incompletely understood. Toll-like receptors (TLRs) have the ability to specifically recognize ligands, subsequently induce the expression of diverse genes and activate innate immunity within the cell. Furthermore, miRNAs play a crucial role in regulating various aspects of immune cell function. The aim of our study was to explore the potential roles of TLRs and the genes implicated in their signal transduction, along with the expression status of miRNAs in the mechanisms underlying MF. Additionally, we assessed the clonal status and compared it with clinicopathological data using a T-cell clonality assay. To determine the expression status of TLR pathway genes and miRNAs, we conducted RT-PCR analysis on 52 MF samples and 50 control paraffin block materials. Pathway analysis were conducted using the KEGG database. T-cell receptor (TCR) gamma clonality changes were evaluated. Results from the study revealed increased expressions of TLR-1, -4, -8, IRF7, TRAF3, MEK1, MEK2, Elk1, NFkB, hsa-miR-21-5p, and hsa-miR-155-5p, as well as decreased expressions of hsa-miR-130a-3p, hsa-miR-210-3p, and hsa-let-7e-5p in the MF group. TCR gamma clonal change analysis demonstrated that 55.5 % of the analysed DNAs exhibited monoclonal and biallelic patterns, while 45.5 % displayed polyclonality. These findings collectively suggest the potential influence and therapeutic possibilities of the TLR signalling pathway in the molecular pathogenesis of MF.
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Affiliation(s)
- Mücahit Seçme
- Department of Medical Biology, Faculty of Medicine, Ordu University, Ordu, Turkey.
| | - Yavuz Dodurga
- Department of Medical Biology, Faculty of Medicine, Pamukkale University, Denizli, Turkey
| | - Neşe Çallı Demirkan
- Department of Pathology, Faculty of Medicine, Pamukkale University, Denizli, Turkey
| | - Nida Kaçar
- Department of Dermatology, Faculty of Medicine, Pamukkale University, Denizli, Turkey
| | - Nur Selvi Günel
- Department of Medical Biology, Faculty of Medicine, Ege University, İzmir, Turkey
| | - İbrahim Açıkbaş
- Department of Medical Biology, Faculty of Medicine, Pamukkale University, Denizli, Turkey
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Kashabano JJ, Rugengamazi E, Matiku SB, Mruma RM, Lugina EL. Mycosis fungoides with spongiosis: a case report. J Med Case Rep 2023; 17:458. [PMID: 37919795 PMCID: PMC10623773 DOI: 10.1186/s13256-023-04188-2] [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: 07/17/2023] [Accepted: 09/20/2023] [Indexed: 11/04/2023] Open
Abstract
BACKGROUND Mycosis fungoides (MF) is the most common form of cutaneous T-cell lymphoma (CTCL). CTCL are an uncommon, heterogeneous group of non-Hodgkin lymphomas (NHLs) of T- and B-cell origin where the skin is the primary organ of involvement. It is characterized by malignant CD4+ T-cells infiltrating the skin and other organs, leading to progressive skin and systemic involvement. Histopathologically, MF is characterized by atypical lymphocytes demonstrating epidermotropism without spongiosis. Spongiosis is the histological hallmark of intercellular epidermal edema, viewed as clear spaces within the epidermis, and is very common in benign inflammatory dermatoses. Very few studies have reported MF in sub-Saharan Africa (SSA). We are reporting a case of MF with a rare presentation of spongiosis treated successfully with a low dose total skin electron beam therapy (TSEBT) followed by maintenance therapy of low dose Methotrexate (MT) at the Ocean Road Cancer Institute (ORCI) in Tanzania. This is the first case of MF to be managed with low-dose TSEBT in Tanzania. The authors wish to create awareness of the disease among physicians and pathologists and expand on the data paucity in SSA. CASE DESCRIPTION We are reporting a case of a 31-year-old male of African origin who self-referred to our oncology center with a 4-year history of skin rashes throughout the body, which was unresponsive to topical steroid treatment. The biopsy was taken, and the patient was diagnosed with MF CD 3 positive with spongiosis. The patient was treated with radiotherapy, whereby he received low dose total skin electron beam therapy (TSEBT) 12 Gy in 3 fractions at a daily dose of 4 Gy, followed by maintenance therapy of low dose Methotrexate and attained an excellent therapeutic response. CONCLUSION Spongiosis is an infrequent presentation of MF. Low-dose TSEBT provides reliable and rapid reduction of disease burden in patients with MF, which could be administered safely multiple times during a patient's disease with an acceptable toxicity profile. Lack of tendency to perform skin biopsies and cost constraints in assessing multiple immunophenotypic markers lead to missing the diagnosis. Diagnosis and treatment of MF in resource-limited countries is challenging.
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Affiliation(s)
- Jesse Jonathan Kashabano
- Department of Clinical Oncology, Muhimbili University of Health and Allied Sciences, Dar Es Salaam, Tanzania.
- Benjamin Mkapa Hospital, Dodoma, Tanzania.
| | - Eulade Rugengamazi
- Department of Clinical Oncology, Muhimbili University of Health and Allied Sciences, Dar Es Salaam, Tanzania
| | - Subira Bhoke Matiku
- Department of Pathology, Muhimbili University of Health and Allied Sciences, Dar Es Salaam, Tanzania
| | - Rashid Mussa Mruma
- Department of Clinical Oncology, Muhimbili University of Health and Allied Sciences, Dar Es Salaam, Tanzania
- Ocean Road Cancer Institute, Dar Es Salaam, Tanzania
| | - Emmanuel L Lugina
- Department of Clinical Oncology, Muhimbili University of Health and Allied Sciences, Dar Es Salaam, Tanzania
- Ocean Road Cancer Institute, Dar Es Salaam, Tanzania
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Erduran F, Adışen E, Soyugür A, Eren F, Neşelioğlu S, Erel Ö. Evaluation of Oxidative Stress by Thiol/Disulphide Homeostasis in Patients with Mycosis Fungoides: A Prospective Double-Centre Study. Indian J Dermatol 2023; 68:724. [PMID: 38371553 PMCID: PMC10869007 DOI: 10.4103/ijd.ijd_339_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/20/2024] Open
Abstract
Background Mycosis fungoides (MF) is the most common cutaneous T-cell lymphoma with unknown etiopathogenesis. Oxidant and antioxidant balance is important for cell function and normal metabolism. An imbalance between pro-oxidants and antioxidants causes oxidative stress. A recent focus has been on thiol/disulphide homeostasis as a novel marker of oxidative stress. Aims and Objectives This study aimed to evaluate the role of oxidative stress in MF by analysing thiol/disulphide homeostasis. Materials and Methods A total of 103 patients (48 female, 55 male) and a control group of 120 healthy individuals (48 female, 72 male) from two tertiary care hospitals were included in our study. Serum native thiol, total thiol and disulphide levels were evaluated using novel method developed by Erel and Neeliolu. Results Native thiol levels were 340.30 ± 87.44 in the patient group and 401.62 ± 69.45 in the control group. Total thiol value was 374.17 ± 87.78 in the patient group and 428.54 ± 70.05 in the control group. Native thiol and total thiol levels were significantly lower in the patient group compared to the control group (P < 0.001 and P < 0.001). The disulphide value was 16.93 ± 6.46 in the patient group and 13.46 ± 5.06 in the control group. Disulphide levels were found to be significantly higher in the patient group compared to the control group (P < 0.001). Conclusions In our study, thiol/disulphide balance shifted towards disulphide which indicates the presence of oxidative stress especially in the early stage while 93.2% of our patients had early-stage MF. We think that this may have pathogenetic and prognostic significance.
