At a Glance
Mycosis fungoides is a form of primary cutaneous T-cell lymphoma. Mycosis fungoides is characterized by evolution of skin patches, plaques, and tumors, which often prompt a skin biopsy.
The histologic diagnosis is difficult in the early stages of mycosis fungoides. Skin biopsies classically show epidermotropic (lymphocytes infiltrating the epidermis) neoplastic T lymphocytes, with a dermal lymphoid infiltrate of varying intensity. Immunohistochemical stains for T-cell antigen expression on the skin biopsy may be helpful and classically demonstrate the lymphocytes to be CD4 positive but CD7 negative. Paraffin embedded tissue may be sent for T-cell receptor gene rearrangement detection by polymerase chain reaction (PCR) to prove the clonality/neoplastic nature of the T cells. The presence of histologic transformation, defined as greater than 25% large lymphoid cells, which may also be CD 30 positive, should also be assessed.
What Tests Should I Request to Confirm My Clinical Dx? In addition, what follow-up tests might be useful?
Patients will typically be referred to dermatologists or oncologists specialized in the treatment of cutaneous T-cell lymphomas. Mycosis fungoides may be an indolent disease. The most important factors for prognosis are the extent of cutaneous disease and extracutaneous spread, the detection of histologic transformation as described, and other indicators of tumor burdens, such as serum LDH.
Clinical staging systems incorporate pathologic assessment of clinically suspicious lymph nodes (>1.5 cm, involving excisional biopsies), for the number of abnormal lymphocytes: none, scattered atypical and large lymphocytes with cerebriform nuclei, or clusters and sheets of cells with replacement of lymph node architecture. Quantitation of neoplastic T lymphocytes within the peripheral blood (Sezary cells) is also performed, either by manual differential, flow cytometry, or both. A count of 1000 cells per micrometer is the cutoff between clinical stages III and IV. A more aggressive histologic variant of mycosis fungoides, "folliculotropic mycosis fungoides," predominantly involves the head and neck.
Copyright © 2017, 2013 Decision Support in Medicine, LLC. All rights reserved.
No sponsor or advertiser has participated in, approved or paid for the content provided by Decision Support in Medicine LLC. The Licensed Content is the property of and copyrighted by DSM.
Clinical Pain Advisor Articles
- Brain Plasticity in Patients With Complex Regional Pain Syndrome
- Perturbation-Based Rehabilitation Effective for Chronic Low Back Pain
- IBS-Associated Chronic Pain: Formulation of Core Diagnostic Criteria
- Cannabis Use Associated With Relationship Between Pain and Negative Affect
- Fluoroscopically Guided Sacroiliac Interventions: Appropriate Use Criteria
- Cannabis Use Associated With Aberrant Drug Behaviors
- Walgreens to Carry Naloxone in All Pharmacies to Combat Drug Abuse
- Independent Pharmacies Expanding Services Available to Patients
- Ketamine Exhibits Effective Pain Relief for Refractory Headaches
- Pain In Elite Athletes: IOC Recommendations on Contributing Factors and Treatment Approach
- Naproxen Plus Muscle Relaxants vs Naproxen Monotherapy for Low Back Pain
- Pain Processing: Examining the Role of Oxytocin
- Short- vs Long-Acting Opioids for Osteoarthritis Pain
- Extended-Release Naltrexone Injections Reduce Opioid Dependence
- Depressive Symptoms in Medical Interns Increased With Work-Family Conflicts