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Alexander-Savino C, Boye-Doe A, Bowers E, Beaven A. Oral Mycosis Fungoides: Report of 2 Cases and Review of the Literature. Case Rep Dermatol 2023; 15:1. [PMID: 37497305 PMCID: PMC10368101 DOI: 10.1159/000530935] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2022] [Accepted: 04/20/2023] [Indexed: 07/28/2023] Open
Abstract
Oral and laryngeal cutaneous T-cell lymphoma (CTCL) is rare and usually associated with poor prognosis. Here, we discuss 2 cases of oral CTCL that developed in heavily pretreated patients and provide a review of the literature. The first case is of a 46-year-old African American male with rapidly progressive disease, presenting with a lesion on his hard palate 6 months after being diagnosed with a CD4+CD8+ CTCL. His cutaneous disease was widespread with tumors on >80% of his body surface area. Unfortunately, the patient died 2 ½ years after his CTCL diagnosis and 7 months after developing the oral CTCL lesion. The second case is of a 38-year-old African American male with stage IIb CD3+CD4+CD30+ mycosis fungoides (MF), who developed a tumor on the hard palate 6 months after diagnosis. He received palliative radiation to the oral lesion and multiple lines of systemic therapy for pulmonary, laryngeal, esophageal, and gastric involvement. Biopsy of the gastric lesions showed a CD30+ T-cell lymphoma with the same clonal peak as in his skin but with large cell transformation. Brentuximab vendoin was started, and the patient is now in complete remission, 30 months later. From the 76 cases of oral CTCL that have been reported in the English language, six were of transformed MF. The most common sites affected were the tongue and palate, and the most common presentation were erythematous or ulcerated tumors, plaques, or nodules associated with dysphagia and pain. Oral CTCL typically occurs years after the initial diagnosis of CTCL and portend a poor prognosis with an average survival of just over 1 year after development of oral lesions.
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Affiliation(s)
- Carolina Alexander-Savino
- Department of Dermatology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- Norton College of Medicine, SUNY Upstate Medical University, Syracuse, NY, USA
| | - Alexandra Boye-Doe
- Division of Hematology, Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Edith Bowers
- Department of Dermatology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Anne Beaven
- Division of Hematology, Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
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Rosebush MS, Allen CM, Accurso BT, Baiocchi RA, Cordell KG. Oral Mycosis Fungoides: A Report of Three Cases and Review of the Literature. Head Neck Pathol 2018; 13:492-499. [PMID: 29700722 PMCID: PMC6684724 DOI: 10.1007/s12105-018-0923-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2018] [Accepted: 04/20/2018] [Indexed: 10/17/2022]
Abstract
Mycosis fungoides (MF) and Sézary syndrome are clonal T-cell proliferations that exhibit skin homing and represent the majority of cutaneous T-cell lymphomas. Early MF is a diagnostic challenge as both the clinical and microscopic features often mimic benign inflammatory conditions. Oral MF is very rare and has been associated in the past with advanced disease and a poor prognosis. Skin lesions are present for an average of > 6 years before oral involvement occurs. The clinical appearance is highly variable with tongue, palate and gingiva most often affected. We report 3 additional cases of oral MF, including one in which oral lesions are the initial disease presentation. Survival in patients presenting with oral MF is improving and can be attributed to advances in therapy.
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Affiliation(s)
- Molly S. Rosebush
- 0000 0001 0662 7451grid.64337.35Louisiana State University, 1100 Florida Avenue, New Orleans, LA 70119 USA
| | - Carl M. Allen
- Central Ohio Skin & Cancer, Inc., Westerville, OH USA ,0000 0001 2285 7943grid.261331.4The Ohio State University, Columbus, OH USA
| | | | - Robert A. Baiocchi
- 0000 0001 2285 7943grid.261331.4Division of Hematology, The Ohio State University College of Medicine, Columbus, OH USA
| | - Kitrina G. Cordell
- 0000 0001 0662 7451grid.64337.35Louisiana State University, 1100 Florida Avenue, New Orleans, LA 70119 USA
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Sultan AS, Mostoufi B, Papadimitriou JC, Koka R, Basile J, Younis RH. Large Cell Transformation of Oral Mycosis Fungoides. Head Neck Pathol 2017; 12:247-251. [PMID: 28741231 PMCID: PMC5953864 DOI: 10.1007/s12105-017-0840-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2017] [Accepted: 07/20/2017] [Indexed: 01/15/2023]
Abstract
Mycosis fungoides (MF) accounts for approximately 50% of all primary cutaneous lymphomas. MF occurrence in the oral cavity is extremely rare with approximately 45 cases reported to date. We present a case of a 68 year-old man with a raised nodular lesion of the ventral tongue with clinical impression of irritational fibroma. Histopathologic and immunohistochemical (IHC) examination revealed a phenotype consistent with MF with large cell transformation in the context of Sezary syndrome. The histological diagnosis of oral MF requires a high index of suspicion and IHC panel to rule out large cell transformation. To our knowledge, only four cases of large cell transformation of oral MF have been reported in the English literature. The clinical and histopathologic features of a rare case of intra-oral MF with large cell transformation are exemplified in this article.
