Darier Nests or Pautrier microabscesses: highlighting the confusion of a decade.

Lucien Marie Pautrier was a skilled dermatologist whose work led to the creation of numerous manuscripts within the field of dermatology. His name, though, most often lends itself to a histopathological finding that was not his own discovery. For years, the origin of the term "pautrier microabscess" was thought to be the result of a misattribution by Louis H. Winer at the 66th annual meeting of the American Dermatological Association in 1946. However, a recently reported citing of the term in a 1932 article has led to speculation that the term could, in fact, have been first coined at a meeting of the New York Society of Dermatology in 1927.

Mycosis Fungoides, Then and Now Have We Travelled?

Mycosis fungoides (MF) is the most common type of cutaneous lymphoma, accounting for almost 50% of all primary cutaneous lymphomas. When initially described, it was believed to be a distinct clinical entity with a pathognomonic histopathologic picture. Through the years we have come to know that, like syphilis, MF is a great masquerader and can present clinically and histopathologically in many ways. This review is an attempt to cover the many faces of MF that have evolved through the years.

Baron Jean-Louis Alibert (1768-1837) and the first description of mycosis fungoides.

The term mycosis fungoides was first used by the French dermatologist Baron Jean-Louis Alibert (1768-1837). He suggested that name because the skin lesions had mushroom-like appearance. Working ceaseless with both patients and collaborators, Alibert brought fame to the Parisian Saint-Louis Hospital as a worldwide training center of dermatology, founding thus the French School of Dermatology.

[Strasbourg, capital of mycosis fungoides research from 1919 to 1964]. / Strasbourg, capitale du mycosis fongoïde de 1919 à 1964, ou la fortune des éponymes.

Both "Pautrier microabscesses" and "Woringer-Kolopp disease" terms make reference to two professors of dermatology of the Faculty of Medicine in Strasbourg. These eponyms, and especially that of Pautrier, are universally used by pathologists throughout the world. Their origin is amazing. Louis Marie Pautrier (1876-1958) is indeed not the father of the microabscesses which are designed by his name. This pathognomonic image of mycosisfungoides was in fact described by Jean Darier in 1889. It is probably due to the close bonds between Pautrier and his colleagues in New York if his name has been attached erroneously for two reasons to this histological sign, since abscesses contain by definition polymorphonuclear leucocytes and not lymphocytes. Pautrier was between 1919 and 1958 one of the major French dermatologists having a passion for granulomatoses and mycosis fungoides. His student Frédéric Woringer (1903-1964) published in 1939 the clinical case of a mysterious affection, which he had interpreted as a case of Paget disease. It is only after his death that this characteristic entity has been called Woringer-Kolopp disease. Kolopp was a dermatologist with private practice in Metz and addressed the biopsy of the princeps case to Strasbourg. This rare affection is considered today as an entity within the spectrum of epidermotropic T lymphomas, among which mycosis fungoides is the major entity.

History: Frederic Woringer (1903-1964) and Woringer-Kolopp disease.

The two most famous dermatologic eponyms born in Strasbourg are Pautrier microabscess and Woringer-Kolopp disease. Frederic Woringer (1903-1964) was one of Pautrier's students, who had been in charge of the Laboratoire d'Histopathologie Cutanée in Strasbourg from 1930 until his death. He achieved a brilliant career in the field of dermatopathology and was very active during the great period between World War I and II. His name is linked to a rare disease, pagetoid reticulosis, which he actually misunderstood, as he was at first convinced that the characteristic intraepidermal changes were due to Paget cells. In this article, we show for the first time the original correspondence between Kolopp (who sent the case to Strasbourg) and Woringer, including discussion with masters such as Pautrier and Civatte. Civatte suggested that these mysterious intraepidermal cells might have common morphologic features with the recently described Sezary cells. After the first publication of pagetoid reticulosis, it took almost 40 years to establish a clear link with mycosis fungoides. It was Braun Falco who named the disease after Woringer and Kolopp in 1974. Woringer would certainly be surprised to know that his name is still world famous, thanks to a rare disease he was the first to extensively describe in 1939, a few days before the declaration of war.

Alopecia mucinosa is mycosis fungoides.

Confusion abounds regarding the terms "follicular mucinosis" and "alopecia mucinosa," not only concerning definition and essential character, but of relationships between themselves on one hand and between themselves and mycosis fungoides on the other. We address here those issues in methodical fashion, first in historical perspective by review, scrupulously and critically, of what has been said in the many articles devoted to the subject; we next tell how the terms "alopecia mucinosa" and "follicular mucinosis" came to be and how they are employed currently; we then set forth our own observations pertinent to clinical, histopathologic, and biologic aspects of the condition called, conventionally, "alopecia mucinosa," those observations based on our own findings in sections of tissue cut from 54 biopsy specimens taken from 45 patients, all of them having been signed out previously as "follicular mucinosis;" we proceed to forge clinico-pathologic correlation of lesions in 14 of those 45 patients, utilizing assessments, by examination grossly and microscopically, of attributes in the very same lesion. Last, we propose a concept, and a terminology that derives from it, that synthesizes all that is known now about "alopecia mucinosa" and "follicular mucinosis," in particular the relationship of "alopecia mucinosa" to mycosis fungoides, including "follicular," "syringotropic," and erythrodermic manifestations of it. In short, we affirm that so-called alopecia mucinosa is but one of many morphologic manifestations of mycosis fungoides.

The man behind the eponym: Lucien Marie Pautrier--Pautrier's microabscess.

Lucien-Marie Pautrier, recognized during his life as a world-renowned dermatologist and venereologist, also wrote prolifically, established and headed a leading department at the medical school of Strasbourg, built an imposing structure to house the department, traveled widely in both Europe and the United States and founded the Société des Amis de la Musique at Strasbourg. He did all this while and between the two tragic World Wars that engulfed his beloved France. In the United States, his name is eponymically associated with Pautrier's microabscesses in mycosis fungoides despite the fact that he did not first describe them.

Los tres grandes. Segunda parte: Jean Louis Marc Alibert (1768-1837) / The three big masters. Second part: Jean Louis Marc Alibert (1768-1837)

Alibert fundó la Escuela Francesa de Dermatología. Trabajó en el Hospital de Saint Louis de París. Brillante orador, describió la micosis fungoide, el queloide y el botón de Oriente, entre otras dermatosis. Su clasificación de las enfermedades cutáneas no ha sobrevivido. Puede ser considerado como el autor del libro sobre dermatosis mejor ilustrado. (AU)