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Affiliation(s)
- Funda Erduran
- From the Department of Dermatology, Ankara City Hospital, Ankara, Turkey
| | - Esra Adışen
- Department of Dermatology, Gazi University Faculty of Medicine, Ankara, Turkey
| | - Ahmet Soyugür
- Department of Dermatology, Gazi University Faculty of Medicine, Ankara, Turkey
| | - Funda Eren
- Department of Medical Biochemistry, Ankara City Hospital, Ankara, Turkey
| | - Salim Neşelioğlu
- Department of Medical Biochemistry, Faculty of Medicine, Ankara Yıldırım Beyazıt University, Ankara, Turkey
| | - Özcan Erel
- Department of Medical Biochemistry, Faculty of Medicine, Ankara Yıldırım Beyazıt University, Ankara, Turkey
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Akilov OE. What Does the Future Hold for Biomarkers of Response to Extracorporeal Photopheresis for Mycosis Fungoides and Sézary Syndrome? Cells 2023; 12:2321. [PMID: 37759543 PMCID: PMC10527589 DOI: 10.3390/cells12182321] [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: 07/31/2023] [Revised: 09/14/2023] [Accepted: 09/19/2023] [Indexed: 09/29/2023] Open
Abstract
Extracorporeal photopheresis (ECP) is an FDA-approved immunotherapy for cutaneous T-cell lymphoma, which can provide a complete response in some patients. However, it is still being determined who will respond well, and predictive biomarkers are urgently needed to target patients for timely treatment and to monitor their response over time. The aim of this review is to analyze the current state of the diagnostic, prognostic, and disease state-monitoring biomarkers of ECP, and outline the future direction of the ECP biomarker discovery. Specifically, we focus on biomarkers of response to ECP in mycosis fungoides and Sézary syndrome. The review summarizes the current knowledge of ECP biomarkers, including their limitations and potential applications, and identifies key challenges in ECP biomarker discovery. In addition, we discuss emerging technologies that could revolutionize ECP biomarker discovery and accelerate the translation of biomarker research into clinical practice. This review will interest researchers and clinicians seeking to optimize ECP therapy for cutaneous T-cell lymphoma.
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Affiliation(s)
- Oleg E Akilov
- Cutaneous Lymphoma Program, University of Pittsburgh, Pittsburgh, PA 15213, USA
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6
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Al Faker I, Cherti K, Marraha F, Chahoub H, Gallouj S. Granulomatous slack skin: One case and a literature review. Ann Dermatol Venereol 2023; 150:246-250. [PMID: 37385912 DOI: 10.1016/j.annder.2023.04.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2022] [Revised: 12/19/2022] [Accepted: 04/04/2023] [Indexed: 07/01/2023]
Affiliation(s)
- I Al Faker
- Dermatology Department, University Hospital Center of Tangier, Faculty of Medicine and Pharmacy, Tangier, Morocco.
| | - K Cherti
- Private Practice, Larache, Morocco
| | - F Marraha
- Dermatology Department, University Hospital Center of Tangier, Faculty of Medicine and Pharmacy, Tangier, Morocco
| | - H Chahoub
- Dermatology Department, University Hospital Center of Tangier, Faculty of Medicine and Pharmacy, Tangier, Morocco
| | - S Gallouj
- Dermatology Department, University Hospital Center of Tangier, Faculty of Medicine and Pharmacy, Tangier, Morocco
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Primary Cutaneous B-Cell Lymphoma Co-Existing with Mycosis Fungoides-A Case Report and Overview of the Literature. LIFE (BASEL, SWITZERLAND) 2022; 12:life12122067. [PMID: 36556432 PMCID: PMC9785996 DOI: 10.3390/life12122067] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/05/2022] [Revised: 11/25/2022] [Accepted: 12/07/2022] [Indexed: 12/13/2022]
Abstract
The existence of two sequential lymphomas, one localized and one systemic, either both with B or T lymphocytes, or one with B cells and one with T cells, with the same patient, is a known possibility. The second lymphoma is often induced by immunodepression or by the initial treatment. However, the existence of two cutaneous lymphomas with different cell lines, without systemic involvement, represents an uncommon situation. In this report, we describe the case of a 37-year-old man with an initial diagnosis of PMZBCL that over 10 months also developed a MF patch/plaque on the left leg.
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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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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:cancers14184466. [PMID: 36139626 PMCID: PMC9497107 DOI: 10.3390/cancers14184466] [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: 08/08/2022] [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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Martini DJ, Goyal S, Switchenko JM, Lechowicz MJ, Allen PB. African American and Caucasian patients with Sézary syndrome have no differences in outcomes at an ethnically diverse urban medical center. Leuk Lymphoma 2022; 63:2094-2101. [PMID: 35481397 PMCID: PMC9842406 DOI: 10.1080/10428194.2022.2067999] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
Sézary syndrome (SS) is an aggressive cutaneous T-cell lymphoma with poor survival. We performed a retrospective review of SS patients at Emory University from 1990 to 2020. We collected data on race, clinical characteristics, therapy, and social determinants of health. Clinical endpoints were overall survival (OS) and time to next treatment (TTNT). Univariate association and multivariable analyses were assessed by Cox proportional hazards models. Among 62 patients, 45.2% were AA. The median OS and TTNT were 3.1 years and 6.3 months, respectively, with no difference by race. AA patients had a higher median baseline LDH (360 vs. 232, p = 0.002) and a longer delay in initiation of systemic therapy compared to CC patients (3.17 vs. 2.14 months, p = 0.039), but a shorter commute (<10 miles) and no difference in insurance coverage (p = 0.260). AA patients at an academic center had unique clinical features and treatment patterns, but similar survival to CC SS patients.
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Affiliation(s)
- Dylan J. Martini
- Department of Hematology, Winship Cancer Institute, Atlanta, GA, USA,Department of Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - Subir Goyal
- Department of Biostatistics and Bioinformatics, Emory University, Atlanta, GA, USA
| | | | - Mary Jo Lechowicz
- Department of Hematology, Winship Cancer Institute, Atlanta, GA, USA
| | - Pamela B. Allen
- Department of Hematology, Winship Cancer Institute, Atlanta, GA, USA
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Banciu ML, Dobrica EC, Soare C, Malciu AM, Voiculescu VM. Healthcare Disparities in the Management of Indolent Mycosis Fungoides. Cureus 2022; 14:e24098. [PMID: 35573524 PMCID: PMC9106548 DOI: 10.7759/cureus.24098] [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] [Accepted: 04/13/2022] [Indexed: 11/18/2022] Open
Abstract
Mycosis fungoides represents the most common cutaneous T-cell lymphoma, clinically manifested with evolving skin lesions, including patches, plaques, tumors, and erythroderma. Early diagnosis remains difficult to establish because it mimics several benign skin conditions, but maintaining a high index of suspicion for the disease is essential in preventing the progression of a potentially fatal disease. We report the case of a 69-year-old female who presented in our dermatology clinic in 2018 with scaly, indurated, itchy erythematous-violaceus patches and plaques, and tumors disseminated throughout the skin evolving for nine years. Skin biopsy supplemented with immunohistochemical staining established the diagnosis of mycosis fungoides. Due to the equivocal clinical presentation and the lack of extracutaneous manifestations, the patient received conventional therapy according to the stage of the disease. The rapidly progressive evolution of the cutaneous lesions in the last year of the disease determined the patient’s death despite instituting systemic chemotherapy. Patient follow-up and a multidisciplinary approach are essential to diagnose and manage this disease in its early stages. This will prevent the progression to a life-threatening malignancy and the use of immunosuppressive therapy, which can cause serious side effects.