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Affiliation(s)
- Ahmed S. Sultan
- 0000 0001 2175 4264grid.411024.2Department of Oncology and Diagnostic Sciences, School of Dentistry, University of Maryland, Baltimore, MD 21201 USA
| | - Behzad Mostoufi
- 0000 0001 2175 4264grid.411024.2Department of Oral and Maxillofacial Surgery, School of Dentistry, University of Maryland, Baltimore, MD 21201 USA
| | - John C. Papadimitriou
- 0000 0001 2175 4264grid.411024.2Department of Pathology, University of Maryland School of Medicine, Baltimore, MD 21201 USA
| | - Rima Koka
- 0000 0001 2175 4264grid.411024.2Department of Pathology, University of Maryland School of Medicine, Baltimore, MD 21201 USA
| | - John Basile
- 0000 0001 2175 4264grid.411024.2Department of Oncology and Diagnostic Sciences, School of Dentistry, University of Maryland, Baltimore, MD 21201 USA ,University of Maryland Greenebaum Cancer Center, Baltimore, MD 21201 USA
| | - Rania H. Younis
- 0000 0001 2175 4264grid.411024.2Department of Oncology and Diagnostic Sciences, School of Dentistry, University of Maryland, Baltimore, MD 21201 USA ,University of Maryland Greenebaum Cancer Center, Baltimore, MD 21201 USA
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DeSesa CR, Appugounder S, Haberland C, Johnson MP. Osteonecrosis of the Jaw in Association With Chemotherapy in the Setting of Cutaneous T-Cell Lymphoma. J Oral Maxillofac Surg 2015; 74:292-301. [PMID: 26296596 DOI: 10.1016/j.joms.2015.07.019] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2015] [Revised: 07/24/2015] [Accepted: 07/24/2015] [Indexed: 01/09/2023]
Abstract
T-cell lymphomas (TCLs) account for approximately 15 to 20% of all non-Hodgkin lymphomas in the United States. The most common form of TCL is cutaneous TCL (CTCL), with Sézary syndrome and mycosis fungoides being the most prevalent subtypes. Sézary syndrome is the more aggressive form and often is referred to as a late-stage variant of mycosis fungoides. Clinically, it is characterized by diffuse erythroderma, cutaneous edema, pruritus, nonhealing cutaneous ulcers, and lymphadenopathy. Patients also can present with changes to their nails, hyperpigmentation, alopecia, palmoplantar keratoderma, ectropion, and hepatosplenomegaly. The overall prognosis for patients with Sézary syndrome is poor. The literature regarding oral manifestations of CTCL mostly report those of mycosis fungoides because it is the most common subtype of CTCL. Currently, there are only 2 reports in the scientific literature of intraoral manifestations of Sézary syndrome. This case report describes a patient with Sézary syndrome who presented with rapidly progressing erythematous lesions of the gingiva and multifocal osteonecrosis of the maxilla and mandible. This is the third reported case of an intraoral manifestation of Sézary syndrome and the first reported case of osteonecrosis in the setting of CTCL.
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Affiliation(s)
- Christopher R DeSesa
- Private Practice, West Springfield, MA; Former Chief Resident, Division of Oral and Maxillofacial Surgery, Yale-New Haven Hospital, New Haven, CT.
| | - Suganya Appugounder
- Private Practice, Maple Grove, MN; Former Chief Resident, Division of Oral and Maxillofacial Surgery, Yale-New Haven Hospital, New Haven, CT
| | - Christel Haberland
- Clinical Instructor, Division of Oral and Maxillofacial Pathology, Yale-New Haven Hospital, New Haven, CT
| | - Michael P Johnson
- Residency Program Director, Division of Oral and Maxillofacial Surgery, Yale-New Haven Hospital, New Haven, CT
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Dereure O, Guilhou JJ. [Mycosis fungoides with predominant periorificial and mucous involvement]. Ann Dermatol Venereol 2006; 132:877-80. [PMID: 16327717 DOI: 10.1016/s0151-9638(05)79506-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
INTRODUCTION Specific involvement of the mucous membranes is possible during the course of mycosis fungoides but has seldom been reported, except in postmortem series. A single mucous membrane is most often involved, mainly in the mouth. Such mucous lesions are generally ominous with regard to the general outcome of the disease. OBSERVATION A 74 year-old woman was investigated for mycosis fungoides complicated with lesions around the mouth and of the mucosa, involving the tongue and esophagus, featuring ulcerated nodules with specific chorion infiltration and epidermotropism. This progression was rapidly followed by a fatal outcome, in spite of various systemic treatments. DISCUSSION This case report of mycosis fungoides displaying multiple and predominant oral and mucosal involvement of mycosis fungoides is unique. The rapidly unfavorable outcome confirms the ominous prognosis of mucous lesions, whereas no patent visceral extension was detected. The mechanisms underlying the mucous membranes involvement is discussed.
