Cutaneous hypopigmented lymphoproliferative disorders: a clinicopathological study of 41 cases / 中华皮肤科杂志

Objective:To investigate clinicopathological features of hypopigmented mycosis fungoides (HMF) and hypopigmented interface T-cell dyscrasia (HITCD) .Methods:A total of 41 patients with cutaneous hypopigmented lymphoproliferative diseases, who had complete clinicopathological data, were collected from Department of Dermatology, the Third People′s Hospital of Hangzhou from January 2015 to September 2020, and the clinicopathological and immunophenotypic features were analyzed. Comparisons of normally distributed measurement data were carried out using t test, comparisons of categorical data using Chi-square test or Fisher′s exact test, and comparisons of ranked data between 2 groups using rank-sum test. Results:All of the 41 patients clinically presented with irregular hypopigmentation, some of which was accompanied by erythema or furfuraceous scales. In terms of pathological features, 21 patients showed infiltration and aggregation of atypical lymphoid cells in the epidermis, which was consistent with typical pathological features of mycosis fungoides, and they were diagnosed with HMF; 20 patients showed vacuolar degeneration of the basal layer, accompanied by infiltration of lymphoid cells and mild epidermotropism, and they were diagnosed with HITCD. All immune cells expressed T-cell phenotype, and epidermal lymphocytes expressed a CD8-dominated phenotype in 14 (67%) cases of HMF and 13 (65%) of HITCD. In the epidermis, the total number of lymphocytes was significantly higher in the HMF group than in the HITCD group ( t= 1.81, P= 0.012) ; in the dermis, the number of CD4 + lymphocytes and CD8 + lymphocytes, and the total number of lymphocytes were all significantly higher in the HMF group than in the HITCD group ( t= 2.64, 1.51, 2.60, P= 0.012, 0.002, 0.001, respectively) . All patients were treated with narrow-band ultraviolet B radiation. Among 34 patients who completed the follow-up, 30 achieved complete clearance of skin lesions without recurrence, including all patients with HITCD, and 4 with HMF achieved partial regression of the lesions. Conclusions:Compared with HMF, HITCD presents different pathological characteristics and benign biological behaviors. Thus, HITCD should be distinguished from HMF as an independent disease. Phototherapy alone is effective for the treatment of HITCD.

A study of clinicopathologic profile of 15 cases of hypopigmented mycosis fungoides.

Background: Mycosis fungoides (MF) is cutaneous lymphoma of the T-cell lineage. Hypopigmented MF is a clinical variant of MF, described mainly in Asians. This is a retrospective clinicopathologic analysis of hypopigmented MF at a tertiary care center. Aims: To describe the clinicopathologic profile of hypopigmented MF. Methods: Records of clinicopathologic notes over a 5-year period ranging from January 2005 up to December 2009 were reviewed over a period of 3 months, of which 15 cases were diagnosed with hypopigmented MF based on clinicopathologic correlation. Results: Hypopigmented MF was found to be more common in males, and between second and fourth decades of life. The latent period between onset and diagnosis was around 3.83 years. Most of the patients were asymptomatic 80% (12/15), with skin changes of subtle atrophy in 46.66% (7/15), scaling in 20% (3/15) and focal changes of poikiloderma in 26.66% (4/15) patients. Most common sites of distribution of the lesions were the trunk and extremities. Many of the cases had been clinically mistaken for Hansen's disease prior to correct diagnosis. Marked epidermotropism and tagging of epidermis by large lymphocytes characterizes the condition histopathologically. Of the 15 cases, immunohistochemistry was possible in 10 cases, of which 8 showed predominant CD8 positive epidermotropic infiltrates and two cases showed absence of CD8 positive and CD4 positive lymphocytic infiltrate in the epidermis. Conclusion: Hypopigmented MF presents as hypopigmented asymptomatic patches without any erythema or infiltration in its early stage and mimics Hansen's disease. Skin biopsy clinches the diagnosis.

Micosis fungoides hipopigmentada: reporte de siete casos / Hypopigmented mycosis fungoides: report of seven cases

Introducción: La micosis fungoides (MF) es el linfoma cutáneo de células T más frecuente. Se presenta de diversas formas clínicas, siendo la micosis fungoides hipopigmentada una variante clínica poco común, sobre todo en población caucásica. Objetivo general: Describir los hallazgos clínicos y anatomopatológicos de la serie de pacientes con diagnóstico de MF hipopigmentada. Material y método: Estudio descriptivo, retrospectivo. Se analizaron todos los casos de MF hipopigmentada diagnosticados en el período 2004-2009 en tres centros de atención dermatológica. Resultados: Se describen siete pacientes con diagnóstico de MF hipopigmentada; el estudio histológico confirmó el diagnóstico en todos los casos, con un período de seguimiento de seis a 66 meses. El promedio de edad al momento del diagnóstico fue de 20,5 años. La inmunohistoquímica en todos los pacientes fue CD8 +, y seis de los siete pacientes evaluados fueron CD4 +. Cinco de los pacientes fueron manejados con PUVA, y de ellos todos lograron la remisión completa.

Introduction:: Mycosis fungoides (MF) is the most common type of cutaneous T-cell lymphoma. It manifests in diverse clinical forms, and a rare variant of MF is hypopigmented mycosis fungoides. Objective: To describe clinical, pathological and immunohistochemicol findings in a group of 7 hypopigmented MF patients. Material and methods: This is a descriptive and retrospective study. We analyzed all patients with diagnosis of hypopigmented MF during the 2004-2009 period in three dermatological centers. Results: We describe 7 patients diagnosed with hypopigmented MF Histological biopsies confirmed the diagnosis in all cases. The follow-up period was 6 to 66 months. The mean age at diagnosis was 20.5 years. Immunohistochemically, all patients were CD8 + and six were CD4 +. Treatment in five cases was with PUVA, which led to complete clinical remission.

A Case of Hypopigmented Mycosis Fungoides / 대한피부과학회지

Hypopigmented mycosis fungoides has been infrequently described as a variant of mycosis fungoides. It mostly occurs in dark-skinned or Asian patients, particularly children, and is often misdiagnosed as a different condition, such as vitiligo, chronic lichenoid pityriasis or postinflammatory hypopigmentation because of its non-specific manifestations. We herein describe a Korean case of hypopigmented mycosis fungoides which was misdiagnosed as a vitiligo. We also emphasize the importance of a biopsy on any persistent or unusual hypopigmented lesion to avoid delay in the diagnosis of mycosis fungoides.