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Ginsburg E, Hennessy K, Mhaskar R, Seminario-Vidal L. Treatment of early-stage mycosis fungoides with oral bexarotene and phototherapy. A systematic review and meta-analysis. Dermatol Ther 2022; 35:e15418. [PMID: 35243730 DOI: 10.1111/dth.15418] [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: 06/03/2021] [Revised: 01/10/2022] [Accepted: 02/24/2022] [Indexed: 11/28/2022]
Abstract
BACKGROUND Mycosis fungoides (MF) is a rare subtype of non-Hodgkin lymphoma, for which no standard treatment exists. OBJECTIVES To provide evidence-based recommendations for adult patients with early-stage MF treated with oral bexarotene and phototherapy. METHODS A systematic review and meta-analysis was conducted utilizing studies identified via Embase, Pubmed, Web of Science, and the Cochrane Library from inception to April 2020 to evaluate the clinical efficacy and adverse events of oral bexarotene and phototherapy. RESULTS Of 645 abstracts retrieved, 17 full-text articles with 143 subjects were included for analysis. There were nine case reports, five retrospective cohort studies, two prospective cohort studies, and one randomized controlled trial. Most subjects were men (24.48%) with stage IB disease (54.4%), and the mean age at presentation was 63. One patient had folliculotropic disease. The retrospective studies' analysis included 67 subjects and indicated that the partial response was 40.36% (95% CI 18.24 to 64.92), complete response was 34.06% (95% CI 10.73 to 62.56), and overall response was 64.48% (95% CI 48.56 to 78.89). Side effects from bexarotene were hypertriglyceridemia (54%), hypothyroidism (50%), and hypercholesterolemia (46%). Similar results were noted in the prospective studies. CONCLUSIONS The literature consists mostly of uncontrolled studies which suggest that combination therapy with oral bexarotene and phototherapy is a therapeutic option. Future randomized control studies with longer follow-up and standardized definitions of treatment responses and dosages are needed to support the development of evidence-based approaches for the treatment of early-stage MF. This article is protected by copyright. All rights reserved.
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Affiliation(s)
| | - Kerry Hennessy
- Department of Dermatology and Cutaneous Surgery, University of South Florida (USF), Tampa, Florida
| | - Rahul Mhaskar
- Departments of Internal Medicine, University of South Florida (USF), Tampa, Florida
| | - Lucia Seminario-Vidal
- Department of Dermatology and Cutaneous Surgery, University of South Florida (USF), Tampa, Florida.,Department of Cutaneous Oncology, H. Lee Moffitt Cancer Center, Tampa, Florida
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13
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Smits K, Quint K, Vermeer M, Daniëls L, Willemze R, Jansen P, Jansen W, Neelis K. Total skin electron beam therapy for cutaneous T-cell lymphomas in the Netherlands: A retrospective analysis of treatment outcomes and selection for high or low dose schedule. Clin Transl Radiat Oncol 2022; 33:77-82. [PMID: 35106383 PMCID: PMC8787769 DOI: 10.1016/j.ctro.2021.12.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2021] [Revised: 12/03/2021] [Accepted: 12/05/2021] [Indexed: 10/25/2022] Open
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14
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Trochopoulos AGX, Zaharieva MM, Marinova MH, Yoncheva K, Tibi IPE, Berger MR, Konstantinov SM. Antineoplastic effect of a novel nanosized curcumin on cutaneous T cell lymphoma. Oncol Lett 2020; 20:304. [PMID: 33093913 PMCID: PMC7573878 DOI: 10.3892/ol.2020.12167] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2020] [Accepted: 08/11/2020] [Indexed: 12/19/2022] Open
Abstract
Cutaneous T cell lymphomas (CTCLs) are a group of heterogeneous, life-threatening, extra-nodal and lymphoproliferative T cell neoplasms. Since chronic inflammation serves a key role in CTCL progression, curcumin, a natural pigment with proven anti-inflammatory and antineoplastic properties, as well as minimal toxicity, may be used as a therapeutic agent. In the present study, two formulations of curcumin (standard ethanolic and a Pluronic®P-123/F-127 micellar solution) were compared regarding their cytotoxic efficacy and speed of internalization in three CTCL cell lines, namely HuT-78, HH and MJ. In addition, the modulating effect of curcumin on selected proteins involved in the proliferation and progression of the disease was determined. The results indicated the superiority of the Pluronic®P-123/F-127 micellar curcumin over the standard ethanol solution in terms of cellular internalization efficiency as determined by spectrophotometric analysis. Notably, the presence of commonly used media components, such as phenol red, may interfere when interpreting the cytotoxicity of curcumin, due to their overlapping absorbance peaks. Therefore, it was concluded that phenol red-free media are superior over media with phenol red in order to correctly measure the cytotoxic efficacy and cell penetration of curcumin. Depending on the cell line, the IC50 values of micellar curcumin varied from 29.76 to 1.24 µΜ, with HH cells demonstrating the highest sensitivity. This cell line had the lowest expression levels of the Wilms' tumor-1 transcription factor. Performing western blot analyses of treated and untreated CTCL cells, selective signal transduction changes were recorded for the first time, thus making curcumin nano-formulation an attractive and prospective option with therapeutic relevance for CTCL as a rare orphan disease.
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Affiliation(s)
- Antonios G X Trochopoulos
- Department of Pharmacology, Pharmacotherapy and Toxicology, Faculty of Pharmacy, Medical University of Sofia, 1000 Sofia, Bulgaria
| | - Maya M Zaharieva
- Department of Infectious Microbiology, Institute of Microbiology 'Stephan Angeloff', Bulgarian Academy of Sciences, 1113 Sofia, Bulgaria
| | - Mirela H Marinova
- Department of Pharmacology, Pharmacotherapy and Toxicology, Faculty of Pharmacy, Medical University of Sofia, 1000 Sofia, Bulgaria
| | - Krasimira Yoncheva
- Department of Pharmaceutical Technology and Biopharmaceutics, Faculty of Pharmacy, Medical University of Sofia, 1000 Sofia, Bulgaria
| | - Ivanka Pencheva-El Tibi
- Department of Pharmaceutical Chemistry, Faculty of Pharmacy, Medical University of Sofia, 1000 Sofia, Bulgaria
| | - Martin R Berger
- Unit of Toxicology and Chemotherapy, German Cancer Research Center, D-69120 Heidelberg, Germany
| | - Spiro M Konstantinov
- Department of Pharmacology, Pharmacotherapy and Toxicology, Faculty of Pharmacy, Medical University of Sofia, 1000 Sofia, Bulgaria
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15
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Gökyayla E, Çetinarslan T, Temiz P, Türel Ermertcan A. Mycosis fungoides mimicking pigmented purpuric dermatosis. Dermatol Ther 2020; 33:e14062. [PMID: 32705758 DOI: 10.1111/dth.14062] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Revised: 07/17/2020] [Accepted: 07/21/2020] [Indexed: 11/30/2022]
Affiliation(s)
- Ece Gökyayla
- Medical Faculty, Department of Dermatology, Manisa Celal Bayar University, Manisa, Turkey
| | - Tubanur Çetinarslan
- Medical Faculty, Department of Dermatology, Manisa Celal Bayar University, Manisa, Turkey
| | - Peyker Temiz
- Medical Faculty, Department of Pathology, Manisa Celal Bayar University, Manisa, Turkey
| | - Aylin Türel Ermertcan
- Medical Faculty, Department of Dermatology, Manisa Celal Bayar University, Manisa, Turkey
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16
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Amorim GM, Quintella DC, Niemeyer-Corbellini JP, Ferreira LC, Ramos-E-Silva M, Cuzzi T. Validation of an algorithm based on clinical, histopathological and immunohistochemical data for the diagnosis of early-stage mycosis fungoides. An Bras Dermatol 2020; 95:326-331. [PMID: 32317132 PMCID: PMC8074686 DOI: 10.1016/j.abd.2020.01.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2019] [Accepted: 01/05/2020] [Indexed: 12/27/2022] Open
Abstract
Background Diagnosis of mycosis fungoides is challenging due to the non-specificity of clinical and histopathological findings. The literature indicates an average delay of 4–6 years for a conclusive diagnosis. Refinement of the histopathological criteria for the diagnosis of patients in early stages of the disease is considered of interest. Objectives To study the histopathological aspects of early-stage mycosis fungoides and the applicability, in a retrospective form, of the diagnostic algorithm proposed by Pimpinelli et al. Methods Observational, retrospective, transversal study based on revision of histopathological exams of patients with suspected mycosis fungoides. Medical records were reviewed, and complementary immunohistochemistry performed. Results Sixty-seven patients were included. The most frequent histopathological features were superficial perivascular lymphoid infiltrate (71.6%), epidermotropism (68.7%), lymphocytic atypia (63.8%), hyperkeratosis (62.7%) and acanthosis (62.7%). Forty-three patients scored 4 points at the algorithm, by clinical and histological evaluation. Immunohistochemistry was performed on 23 of the 24 patients with less than 4 points. Of those 23, 22 scored 1 point, allowing a total of 61 patients (91%) with the diagnosis of early-stage mycosis fungoides. Study limitations Its retrospective character, reduced sample size and incomplete application of the algorithm. Conclusions Application of the Pimpinelli et al. algorithm, even in an incomplete form, increased the percentage of cases diagnosed as mycosis fungoides. Routine application of the algorithm may contribute to earlier and specific management and improvement of the patients’ outcome.
