Reassessment of Histologic Parameters in the Diagnosis of Mycosis Fungoides

Smoller, Bruce R.; Bishop, Kay; Glusac, Earl J.; Kim, Youn H.; Hendrickson, Michael

doi:10.1097/00000478-199512000-00009

Cited by 172 publications

(174 citation statements)

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“…In an earlier study, some of the present authors called into the question the specificity of these hyperconvoluted cells (9). In their study, hyperconvoluted and hyperchromatic lymphocytes were detected in the great majority of cases of MF.…”

Section: Discussionmentioning

confidence: 63%

Reassessment of Lymphocytic Atypia in the Diagnosis of Mycosis Fungoides

et al. 2001

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The manifestations of mycosis fungoides in its early stage may mimic clinically and histologically those of many benign inflammatory dermatoses. Therefore, the diagnosis of mycosis fungoides remains a major challenge for dermatologists and dermatopathologists. For many years, it has been proposed that atypical lymphocytes within the epidermis constitute one of the diagnostic features in mycosis fungoides. Presence of dermal atypical lymphocytes remains controversial as a diagnostic criterion. We reassessed the feasibility of applying lymphocytic atypia within epidermis and dermis as diagnostic criteria discriminating between mycosis fungoides and spongiotic dermatitis. Thirty cases of mycosis fungoides and 30 cases of spongiotic dermatitis were retrieved from archival hematoxylin and eosin-stained histologic sections. Punch biopsy sections were examined by light microscopy; epidermal and dermal lymphocytes were photographed at 1000؋ (oil immersion). A total of 92 ektachrome slides (35 mM) were developed, coded, and ordered randomly. For each slide, cells were interpreted as typical or atypical lymphocytes by seven pathologists. Atypical epidermal lymphocytes were judged to be present in 9 ؎ 2 out of 16 (56%) cases of mycosis fungoides photographed as compared with 8 ؎ 3 out of 16 (50%) in spongiotic dermatitis. Dermal lymphocytic atypia was thought to be present in 14 ؎ 6 out of 30 (47%) patients with mycosis fungoides. Thirteen ؎ 6 out of 30 (43%) patients with non-mycosis fungoides also displayed dermal lymphocytic atypia. No statistical significance was observed in these comparisons (t test, P > .05). Furthermore, atypia of lymphocytes was deemed to be present in 41, 38, 59, 70, 23, 47, and 40 out of 92 slides examined by the investigators, suggesting that observer variation is a very significant factor in our present study. We conclude that it is not possible to distinguish mycosis fungoides from spongiotic dermatitis merely based on lymphocytic atypia within epidermis or dermis.

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Section: Discussionmentioning

confidence: 63%

Reassessment of Lymphocytic Atypia in the Diagnosis of Mycosis Fungoides

et al. 2001

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“…In a retrospective review, biopsy specimens obtained from 64 patients with bona fide MF (based on their clinical course) were systematically compared with 47 non-MF biopsy specimens. On univariate analysis, seven characteristics were significantly associated with MF, including: Pautrier's microabscesses, haloed lymphocytes, exocytosis, disproportionate epidermotropism, epidermal lymphocytes larger than dermal lymphocytes, hyperconvoluted (i.e., cerebriform nuclear contour) intraepidermal lymphocytes, and lymphocytes aligned within the basal layer [103]. Of these, the presence of haloed lymphocytes was the most significant discriminator on multivariate analysis.…”

Section: Mycosis Fungoidesmentioning

confidence: 98%

Cutaneous T‐cell lymphoma: 2011 update on diagnosis, risk‐stratification, and management

Wilcox

2011

American J Hematol

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Disease overview: Cutaneous T‐cell lymphomas are a heterogenous group of T‐cell lymphoproliferative disorders involving the skin, the majority of which may be classified as Mycosis fungoides (MF) or Sézary syndrome (SS).Diagnosis: The diagnosis of MF or SS requires the integration of clinical and histopathologic data.Risk‐adapted therapy: Tumor, node, metastasis, and blood (TNMB) staging remains the most important prognostic factor in MF/SS and forms the basis for a “risk‐adapted,” multidisciplinary approach to treatment. For patients with disease limited to the skin, expectant management or skin‐directed therapies is preferred, as both disease‐specific and overall survival for these patients is favorable. In contrast, patients with advanced‐stage disease with significant nodal, visceral, or blood involvement are generally approached with biologic‐response modifiers, denileukin diftitox, and histone deacetylase inhibitors before escalating therapy to include systemic, single‐agent chemotherapy. Multiagent chemotherapy may be used for those patients with extensive visceral involvement requiring rapid disease control. In highly‐selected patients with disease refractory to standard treatments, allogeneic stem‐cell transplantation may be considered. Am. J. Hematol., 2011. © 2011 Wiley‐Liss, Inc.

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“…4,[6][7][8][9][10][11] The histopathologic features of early MF vary from person to person, over time, and even between multiple sites in a single patient. 12,13 In addition, Figure 1.…”

Section: Commentmentioning

confidence: 99%

Selected Inflammatory Imitators of Mycosis Fungoides: Histologic Features and Utility of Ancillary Studies

Arps

Chen

Fullen

et al. 2014

Archives of Pathology &Amp; Laboratory Medicine

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Mycosis fungoides is the most common primary cutaneous lymphoma; however, it remains a significant diagnostic challenge, in part because of the overlap with several inflammatory dermatoses. Despite advances in immunohistochemistry and molecular diagnostics, false-positive, false-negative, and indeterminate diagnoses are not uncommon. In most cases, the overall balance of morphologic, immunophenotypic, and genetic features must be considered carefully because there are few sensitive and specific clues to the diagnosis. Moreover, an appropriate clinical presentation is essential to the diagnosis and helps to favor or exclude inflammatory/reactive processes. Herein, we discuss 3 important inflammatory dermatoses that may closely simulate mycosis fungoides, and we review the use of ancillary studies in these challenging cases.

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Reassessment of Histologic Parameters in the Diagnosis of Mycosis Fungoides

Cited by 172 publications

References 0 publications

Reassessment of Lymphocytic Atypia in the Diagnosis of Mycosis Fungoides

Reassessment of Lymphocytic Atypia in the Diagnosis of Mycosis Fungoides

Cutaneous T‐cell lymphoma: 2011 update on diagnosis, risk‐stratification, and management

Selected Inflammatory Imitators of Mycosis Fungoides: Histologic Features and Utility of Ancillary Studies

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