ABSTRACT
Mycosis fungoides (MF) has been widely reported to mimick a considerable number of different dermatoses, including scarring alopecia, bullous dermatoses or cysts, and comedones. In atypical presentations, histopathology is essential for the diagnosis. We present two cases of MF with clinical urticarial lesions and a striking blood involvement that responded to mogamulizumab treatment. Histopathologically, both cases had classic MF features and shared a peculiar immunophenotype, with positivity for CD25 and FOXP3. Differential diagnoses included urticarial lymphomatoid drug reactions and other lymphomas, like T-cell prolymphocytic leukemia, atypical Sézary syndrome, or adult T-cell lymphocytic leukemia. A low suspicion threshold is necessary for the diagnosis of atypical presentations of MF.
Subject(s)
Antineoplastic Combined Chemotherapy Protocols , Brentuximab Vedotin , Deoxycytidine , Gemcitabine , Mycosis Fungoides , Skin Neoplasms , Humans , Mycosis Fungoides/drug therapy , Mycosis Fungoides/pathology , Brentuximab Vedotin/administration & dosage , Deoxycytidine/analogs & derivatives , Deoxycytidine/administration & dosage , Skin Neoplasms/drug therapy , Skin Neoplasms/pathology , Antineoplastic Combined Chemotherapy Protocols/adverse effects , Antineoplastic Combined Chemotherapy Protocols/administration & dosage , Antineoplastic Combined Chemotherapy Protocols/therapeutic use , Male , Injections, Intralesional , Middle Aged , Treatment Outcome , Neoplasm Staging , Female , Aged , Immunoconjugates/administration & dosage , Immunoconjugates/adverse effectsABSTRACT
Toker cells (TCs) are sometimes present in the nipple epidermis as oval cells with pale cytoplasm and roundish nuclei. In most cases, TCs may be easily distinguished from cancerous cells of Paget disease of the nipple (PCs). Especially in TC hyperplasia, in which mild-to-moderate atypia may be present, it may be challenging to distinguish between TCs and PCs. The combination of chronic inflammatory changes in the nipple, in the context of Zuska disease, and TC hyperplasia, may easily lead to an erroneous diagnosis of mammary Paget disease.