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Affiliation(s)
- Gustavo Moreira Amorim
- Postgraduate Program in Anatomical Pathology, Faculdade de Medicina, Universidade Federal do Rio de Janeiro, Rio de Janeiro, RJ, Brazil.
| | - Daniele Carvalho Quintella
- Department of Pathology, Faculdade de Medicina, Universidade Federal do Rio de Janeiro, Rio de Janeiro, RJ, Brazil
| | | | - Luiz Claudio Ferreira
- Instituto Nacional de Infectologia, Fundação Oswaldo Cruz, Rio de Janeiro, RJ, Brazil
| | - Marcia Ramos-E-Silva
- Discipline of Dermatology, Departamento de Clínica Médica, Faculdade de Medicina, Universidade Federal do Rio de Janeiro, Rio de Janeiro, RJ, Brazil
| | - Tullia Cuzzi
- Postgraduate Program in Anatomical Pathology, Faculdade de Medicina, Universidade Federal do Rio de Janeiro, Rio de Janeiro, RJ, Brazil; Department of Pathology, Faculdade de Medicina, Universidade Federal do Rio de Janeiro, Rio de Janeiro, RJ, Brazil; Instituto Nacional de Infectologia, Fundação Oswaldo Cruz, Rio de Janeiro, RJ, Brazil
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17
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Gunawan H, Utami F, Achdiat PA, Avriyanti E, Hindritiani R, Suwarsa O. A unique case of borderline lepromatous leprosy with psoriasis-like lesions all over the body and mycosis fungoides-like lesions on the face. J Clin Tuberc Other Mycobact Dis 2019; 17:100134. [PMID: 31867445 PMCID: PMC6904841 DOI: 10.1016/j.jctube.2019.100134] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Clinical manifestations of leprosy are various and may resemble other skin diseases. Skin lesions of leprosy mimicking psoriasis and mycosis fungoides (MF) that simultaneously occurs in one patient are rare. We reported a unique case of borderline lepromatous (BL) leprosy with severe reversal reaction manifested as psoriasis-like lesions and MF-like lesions in a 43-year-old-man. Psoriasis-like lesions all over the body accompanied by plaques and tumor-like lesions mimicking MF on the face could be found in this patient. Histopathological examination on an MF-like lesion from the face and psoriasis-like lesions from the posterior trunk and lower extremities revealed granulomatous reaction with epithelioid cells, Langhans giant cells, and foam cells which supported the diagnosis of BL leprosy. The patient was treated with multidrug therapy multibacillary (MDT-MB) regimen and 40 mg prednisone daily which was tapered off. Clinical improvement was observed on the 32nd day of observation as psoriasis-like and MF-like lesions became hyperpigmented macules and plaques, respectively. Due to the rarity of the multitype skin lesions of leprosy in one patient, a diagnosis of leprosy should be suspected by the clinicians in any patients with previously described skin disorders, especially in an endemic area.
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Affiliation(s)
- Hendra Gunawan
- Department of Dermatology and Venereology, Faculty of Medicine, Universitas Padjadjaran-Dr. Hasan Sadikin Hospital, Jl. Pasteur No. 38, Bandung, 40161 Indonesia
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18
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Abstract
Radiation plays an important role in the management of a variety of skin cancers. This article discusses the role of radiation in the treatment of cutaneous squamous cell carcinoma, basal cell carcinoma, Merkel cell carcinoma, cutaneous T-cell lymphoma, and B-cell lymphomas.
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Abstract
OBJECTIVE: Differential diagnosis of mycosis fungoides (MF) in the early stages can be challenging. Dermoscopy has been reported to be useful in the evaluation of early MF. However, to our knowledge, there is no study that specifies these early stages as stage IA, IB or IIA. The present study aims to evaluate the dermoscopic findings of stage IIA MF in comparison with plaque psoriasis (PP). METHODS: Thirty-four patients aged between 16-70 years with stage IIA MF (n=17) and PP (n=17) were evaluated in this prospective study. Dermoscopic examinations were performed by manual dermatoscopy (Dermlite DL4). χ2 test was used. RESULTS: In patients with stage IIA MF, orange-yellow patches (88.2%), short, fine and linear vessels (82.3%), geometric white scales (70.5%), perifollicular white scales (47%) and white patches (35.2%) were common, while dotted vessels (94.1%), diffuse lamellar white scales (88.2%) and dotted and globular vessels (70.5%) were common in patients with PP. Although spermatozoa-like structures, purpuric dots, collarette white scales and Y-shaped arborizing vessels were common in patients with MF, this was not statistically significant. Geometric white scales (clinically; cigarette paper-like wrinkly scales) correlated with alternating parakeratosis and orthokeratosis in the stratum corneum histopathologically. CONCLUSION: A unique aspect of our study is that this study provides insights about the importance of scales in differentiating MF from PP. Orange-yellow and white patches, short, fine and linear vessels, geometric and perifollicular white scales may be useful in distinguishing stage IIA MF from PP by hand-held dermoscopy.
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20
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Ahmad I, Maurya RK, Sushama S, Mahmud AA. NBUVB Phototherapy at the Donor Site Can Enhance the Graft Uptake in the Nonhealing of Ulcers of Mycosis Fungoides: A Case Report. J Cutan Aesthet Surg 2019; 12:128-131. [PMID: 31413482 PMCID: PMC6676812 DOI: 10.4103/jcas.jcas_77_18] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Mycosis fungoides is a rare form of non-Hodgkin’s lymphoma, which is formed of mature, skin homing, clonal, malignant T lymphocytes. It can sometimes present with skin ulcers that are difficult to heal because of the presence of large number T lymphocytes and antigen-presenting cells. We present a case of nonhealing ulcers in a patient with mycosis fungoides, which was treated by narrow band ultraviolet B targeted phototherapy followed by split-thickness skin grafting. The graft uptake was well and the donor area also healed without any complications.
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Affiliation(s)
- Imran Ahmad
- Department of Plastic and Reconstructive Surgery, Jawaharlal Nehru Medical College and Hospital, Aligarh, Uttar Pradesh, India
| | - Rajesh K Maurya
- Department of Plastic and Reconstructive Surgery, Jawaharlal Nehru Medical College and Hospital, Aligarh, Uttar Pradesh, India
| | - Sushama Sushama
- Department of Dermatology, Kailash Hospital, Khurja, Uttar Pradesh, India
| | - Ali A Mahmud
- Department of Plastic and Reconstructive Surgery, Jawaharlal Nehru Medical College and Hospital, Aligarh, Uttar Pradesh, India
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21
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Aldana PC, Shaikh G, Driscoll MS. Diffuse Poikilodermatous Patches in a Middle-aged Man. JAMA Dermatol 2019; 155:958-959. [DOI: 10.1001/jamadermatol.2019.1525] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
| | - Gibran Shaikh
- Department of Dermatology, University of Maryland School of Medicine, Baltimore
| | - Marcia S. Driscoll
- Department of Dermatology, University of Maryland School of Medicine, Baltimore
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22
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Shamim H, Johnson EF, Gibson LE, Comfere N. Mycosis fungoides with spongiosis: A potential diagnostic pitfall. J Cutan Pathol 2019; 46:645-652. [DOI: 10.1111/cup.13477] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2018] [Revised: 04/04/2019] [Accepted: 04/09/2019] [Indexed: 12/17/2022]
Affiliation(s)
- Huma Shamim
- Department of DermatologyMayo Clinic Rochester Rochester Minnesota
| | - Emma F. Johnson
- Department of DermatologyMayo Clinic Rochester Rochester Minnesota
| | - Lawrence E. Gibson
- Department of DermatologyMayo Clinic Rochester Rochester Minnesota
- Department of Laboratory Medicine and PathologyMayo Clinic Rochester Rochester Minnesota
| | - Nneka Comfere
- Department of DermatologyMayo Clinic Rochester Rochester Minnesota
- Department of Laboratory Medicine and PathologyMayo Clinic Rochester Rochester Minnesota
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23
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Ito A, Sugita K, Ikeda A, Yamamoto O. CD4/CD8 Double-negative Mycosis Fungoides: A Case Report and Literature Review. Yonago Acta Med 2019. [PMID: 30962758 DOI: 10.33160/yam.2019.03.021] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Mycosis fungoides, the most common subtype of cutaneous T-cell lymphoma, displays a broad spectrum of clinical, histological and phenotypic variants with different prognostic impacts. The classic immunophenotype is CD3+/CD4+/CD45RO+memory T cells. CD4/CD8 double-negative mycosis fungoides is rare. Here we describe the clinicopathological features of CD4/CD8 double-negative mycosis fungoides in a 55-year-old female with a review of the literature. Although the CD4/CD8 double-negative phenotype appears to be associated with an unusual clinical presentation, it does not appear to confer prognostic significance.
