Attempts to enhance light microscopic diagnosis of cutaneous T-cell lymphoma (mycosis fungoides)

Abstract

Precise pathologic criteria for the diagnosis of mycosis fungoides (MF) remain controversial. With the use of a specific counting technique and defined criteria for cell types, we attempted to differentiate between a series of slides from patients with eczematous dermatitis, large plaque parapsoriasis, and atypical dermatitis with features that suggest MF, the plaque stage of MF, and the tumor stage of MF. This could not be done on the basis of cellular density in e defined field in the papillary dermis or on the basis of the percentage of atypical lymphocytes in the fields counted. Furthermore, individual investigator variance was shown to be highly significant despite efforts to minimize this factor.

A Review of Survival in Mycosis Fungoides

“…Variability in the histopathologic diagnosis of MF must have added to these, because disagreements between pathologists about the diagnosis of MF are well documented. 3,7,8,14,33,34 How to improve diagnostic agreement is not, however, clear. The International Society for Cutaneous Lymphomas has proposed an algorithm that combines clinical, histologic, molecular, and immunohistochemical (IHC) components.…”

“…Yet, MF is not common, and its histologic definition remains both elusive and controversial. [1][2][3][4][5] Many investigators have thoroughly studied the histologic features of MF, [3][4][5][6][7][8][9][10][11][12][13][14][15][16] finally achieving a consensus of sorts that emphasizes the importance of the following: MF cells' cytology (modestly enlarged lymphocytes with dark convoluted nuclei and, for the most part, a high nuclear-to-cytoplasmic ratio), the presence of these cells in the epidermis (in basilar epidermal rows, scattered singly, or in Pautrier clusters), the clear halos that often surround these cells, their presence in the papillary dermis (where they are often appear interstitially among collagen fibers), and the limited changes typical for spongiotic or other dermatoses. 1,[3][4][5]15,[17][18][19][20] Despite this consensus, benign nonlymphomatous mimics of MF confound the diagnosis.…”

Mycosis Fungoides and Sézary’s Syndrome Show Distinct Histomorphological Features

“…Furthermore, our study reveals that immunoblasts are rare in MF or SS (particularly in SS), histiocytes, plasma cells and eosinophils are not a specific diagnostic hint, either [6], although they may be more frequently found in MF infiltrates.…”

Loss of SHP-1 tyrosine phosphatase expression correlates with the advanced stages of cutaneous T-cell lymphoma.

“…1-3, and the entire data set is summarized in Table 1. The standard histopathologic criteria were applied for classifying the biopsies as representing the patch, plaque, and tumor stage of MF [7,8]. Briefly, in the early patch stage, there was a perivascular infiltrate of the predominantly small lymphocytes with round or cerebriform nuclei admixed with plasma cells and eosinophils.…”