Diagnosis of mycosis fungoides with different algorithmic approaches

Abstract

We could not document a statistically significant advantage of adding ancillary immunohistochemical and molecular testing to careful histologic evaluation in the workup of suspected cases of early MF. A systemic approach to histologic diagnosis by a single pathologist correlated favorably to the MF panel diagnosis.

Immunophenotypic Correlation Between Skin Biopsy and Peripheral Blood Findings in Mycosis Fungoides

“…[15][16][17] Decreased expression of CD2 or CD5 has been described as very specific but relatively insensitive for MF; for example, a recent study by Furmanczyk et al 18 observed sensitivity and specificity of 22% and 100%, respectively, for decreased expression of CD2 or CD5 in epidermal T cells. 18 Other investigators observed similarly low sensitivity for decreased expression of CD2, CD3, and CD5. 15,19 In another recent study, Florell et al 15 found that immunohistochemical stains were of limited usefulness in establishing a diagnosis in difficult cases in which the routine pathologic features were insufficient for the diagnosis of MF.…”

A Review of Survival in Mycosis Fungoides

“…15 Yet, some have not found it helpful and even discovered that IHC stains offered limited help. [2][3][4][5] For example, McCalmont recently wrote that "one cannot immunostain one's way to a diagnosis of mycosis fungoides." 35 Despite these issues, the collected data illustrated in Figures 2 to 6 and in Table 2 emphasize how overall survival relates closely to T stage, how patients with stage T1 do well, and how most of those with shortened survival have higher T stages.…”

“…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 syndrome: clinical, histopathological and immunohistochemical review and update

“…Density of the infiltrate is variable and it increases as the lesion develops and clinically resembles plaque lesions. 15,31,59-62 …”

“…Pautrier's abscesses are found in one-third of the cases, and lymphocyte alignment in the basal layer as well as dermal infiltrate with atypical cells with irregular and ceribriform nuclei are frequently found (Figures 7 and 8). 15,31,59 …”