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Affiliation(s)
- Ayako Ito
- Division of Dermatology, Department of Medicine of Sensory and Motor Organs, School of Medicine, Tottori University Faculty of Medicine, Yonago 683-8503, Japan
| | - Kazunari Sugita
- Division of Dermatology, Department of Medicine of Sensory and Motor Organs, School of Medicine, Tottori University Faculty of Medicine, Yonago 683-8503, Japan
| | - Ayano Ikeda
- Division of Dermatology, Department of Medicine of Sensory and Motor Organs, School of Medicine, Tottori University Faculty of Medicine, Yonago 683-8503, Japan
| | - Osamu Yamamoto
- Division of Dermatology, Department of Medicine of Sensory and Motor Organs, School of Medicine, Tottori University Faculty of Medicine, Yonago 683-8503, Japan
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24
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SnapshotDx Quiz: February 2019. J Invest Dermatol 2019. [DOI: 10.1016/j.jid.2018.12.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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25
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Horna P, Moscinski LC, Sokol L, Shao H. Naïve/memory T-cell phenotypes in leukemic cutaneous T-cell lymphoma: Putative cell of origin overlaps disease classification. CYTOMETRY PART B-CLINICAL CYTOMETRY 2018; 96:234-241. [PMID: 30328260 DOI: 10.1002/cyto.b.21738] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/23/2018] [Revised: 08/29/2018] [Accepted: 09/06/2018] [Indexed: 01/18/2023]
Abstract
BACKGROUND Mycosis fungoides (MF) and Sézary Syndrome (SS) are clinically distinct cutaneous T-cell lymphomas with strikingly similar morphologic and phenotypic features. Prior studies have suggested phenotypic differences based on markers of antigen experience, suggesting a different cell of origin. METHODS Seventy-nine involved peripheral blood or bone marrow samples from 33 patients with SS and 19 patients with MF were studied by 10-color flow cytometry, including CD62L, CD45RA, CCR4, and PD-1. Gated tumor events were classified as naïve (TN ), central memory (TCM ), effector memory (TEM ), or effector memory with reacquired CD45RA (TEMRA ); based on CD62L+ /CD45RA+ , CD62L+ /CD45RA- , CD62L- /CD45RA- , or CD62L- /CD45RA+ phenotype, respectively. Sequential specimens were compared to assess for phenotypic stability. RESULTS The naïve/memory phenotype of the neoplastic T-cells was markedly heterogeneous, with a dominant TN , TCM , TEM , or TEMRA subset on 11 (14%), 32 (41%), 30 (38%), and 6 (8%) cases, respectively. There was no correlation between the diagnosis of MF or SS and putative cell of origin (P = 0.4). Overexpression of CCR4 and PD1 was observed in most cases, with higher intensity in SS compared to MF. The naïve/memory phenotype remained the same for 10 patients up to 273 days after the initial analysis; while on six patients, the naïve/memory phenotype was different from the original phenotype. CONCLUSIONS Both SS and MF can have phenotypic features of any of the major naïve/memory T-cell subsets, which questions the current principle of "cell-of-origin" distinction between SS and MF. Phenotypic shifts within these subsets are common, suggesting a functional state rather than a cell-of-origin surrogate. © 2018 International Clinical Cytometry Society.
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Affiliation(s)
- Pedro Horna
- Division of Hematopathology, Mayo Clinic, Rochester, Minnesota
| | - Lynn C Moscinski
- Department of Hematopathology and Laboratory Medicine, H. Lee Moffitt Cancer Center, Tampa, Florida
| | - Lubomir Sokol
- Department of Malignant Hematology, H. Lee Moffitt Cancer Center, Tampa, Florida
| | - Haipeng Shao
- Department of Hematopathology and Laboratory Medicine, H. Lee Moffitt Cancer Center, Tampa, Florida
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26
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Amorim GM, Corbellini JPN, Quintella DC, Cuzzi T, Ramos-e-Silva M. Evaluation of the Cutaneous Lymphoma International Prognostic Index in patients with early stage mycosis fungoides. An Bras Dermatol 2018; 93:680-685. [PMID: 30156617 PMCID: PMC6106654 DOI: 10.1590/abd1806-4841.20187134] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2017] [Accepted: 06/23/2017] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND Mycosis fungoides (MF) is the most common subtype of cutaneous T-cell lymphoma. TNMB system is the staging method used in MF, and it not only guides therapeutic management, but represents the main prognostic factor. In order to improve the prognostic evaluation, the Cutaneous Lymphoma International Prognostic Index (CLIPi) was proposed. OBJECTIVE To evaluate the performance of CLIPi score for prognostic analysis in patients with early stage MF. METHODS This is a retrospective cross-sectional observational study, with exploratory analysis. The outcome variables were disease progression and related death. RESULTS One hundred and two patients were stratified according to CLIPi score, being the majority classified as low risk. Patients with intermediate or high risk presented disease progression more frequently than those with low risk (PR: 1.2 / p = 0.004 / 95%CI: 1.0 - 1.6). The same did not occur with the variable related death. In addition, survival rates were not consistent with risk stratification. STUDY LIMITATIONS Small sample and its retrospective analysis. CONCLUSIONS Since CLIPi score was proposed, four other studies that we could consult showed conflicting results, similar to the present study. Further studies are necessary for a recommendation of its use.
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Affiliation(s)
- Gustavo Moreira Amorim
- Program of Post-graduation in Anatomical Pathology, Hospital
Universitário Clementino Fraga Filho, Faculdade de Medicina, Universidade
Federal do Rio de Janeiro, Rio de Janeiro (RJ), Brazil
- Outpatient clinic of Dermatology, Faculdade de Medicina,
Universidade do Sul de Santa Catarina, Palhoça (SC), Brazil
| | - João Paulo Niemeyer Corbellini
- Dermatology Division, Hospital Universitário Clementino Fraga
Filho, Universidade Federal do Rio de Janeiro, Rio de Janeiro (RJ), Brazil
| | - Danielle Carvalho Quintella
- Pathology Division, Hospital Federal de Bonsucesso, Rio de Janeiro
(RJ), Brazil
- Department of Pathology, Universidade Federal do Rio de Janeiro, Rio
de Janeiro (RJ), Brazil
| | - Tullia Cuzzi
- Department of Pathology, Universidade Federal do Rio de Janeiro, Rio
de Janeiro (RJ), Brazil
- Instituto Nacional de Infectologia Evandro Chagas,
Fundação Oswaldo Cruz, Rio de Janeiro (RJ), Brazil
| | - Márcia Ramos-e-Silva
- Dermatology Division, Hospital Universitário Clementino Fraga
Filho, Universidade Federal do Rio de Janeiro, Rio de Janeiro (RJ), Brazil
- Discipline of Dermatology, Faculdade de Medicina, Universidade
Federal do Rio de Janeiro, Rio de Janeiro (RJ), Brazil
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27
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Amorim GM, Niemeyer-Corbellini JP, Quintella DC, Cuzzi T, Ramos-e-Silva M. Clinical and epidemiological profile of patients with early stage mycosis fungoides. An Bras Dermatol 2018; 93:546-552. [PMID: 30066762 PMCID: PMC6063099 DOI: 10.1590/abd1806-4841.20187106] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2017] [Accepted: 06/23/2017] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Mycosis fungoides is the most common form of primary cutaneous lymphoma, with an indolent, slowly progressive course and 88% five-year survival rate. The diagnosis is challenging, especially in the early stages, and usually relies on a good clinical-histopathological correlation. OBJECTIVE The aim was to establish the clinical and epidemiological profile of patients with early-stage mycosis fungoides. METHODS This was a retrospective cross-sectional observational study with an exploratory analysis. Outcome variables were disease progression and mycosis fungoides-related death. RESULTS One hundred and two patients were included. The majority were white males, with a mean age of 55.6 years. Mean time from onset of lesions to diagnosis was 51.08 months. The majority of patients were classified as IB stage according to TNMB. Mean follow-up time was 7.85 years. Disease progression was seen in 29.4% of the patients. Death related to the disease occurred in 7.9% of patients. Plaque lesions, involvement of more than 10% of the body surface, altered lactate dehydrogenase and beta-2-microglobulin, and stage IB were significantly associated with disease progression, and altered lactate dehydrogenase and beta-2-microglobulin also correlated with higher frequency of deaths. STUDY LIMITATIONS Small sample and retrospective design. CONCLUSIONS The clinical and epidemiological profile of patients with early-stage mycosis fungoides in our sample corroborates reports in the literature. Diagnostic delay in our series is also consistent with previous findings, but the rate of disease progression, despite treatment, was higher than reported in the literature.
