Evaluation of CD[7] T-cell deletion marker for diagnosis of mycosis fungoides

Clinical diagnosis of mycosis fungoides [MF] in its early stages can be difficult and requires biopsy confirmation of disease. Even with histological evaluation, early-stage MF is still difficult to distinguish from various benign inflammatory dermatoses [BID]. Recent attempts to enhance the diagnostic sensitivity and specificity have mainly focused on lymphocyte Immunophenotyping and genotyping [1, 2]. Our purposes in this study were clinical and histopathologic assessment of MF patients in addition to evaluate the diagnostic value of Immunophenotyping with special reference to CD7 deletion. The study was carried on 19 MF patients and 16 cases of BID as a control group. They were subjected to full clinical examination, routine laboratory investigations and chest x- ray. Skin biopsies were obtained from all MF cases and BID control group. The paraffin embedded skin specimens were stained with hematoxylin-eosin stain [H and E] and immunostains for CD3, CD4, CD8 and CD7. According to Smoller's [3] histological criteria, the diagnosis of MF was confirmed; showing various pathologic patterns including granulomatous MF in one case. Immunophenotyping results revealed that T-cells in all MF and BID specimens were predominantly expressed CD3+, CD4+ and negatively stained by CD8. Conversely, the mean CD7+ count as a percentage of total T-cells in MF specimens [16.8%] was significantly lower than those of BID [61.7%]. The sensitivity and specificity of CD7 deletion [expressed by <50% of T-cells] for diagnosis of MF was 89.5% and 93.75% respectively. CD4/CD8 ratios greater than 2:1 and 10:1 were noticed in 73.7% and 31.3% of MF biopsies. CD4/CD8 ratios more than 10:1 were specific for MF while ratios greater than 2:1 were also found in 15.8% of BID. We can conclude that MF may manifest a variety of histological forms. Expressions of conventional T-cell markers including CD3, CD4 and CD8- do not generally distinguish benign T-cell infiltrate from MF, however, deletion of CD7 [<50%] has demonstrated considerable usefulness in the diagnosis of MF [89.5%] and was occasionally found in BID [6.25%]

Recalcitrant alopecia areata, what are the possible underlying factors?

Twenty-four patients with long standing alopecia areata [AA] [13 females and 11 males, whose ages ranged from 8 to 43 years] were studied. The duration of the disease varied from 3 to 16 years. All patients were subjected to detailed clinical and family history, laboratory and immunological studies. Skin biopsies were taken and stained with H/E and immunohistochemically for CD3, CD4 and CD8. Nineteen patients developed AA before puberty and 15 cases had a wide spread alopecia [7 subtotalis, 4 totalis and 4 universalis]. Five patients gave a family history, two of them were nonidentical female twins. The associated clinical features were Down's syndrome [two cases], atopic eczema [three cases, nail pitting [four cases] and only one case with thyroid disease. Five patients had low serum iron, one patient showed positive antithyroid antibodies and two patients with weak positive antinuclear antibodies. Only a female patient with alopecia subtotalis of 10-year duration had low serum immunoglobulin levels, low B-lymphocytes count and high suppressor T-cell number. Histopathologically, there were a reduced number of hair follicles and an increased number of catagen and telogen follicles. Fourteen biopsies showed moderate to dense infiltrate. The infiltrate affected predominantly the anagen follicles, which were reduced in the size. The infiltrate consists mainly of T-cells [CD3]. T-helper [CD4] cells were predominant in nine biopsies

Clinicopathological assessment of kaposi's sarcoma

Out of 20 cases of Kaposi's sarcoma [KS] received in Dermatology and Venereology Department [1980-1996], 19 cases [95%] were classic form and one case [5%] was KS associated with immunosuppressive therapy after renal transplant. There was a male preponderance. The commonest sites affected were the lower limbs and the commonest lesion detected was plaque either singly, or in combination with nodules and patchlesions. Ultrastructural examination of 6 lesions [3 plaques and 3 nodules] proved vascular endothelial origin of tumor cells. Image DNA cytophotometric analysis of 14 lesions [8 plaques and 6 nodules] revealed aneuploid cell population