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Affiliation(s)
- O Dereure
- Service de Dermatologie, Hôpital Saint-Eloi, Montpellier.
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Pujol RM, Muret MPG, Bergua P, Bordes R, Alomar A. Oral Involvement in Lymphomatoid Papulosis. Dermatology 2005; 210:53-7. [PMID: 15604547 DOI: 10.1159/000081485] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2003] [Accepted: 05/28/2004] [Indexed: 11/19/2022] Open
Abstract
Oral involvement in cutaneous CD30+ T-cell lymphoid proliferations is rare and has received little attention in the dermatologic literature. The authors report 2 patients with self-healing, recurrent papulonodular eruptions with the classic clinical, histopathological and immunophenotypic features of lymphomatoid papulosis, which developed two ulcerated papules and an ulcerative nodule on the dorsum of the tongue, respectively. The lesions appeared coincident with a new cutaneous relapse of the disease. Histopathological and immunophenotypic features were similar to those of the cutaneous lesions. All lesions regressed spontaneously after several weeks. Since then, and after follow-up periods of 3 and 7 years, respectively, no evidence of extracutaneous involvement has been detected. Oral involvement in lymphomatoid papulosis is an uncommon event, probably without prognostic significance. Previously reported cases are reviewed. The differential diagnosis of atypical T-cell lymphoid infiltrates observed in the oral mucosa is discussed.
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Affiliation(s)
- Ramon M Pujol
- Department of Dermatology, Hospital del Mar, IMAS, Barcelona, Spain.
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Abstract
Mycosis fungoides is a malignant T-cell lymphoproliferative disease with a predilection for cutaneous involvement. Extracutaneous disease is uncommon and oral mucosal involvement is rare. We describe a case of mycosis fungoides involving the hard palate treated with radiotherapy. The relevant literature on this topic is reviewed.
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Affiliation(s)
- Margaret S-T Chua
- Department of Radiation Oncology, Westmead Hospital, Sydney, Australia
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Harman M, Akdeniz S, Arslan A, Aöyoĝlu S. Mycosis fungoides with involvement of the oral cavity. J Eur Acad Dermatol Venereol 1998. [DOI: 10.1111/j.1468-3083.1998.tb00746.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Manganaro AM, Startzell JM. An asymptomatic enlargement of the upper lip. ORAL SURGERY, ORAL MEDICINE, ORAL PATHOLOGY, ORAL RADIOLOGY, AND ENDODONTICS 1996; 82:238-40. [PMID: 8884818 DOI: 10.1016/s1079-2104(96)80345-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Affiliation(s)
- A M Manganaro
- Department of Oral and Maxillofacial Surgery, Brooke Army Medical Center, Fort Sam Houston, Texas, USA
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Sirois DA, Miller AS, Harwick RD, Vonderheid EC. Oral manifestations of cutaneous T-cell lymphoma. A report of eight cases. ORAL SURGERY, ORAL MEDICINE, AND ORAL PATHOLOGY 1993; 75:700-5. [PMID: 8515982 DOI: 10.1016/0030-4220(93)90426-5] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Cutaneous T-cell lymphoma rarely involves the oral cavity. Only 14 detailed cases of oral cutaneous T-cell lymphoma have been described in the English-language literature; this report describes eight additional cases observed among 824 patients evaluated at our cutaneous T-cell lymphoma center since 1968. Oral involvement occurs late in the course of cutaneous T-cell lymphoma and usually is associated with poor prognosis; most patients die of disease complications within 3 years of the diagnosis of oral involvement.
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Affiliation(s)
- D A Sirois
- Department of Oral Pathology, Biology, and Diagnostic Science, University of Medicine and Dentistry of New Jersey, New Jersey Dental School, Newark
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Abstract
Oral manifestations of cutaneous T cell lymphoma (CTCL) have received little attention in the dermatologic literature. The authors report two patients with lingual lesions. The histologic features are similar to those of the glabrous skin. A review of the 22 previously reported cases indicate a shortened survival. A retrospective review of 82 patients with CTCL treated at the authors' medical center identified only three with oral involvement. Radiation therapy offers effective palliation for these lesions.
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Affiliation(s)
- E E Kasha
- Department of Dermatology, Indiana University, Indianapolis 46202
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