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Affiliation(s)
- Gustavo Moreira Amorim
- Master’s student, Postgraduate Program in Anatomical Pathology,
Faculdade de Medicina, Universidade Federal do Rio de Janeiro, Hospital
Universitário Clementino Fraga Filho, Rio de Janeiro (RJ), Brazil
- Dermatology Outpatient Clinic, Faculdade de Medicina, Universidade
do Sul de Santa Catarina, Palhoça (SC), Brazil
| | - João Paulo Niemeyer-Corbellini
- Dermatology Service, Hospital Universitário Clementino Fraga
Filho, Universidade Federal do Rio de Janeiro, Rio de Janeiro (RJ), Brazil
| | - Danielle Carvalho Quintella
- Pathology Service, Hospital Federal de Bonsucesso, Rio de Janeiro
(RJ), Brazil
- Department of Pathology, Universidade Federal do Rio de Janeiro,
Rio de Janeiro (RJ), Brazil
| | - Tullia Cuzzi
- Department of Pathology, Universidade Federal do Rio de Janeiro,
Rio de Janeiro (RJ), Brazil
- Instituto Nacional de Infectologia Evandro Chagas -
Fundação Oswaldo Cruz, Rio de Janeiro (RJ), Brazil
| | - Márcia Ramos-e-Silva
- Dermatology Service, Hospital Universitário Clementino Fraga
Filho, Universidade Federal do Rio de Janeiro, Rio de Janeiro (RJ), Brazil
- Discipline of Dermatology, Faculdade de Medicina da Universidade
Federal do Rio de Janeiro, Rio de Janeiro (RJ), Brazil
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Amorim GM, Niemeyer-Corbellini JP, Quintella DC, Cuzzi T, Ramos-e-Silva M. Hypopigmented mycosis fungoides: a 20-case retrospective series. Int J Dermatol 2018; 57:306-312. [DOI: 10.1111/ijd.13855] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2017] [Revised: 11/02/2017] [Accepted: 11/10/2017] [Indexed: 12/20/2022]
Affiliation(s)
- Gustavo M. Amorim
- Sector of Dermatology and Post Graduation Program in Medical Clinics; HUCFF-UFRJ and School of Medicine; Federal University of Rio de Janeiro; Rio de Janeiro Brazil
| | - Joao P. Niemeyer-Corbellini
- Sector of Dermatology and Post-Graduation Course in Dermatology; University Hospital and School of Medicine; Federal University of Rio de Janeiro; Rio de Janeiro Brazil
| | - Danielle C. Quintella
- Department of Pathology; University Hospital and School of Medicine; Federal University of Rio de Janeiro; Rio de Janeiro Brazil
| | - Tullia Cuzzi
- Department of Pathology; University Hospital and School of Medicine; Federal University of Rio de Janeiro; Rio de Janeiro Brazil
| | - Marcia Ramos-e-Silva
- Sector of Dermatology; Post-Graduation Course in Dermatology and Post Graduation Program in Medical Clinics; University Hospital and School of Medicine; Federal University of Rio de Janeiro; Rio de Janeiro Brazil
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TOX as a diagnostic and prognostic marker for mycosis fungoides. JOURNAL OF THE EGYPTIAN WOMENʼS DERMATOLOGIC SOCIETY 2018. [DOI: 10.1097/01.ewx.0000525982.47129.30] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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30
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Diminished microRNA-29b level is associated with BRD4-mediated activation of oncogenes in cutaneous T-cell lymphoma. Blood 2017; 131:771-781. [PMID: 29180399 DOI: 10.1182/blood-2017-09-805663] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2017] [Accepted: 11/15/2017] [Indexed: 02/07/2023] Open
Abstract
MicroRNA (miRNA) dysregulation is a hallmark of cutaneous T-cell lymphoma (CTCL), an often-fatal malignancy of skin-homing CD4+ T cells for which there are few effective therapies. The role of microRNAs (miRs) in controlling epigenetic modifier-dependent transcriptional regulation in CTCL is unknown. In this study, we characterize a novel miR dysregulation that contributes to overexpression of the epigenetic reader bromodomain-containing protein 4 (BRD4). We used patient CD4+ T cells to show diminished levels of miR-29b compared with healthy donor cells. Patient cells and miR-29b-/- mouse cells revealed an inverse relationship between miR-29b and BRD4, the latter of which is overexpressed in these cells. Chromatin immunoprecipitation and sequencing analysis revealed increased genome-wide BRD4 occupancy at promoter and enhancer regions in CD4+ T cells from CTCL patients. The cumulative result of BRD4 binding was increased expression of tumor-associated genes such as NOTCH1 and RBPJ, as well as the interleukin-15 (IL-15) receptor complex, the latter enhancing IL-15 autocrine signaling. Furthermore, we confirm the in vivo relevance of this pathway in our IL-15 transgenic mouse model of CTCL by showing that interference with BRD4-mediated pathogenesis, either by restoring miR-29b levels via bortezomib treatment or by directly inhibiting BRD4 binding via JQ1 treatment, prevents progression of CTCL. We describe a novel oncogenic pathway featuring IL-15, miR-29b, and BRD4 in CTCL and suggest targeting of these components as a potentially effective therapy for CTCL patients.
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31
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Zhou H, Luo ZD, Tang XH, Han JD, Gao Q. Folliculotropic mycosis fungoides associated with atopic dermatitis. Australas J Dermatol 2017; 59:e143-e145. [PMID: 28731507 DOI: 10.1111/ajd.12607] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Hui Zhou
- Department of Dermatology, First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Zhuo-di Luo
- Department of Dermatology, First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Xu-Hua Tang
- Department of Dermatology, First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Jian-de Han
- Department of Dermatology, First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Qian Gao
- Department of Dermatology, First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
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Lynoora ER. SEZARY SYNDROME MIMICKING GENERALIZED PSORIASIS VULGARIS. INDONESIAN JOURNAL OF TROPICAL AND INFECTIOUS DISEASE 2017. [DOI: 10.20473/ijtid.v6i3.3134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Background: Sezary syndrome is the one type of cutaneous T cell. This disease is characterized by reddish patches or plaques on the skin which extends to whole body into erythroderma, lymphadenopathy and presence of atypical lymphocytes called Sezary cells.Purpose: To know clinical manifestation, examination and management of Sezary syndrome which clinically resembles generalized psoriasis.Case: A man 60 years old came with scaly plaques reddish brown on almost of his body accompanied by lymphadenopathy on the supraclavicular lymph node right and left and accompanied by intense itchy also. Another clinical features were alopecia, palmoplantar hyperkeratosis, onychodysthropy, facies leonine without anesthesia on the lesion and without enlargement of peripheral nerve. From laboratory test, there is an increasing in the number of leukocytes, from the peripheral blood smear examination found Sezary cells and histopathology showed focal athrophy and acanthosis of the epidermis and dense infiltration of lymphocytes in the dermo-epidermal junction and superficial dermis. Case management: Patient received methotrexate (MTX) 3 x 5 mg (1 cylcle) with mometasone furoate 0,1% cream and CTM 3x1 tablet for adjunctive therapy. Methotrexte was discontinued because there are increasing of liver function and deterioration of patient’s condition. After 25 days of treatment, the patient got sepsis and then the patient died. Conclusion: Early onset of Sezary syndrome in this case is difficult to know because the clinical manifestation is similar with psoriasis vulgaris. Supporting examination such as laboratory test, blood smears and histopathology examination could help diagnosis. The presence of lymphadenopathy, atypical lymphocytes in the peripheral blood and extensive skin involvement reflecting the poor prognosis. The most common cause of death was sepsis.
