A Clinicopathological Study of Early Mycosis Fungoides / 대한피부과학회지

ABSTRACT

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.