The Value of PCR Detection of TCR gamma Gene Rearrangement in the Diagnosis of Early Mycosis Fungoides / 대한피부과학회지

BACKGROUND: The diagnosis and differential diagnosis of mycosis fungoides(MF) is often difficult, clinically and histologically. A variety of inflammatory dermatoses may be seen with similar clinical and histological features. Given the limitation of histologic diagnosis in the early MF, an ancillary method to demonstrate a clonal T cell proliferation would be helpful. Recent attempts to enhance diagnostic sensitivity have involved T-cell receptor(TCR) gene rearrangement studies, using polymerase chain reaction(PCR) technique. OBJECTIVE: The purpose of this study was the value of PCR detection of TCR gamma gene rearrangement in the diagnosis of early MF. MATERIALS AND METHODS: Thirty-two cases of paraffin embedded tissue(PET) from patients of early MF were investigated for the presence of TCR gamma gene rearrangement using a nested PCR technique and analyzed by polyacrylamide gel electrophoresis(PAGE). As a control, PET from patients of 6 psoriasis, 3 lichen planus, 1 neurodermatitis, and 1 allergic contact dermatitis were tested. RESULTS: Monoclonal TCR gamma gene rearrangement was detected in 28 out of 32 (88%) patients with early MF and in none out of 11 patients with inflammatory skin diseases. CONCLUSION: TCR gamma gene rearrangement studies on lesional skin using PCR may be helpful as an adjunct to the histopathologic diagnosis of early MF.

A Clinicopathological Study of Early Mycosis Fungoides / 대한피부과학회지

BACKGROUND: Mycosis fungoides(MF) is a representative of cutaneous T-cell lymphoma and progresses through clinical stages, such as initial pre-mycotic(macule or patch), plaque, and tumor stage. Although lesions of plaque and tumor stage show typical features, those of pre-mycotic stage are commonly non-specific that precise diagnosis of early MF remains elusive. OBJECTIVES: This study attempted to elucidate the clinical and histopathologic features of early MF. METARIALS AND METHODS: We investigated 11 cases of MF stage Ia(based on TNM staging system) that visited the department of dermatology at the Seoul National University Hospital for the past decade year(1988-1998). Medical records and biopsy slides were reviewed. RESULTS: The results were as follows : 1. Clinical characteristics: Lesions were relatively well-defined erythematous scaly patches or plaques on lower abdomen, buttocks, proximal extremities or whole body. Clinically initial diagnoses were large plaque parapsoriasis in nine cases and in the remainders, poikiloderma atrophicans vasculare and MF, respectively. Duration of disease ranged from one month to 41 years, averaging 15.2 years. 2. Treatments: Follow-up of 8 patients was continued and all showed partial responses to application of topical steroids or BCNU(carmustine) and PUVA therapy. 3. Histopathologic findings: Epidermotropism was found in all cases and can be the most important pathologic finding, but typical Pautriers microabscesses were found in a few cases. Mild spongiosis was seen in epidermis and superficial perivascular infiltration was the most common finding in dermis. Lichenoid infiltration with epidermal psoriasiform change was found in two cases. Atypism of infiltrating cells was found in all cases and more prominent in epidermis. CONCLUSION: Lesions of early mycosis fungoides were relatively non-specific erythematous patches/plaques but characteristically, patients had relatively long duration of stationary disease status and showed good responses to treatments. Histopathologically, variable degree of epidermotropism was the most constant finding.