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Vargas TJDS, Jorge SB, Gonzaga YBDM. CD30-positive cutaneous lymphoma: report of four cases with an emphasis on clinicopathological correlations. An Bras Dermatol 2017; 92:86-91. [PMID: 28225962 PMCID: PMC5312184 DOI: 10.1590/abd1806-4841.20174807] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2015] [Accepted: 10/13/2015] [Indexed: 12/18/2022] Open
Abstract
The classification of cutaneous lymphomas is multidisciplinary and requires the
correlation between clinical, histopathological, immunohistochemical, and
molecular diagnostic elements. In this article, we present four different cases
of CD30-positive T-cell lymphoma with cutaneous manifestations. We compare cases
with definitive diagnosis of papulosis lymphomatoid type C, primary cutaneous
anaplastic large T-cell lymphoma, systemic anaplastic large T-cell lymphoma with
secondary skin involvement, and mycosis fungoides with large cell
transformation, highlighting the importance of clinicopathological correlation
to classify these cases.
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Affiliation(s)
| | | | - Yung Bruno de Mello Gonzaga
- Hospital Federal de Bonsucesso - Bonsucesso (RJ), Brazil.,Instituto Nacional de Câncer (INCA) - Rio de Janeiro (RJ), Brazil
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Charli-Joseph YV, Gatica-Torres M, Pincus LB. Approach to Cutaneous Lymphoid Infiltrates: When to Consider Lymphoma? Indian J Dermatol 2016; 61:351-74. [PMID: 27512181 PMCID: PMC4966394 DOI: 10.4103/0019-5154.185698] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Cutaneous lymphoid infiltrates (CLIs) are common in routine dermatopathology. However, differentiating a reactive CLI from a malignant lymphocytic infiltrate is often a significant challenge since many inflammatory dermatoses can clinically and/or histopathologically mimic cutaneous lymphomas, coined pseudolymphomas. We conducted a literature review from 1966 to July 1, 2015, at PubMed.gov using the search terms: Cutaneous lymphoma, cutaneous pseudolymphoma, cutaneous lymphoid hyperplasia, simulants/mimics/imitators of cutaneous lymphomas, and cutaneous lymphoid infiltrates. The diagnostic approach to CLIs and the most common differential imitators of lymphoma is discussed herein based on six predominant morphologic and immunophenotypic, histopathologic patterns: (1) Superficial dermal T-cell infiltrates (2) superficial and deep dermal perivascular and/or nodular natural killer/T-cell infiltrates (3) pan-dermal diffuse T-cell infiltrates (4) panniculitic T-cell infiltrates (5) small cell predominant B-cell infiltrates, and (6) large-cell predominant B-cell infiltrates. Since no single histopathological feature is sufficient to discern between a benign and a malignant CLI, the overall balance of clinical, histopathological, immunophenotypic, and molecular features should be considered carefully to establish a diagnosis. Despite advances in ancillary studies such as immunohistochemistry and molecular clonality, these studies often display specificity and sensitivity limitations. Therefore, proper clinicopathological correlation still remains the gold standard for the precise diagnosis of CLIs.
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Affiliation(s)
- Yann Vincent Charli-Joseph
- Cutaneous Hematopathology Clinic, Department of Dermatology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Michelle Gatica-Torres
- Cutaneous Hematopathology Clinic, Department of Dermatology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Laura Beth Pincus
- Department of Dermatology and Pathology, University of California, San Francisco, United States of America
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Sibbald C, Pope E. Systematic review of cases of cutaneous T-cell lymphoma transformation in pityriasis lichenoides and small plaque parapsoriasis. Br J Dermatol 2016; 175:807-9. [DOI: 10.1111/bjd.14605] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- C. Sibbald
- Department of Dermatology; University of Toronto; Toronto ON Canada
| | - E. Pope
- Department of Dermatology; University of Toronto; Toronto ON Canada
- Division of Dermatology; The Hospital for Sick Children; Toronto ON Canada
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Affiliation(s)
- Judy K Qiang
- Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Joseph E Marinas
- Michael G. DeGroote School of Medicine, McMaster University, Toronto, Ontario, Canada
| | - Dusan Sajic
- Division of Dermatology, University of Toronto, Toronto, Ontario, Canada
| | - Jensen Yeung
- Division of Dermatology, University of Toronto, Toronto, Ontario, Canada
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38
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Mycosis fungoides: therapeutic difficulties. Postepy Dermatol Alergol 2016; 32:404-8. [PMID: 26759552 PMCID: PMC4692811 DOI: 10.5114/pdia.2014.44005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2013] [Accepted: 01/19/2014] [Indexed: 11/17/2022] Open
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39
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Adriano AR, Lima TS, Battistella M, Bagot M. Granulomatous slack skin T-cell lymphoma: an important differential diagnosis with giant cell tumor of soft tissue. An Bras Dermatol 2016; 90:892-5. [PMID: 26734874 PMCID: PMC4689081 DOI: 10.1590/abd1806-4841.20153807] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2014] [Accepted: 10/02/2014] [Indexed: 11/21/2022] Open
Abstract
Granulomatous slack skin is an indolent T-cell lymphoma, considered to be a variant of mycosis fungoides. Clinically it is characterized by areas of redundant skin, wrinkled, inelastic, with variable erythema and infiltration besides a poikilodermic surface. A differential diagnosis unknown to most dermatologists is the giant cell tumor of soft tissue, which is an extremely rare low-grade sarcoma. The authors report a patient who had undergone extensive surgery because of a primary diagnosis of giant cell tumor of soft tissue, but which proved to be granulomatous slack skin after a second interventional procedure with confirmatory histopathology.
