The Influence of the Coexpression of CD4 and CD8 in Cutaneous Lesions on Prognosis of Mycosis Fungoides: A Preliminary Study

Abstract

Background. Although techniques of immunophenotyping have been successful in characterizing the cells in the cutaneous infiltrates of mycosis fungoides little evidence suggests that variations in the phenotypic characterization correlate with prognosis. Objectives. In a preliminary prospective, single-centre, study we correlated the T-cell phenotype in cutaneous biopsies with the progression of the disease to determine whether the coexpression of CD4 and CD8 has an impact on prognosis. Methods. Skin biopsy specimens from 30 newly diagnosed patients were stained with immunoperoxidase techniques to determine their phenotypic characteristics. After a median followup of 42 months patients were divided into two groups with stable and progressive disease. Results. Eighteen patients had the conventional CD4+CD8− T-cell phenotype. Ten patients showed the coexpression of CD4 and CD8 and had a slightly lower rate of progressive disease. Conclusions. The coexpression of CD4 and CD8 in cutaneous lesions is not rare and is associated with a slightly lower rate of progressive disease. Since double positive CD4/CD8 phenotype is rarely reported in mycosis fungoides the presence on conventional immunophenotyping of both CD may be due to a “mixture” of neoplastic cells and inflammatory CD8+ tumor infiltrating lymphocytes. Immunohistochemical study combined with confocal microscopy could clarify this issue.

Mycosis Fungoides in Iranian Population: An Epidemiological and Clinicopathological Study

“…de Marchi et al showed that the coexpression of CD4 and CD8 in patients with MF is associated with a slightly lower rate of progressive disease compared with patients with conventional CD4+/CD8− phenotype. These findings raise the possibility that the coexpression of CD4 and CD8 in cutaneous lesions may confer a better prognosis in MF [ 36 ]. The lower tendency of progression of the disease in our patients with the coexpression of CD4 and CD8 might be related to the increased activity of antitumor CD8+ lymphocytes infiltrating the lesions [ 36 ].…”

Influence of the phenotype on mycosis fungoides prognosis, a retrospective cohort study of 160 patients

“…Regarding DP immunophenotype, De Marchi et al . reported that 33% of their 30 patients showed the coexpression of CD4 and CD8.…”

“…published a retrospective cohort of 68 patients with early‐stage MF and 10 years of follow‐up and concluded that cytotoxic phenotypes and detection of monoclonal T‐cell receptor‐c gene rearrangements in early lesions of mycosis fungoides did not have any prognostic significance. De Marchi and his group published a prospective cohort of 30 DP patients followed for 3.5 years. They concluded that the coexpression of CD4 and CD8 in cutaneous lesions is not rare and is associated with a slightly lower rate of progressive disease.…”

“…Our lower incidence could also be explained by rigorous inclusion criteria. Although we did not resort to confocal microscopy for confirmation, we only considered MF was of DP subtype when expression was assessed by an experienced pathologist to be in the same neoplastic lymphoid population in the intraepidermal infiltrate, in contrast to the broader inclusion criteria used by De Marchi et al . It has been suggested that aberrant immunophenotypes are associated with unusual morphologic presentations of MF, such as hypopigmented, ichthyosiform, purpuric, erythema gyratum repens (EGR)‐like lesions, and sclerotic plaques resembling morphea .…”

“…From limited reports, it appears that these entities display similar clinical behavior and prognosis when compared to the conventional CD4 + CD8 − phenotype. However, only two smaller studies have examined a larger series of patients with adequate follow‐up . As the recognition of new immunophenotype variants has been increasing with time, it is important to be certain that the aberrant MF immunophenotypes do not behave differently and do not impact prognosis.…”