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Affiliation(s)
| | - Tiago Silveira Lima
- Instituto de Dermatologia Professor Rubem David Azulay, Rio de Janeiro, RJ, Brazil
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Lim EH, Lim SK, Im M, Seo YJ, Lee JH, Lee Y. Mycosis Fungoides Diagnosed with an Initial Sign Resembling Benign Dermatosis on the Upper Eyelids. Ann Dermatol 2015; 27:469-71. [PMID: 26273174 PMCID: PMC4530168 DOI: 10.5021/ad.2015.27.4.469] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2014] [Revised: 09/04/2014] [Accepted: 09/11/2014] [Indexed: 12/24/2022] Open
Affiliation(s)
- Eun-Hwa Lim
- Department of Dermatology, Chungnam National University School of Medicine, Daejeon, Korea
| | - Seul-Ki Lim
- Department of Dermatology, Chungnam National University School of Medicine, Daejeon, Korea
| | - Myung Im
- Department of Dermatology, Chungnam National University School of Medicine, Daejeon, Korea
| | - Young-Joon Seo
- Department of Dermatology, Chungnam National University School of Medicine, Daejeon, Korea
| | - Jeung-Hoon Lee
- Department of Dermatology, Chungnam National University School of Medicine, Daejeon, Korea
| | - Young Lee
- Department of Dermatology, Chungnam National University School of Medicine, Daejeon, Korea
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41
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Cutaneous T-cell lymphoma with nasal necrosis. Arch Plast Surg 2015; 42:259-61. [PMID: 25798408 PMCID: PMC4366718 DOI: 10.5999/aps.2015.42.2.259] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2014] [Revised: 09/29/2014] [Accepted: 10/07/2014] [Indexed: 12/02/2022] Open
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42
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Hoogedoorn L, Peppelman M, van de Kerkhof P, van Erp P, Gerritsen M. The value ofin vivoreflectance confocal microscopy in the diagnosis and monitoring of inflammatory and infectious skin diseases: a systematic review. Br J Dermatol 2015; 172:1222-48. [DOI: 10.1111/bjd.13499] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/14/2014] [Indexed: 11/27/2022]
Affiliation(s)
- L. Hoogedoorn
- Department of Dermatology; Radboud University Medical Center; PO Box 9101 NL 6500 HB Nijmegen the Netherlands
| | - M. Peppelman
- Department of Dermatology; Radboud University Medical Center; PO Box 9101 NL 6500 HB Nijmegen the Netherlands
| | - P.C.M. van de Kerkhof
- Department of Dermatology; Radboud University Medical Center; PO Box 9101 NL 6500 HB Nijmegen the Netherlands
| | - P.E.J. van Erp
- Department of Dermatology; Radboud University Medical Center; PO Box 9101 NL 6500 HB Nijmegen the Netherlands
| | - M.J.P. Gerritsen
- Department of Dermatology; Radboud University Medical Center; PO Box 9101 NL 6500 HB Nijmegen the Netherlands
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Inkeles MS, Scumpia PO, Swindell WR, Lopez D, Teles RMB, Graeber TG, Meller S, Homey B, Elder JT, Gilliet M, Modlin RL, Pellegrini M. Comparison of molecular signatures from multiple skin diseases identifies mechanisms of immunopathogenesis. J Invest Dermatol 2014; 135:151-159. [PMID: 25111617 PMCID: PMC4268388 DOI: 10.1038/jid.2014.352] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2014] [Revised: 06/22/2014] [Accepted: 07/15/2014] [Indexed: 01/06/2023]
Abstract
The ability to obtain gene expression profiles from human disease specimens provides an opportunity to identify relevant gene pathways, but is limited by the absence of data sets spanning a broad range of conditions. Here, we analyzed publicly available microarray data from 16 diverse skin conditions in order to gain insight into disease pathogenesis. Unsupervised hierarchical clustering separated samples by disease and common cellular and molecular pathways. Disease specific signatures were leveraged to build a multi-disease classifier which predicted the diagnosis of publicly and prospectively collected expression profiles with 93% accuracy. In one sample, the molecular classifier differed from the initial clinical diagnosis and correctly predicted the eventual diagnosis as the clinical presentation evolved. Finally, integration of interferon (IFN) regulated gene programs with the skin database revealed a significant inverse correlation between IFN–β and IFN–γ programs across all conditions. Our study provides an integrative approach to the study of gene signatures from multiple skin conditions, elucidating mechanisms of disease pathogenesis. Additionally, these studies provide a framework for developing tools for personalized medicine towards the precise prediction, prevention, and treatment of disease on an individual level.
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Affiliation(s)
- Megan S Inkeles
- Department of Molecular, Cell, and Developmental Biology, University of California, Los Angeles, Los Angeles, California, USA
| | - Philip O Scumpia
- Division of Dermatology, University of California, Los Angeles, Los Angeles, California, USA
| | - William R Swindell
- Department of Dermatology, University of Michigan School of Medicine, Ann Arbor, Michigan, USA
| | - David Lopez
- Department of Molecular, Cell, and Developmental Biology, University of California, Los Angeles, Los Angeles, California, USA
| | - Rosane M B Teles
- Division of Dermatology, University of California, Los Angeles, Los Angeles, California, USA
| | - Thomas G Graeber
- Crump Institute for Molecular Imaging, Institute for Molecular Medicine, Johnson Comprehensive Cancer Center, California NanoSystems Institute, Department of Molecular and Medical Pharmacology, University of California, Los Angeles, Los Angeles, California, USA
| | - Stephan Meller
- Department of Dermatology, University Hospital Duesseldorf, Duesseldorf, Germany
| | - Bernhard Homey
- Department of Dermatology, University Hospital Duesseldorf, Duesseldorf, Germany
| | - James T Elder
- Department of Dermatology, University of Michigan School of Medicine, Ann Arbor, Michigan, USA; Ann Arbor VA Hospital, Ann Arbor, Michigan, USA
| | - Michel Gilliet
- Department of Dermatology, University Hospital Lausanne, Lausanne, Switzerland
| | - Robert L Modlin
- Division of Dermatology, University of California, Los Angeles, Los Angeles, California, USA; Department of Microbiology, Immunology and Molecular Genetics, University of California, Los Angeles, Los Angeles, California, USA.
| | - Matteo Pellegrini
- Department of Molecular, Cell, and Developmental Biology, University of California, Los Angeles, Los Angeles, California, USA.
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Atalla A, Hallack Neto AE, Siqueira DB, Toledo GC. Allogeneic hematopoietic stem cell transplantation in mycosis fungoides. An Bras Dermatol 2013; 88:216-9. [PMID: 24346924 PMCID: PMC3875963 DOI: 10.1590/abd1806-4841.20132365] [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: 12/13/2012] [Accepted: 01/06/2013] [Indexed: 11/21/2022] Open
Abstract
Mycosis Fungoides is typically an indolent disease in early stages. However, approximately 30% of patients have advanced staged disease at presentation and 20% will develop it at some time. These patients have a poorer prognosis with a median survival of 2-4 years. The only curative option for mycosis fungoides may be hematopoietic allogeneic stem cell transplantation. We report the case of a patient with mycosis fungoides in an advanced stage (IIB), refractory to treatment options. She underwent allogeneic hematopoietic stem-cell transplantation (allo-HSCT). The patient remains in complete remission nineteen months after allo-HSCT. Allogeneic transplantation can alter the natural history of mycosis fungoides and should be considered in patients who have refractory disease or short-lived responses with standard therapies.
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45
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Furlan FC, Sanches JA. Hypopigmented mycosis fungoides: a review of its clinical features and pathophysiology. An Bras Dermatol 2013; 88:954-60. [PMID: 24474105 PMCID: PMC3900347 DOI: 10.1590/abd1806-4841.20132336] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2012] [Accepted: 01/14/2013] [Indexed: 12/31/2022] Open
Abstract
Several distinct clinical forms of mycosis fungoides have been described. Hypopigmented mycosis fungoides should be regarded as a subtype of mycosis fungoides, insofar as it presents some peculiar characteristics that contrast with the clinical features of the classical form. Most patients with hypopigmented mycosis fungoides are younger than patients typically diagnosed with classical mycosis fungoides. In addition to typical dark-skinned individuals impairment, hypopigmented mycosis fungoides has also been described in Asian patients. The prognosis for hypopigmented mycosis fungoides is much better than for classical mycosis fungoides: hypopigmented mycosis fungoides is diagnosed when there are only patches of affected skin, and lesions usually will not progress beyond terminal stages, although they can persist for many years. Diagnosis should involve clinicopathologic correlation: skin biopsy analysis often reveals intense epidermotropism, characterized by haloed, large, and atypical CD8+ lymphocytes with convoluted nuclei, in contrast to mild to moderate dermal lymphocytic infiltrate. These CD8+ cells, which participate in T helper 1-mediated immune responses, prevent evolution to mycosis fungoides plaques and tumors and could be considered the main cause of the inhibition of melanogenesis. Therefore, hypopigmentation could be considered a marker of good prognosis for mycosis fungoides.
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Affiliation(s)
- Fabricio Cecanho Furlan
- MD, PhD, Department of Dermatology, University of São Paulo Medical
School (FMUSP)- São Paulo (SP), Brazil
| | - José Antonio Sanches
- MD, PhD, Full Professor, Department of Dermatology, University of São
Paulo Medical School (FMUSP)- São Paulo (SP), Brazil
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