Yeh Y A, Hudson A R, Prieto V G, Shea C R, Smoller B R
Department of Pathology, University of Arkansas for Medical Sciences, Little Rock, Arkansas 72205, USA.
Mod Pathol. 2001 Apr;14(4):285-8. doi: 10.1038/modpathol.3880304.
The manifestations of mycosis fungoides in its early stage may mimic clinically and histologically those of many benign inflammatory dermatoses. Therefore, the diagnosis of mycosis fungoides remains a major challenge for dermatologists and dermatopathologists. For many years, it has been proposed that atypical lymphocytes within the epidermis constitute one of the diagnostic features in mycosis fungoides. Presence of dermal atypical lymphocytes remains controversial as a diagnostic criterion. We reassessed the feasibility of applying lymphocytic atypia within epidermis and dermis as diagnostic criteria discriminating between mycosis fungoides and spongiotic dermatitis. Thirty cases of mycosis fungoides and 30 cases of spongiotic dermatitis were retrieved from archival hematoxylin and eosin-stained histologic sections. Punch biopsy sections were examined by light microscopy; epidermal and dermal lymphocytes were photographed at 1000x (oil immersion). A total of 92 ektachrome slides (35 mM) were developed, coded, and ordered randomly. For each slide, cells were interpreted as typical or atypical lymphocytes by seven pathologists. Atypical epidermal lymphocytes were judged to be present in 9 +/- 2 out of 16 (56%) cases of mycosis fungoides photographed as compared with 8 +/- 3 out of 16 (50%) in spongiotic dermatitis. Dermal lymphocytic atypia was thought to be present in 14 +/- 6 out of 30 (47%) patients with mycosis fungoides. Thirteen +/- 6 out of 30 (43%) patients with non-mycosis fungoides also displayed dermal lymphocytic atypia. No statistical significance was observed in these comparisons (t test, P >.05). Furthermore, atypia of lymphocytes was deemed to be present in 41, 38, 59, 70, 23, 47, and 40 out of 92 slides examined by the investigators, suggesting that observer variation is a very significant factor in our present study. We conclude that it is not possible to distinguish mycosis fungoides from spongiotic dermatitis merely based on lymphocytic atypia within epidermis or dermis.
蕈样肉芽肿早期的临床表现可能在临床和组织学上与许多良性炎症性皮肤病相似。因此，蕈样肉芽肿的诊断对皮肤科医生和皮肤病理学家来说仍然是一项重大挑战。多年来，一直有人提出表皮内的非典型淋巴细胞是蕈样肉芽肿的诊断特征之一。真皮内非典型淋巴细胞作为诊断标准仍存在争议。我们重新评估了将表皮和真皮内淋巴细胞异型性作为区分蕈样肉芽肿和海绵状皮炎诊断标准的可行性。从存档的苏木精和伊红染色组织切片中检索出30例蕈样肉芽肿和30例海绵状皮炎病例。通过光学显微镜检查打孔活检切片；在1000倍（油浸）下拍摄表皮和真皮淋巴细胞照片。共冲洗出92张（35毫米）彩色反转片，编码并随机排序。由七位病理学家将每张切片上的细胞解读为典型或非典型淋巴细胞。在拍摄的16例蕈样肉芽肿病例中，9±2例（56%）被判定存在非典型表皮淋巴细胞，而在海绵状皮炎的16例病例中，8±3例（50%）存在非典型表皮淋巴细胞。30例蕈样肉芽肿患者中有14±6例（47%）被认为存在真皮淋巴细胞异型性。30例非蕈样肉芽肿患者中也有13±6例（43%）表现出真皮淋巴细胞异型性。这些比较中未观察到统计学意义（t检验，P>.05）。此外，在研究者检查的92张切片中，分别有41、38、59、70、23、47和40张被判定存在淋巴细胞异型性，这表明观察者差异在我们目前的研究中是一个非常重要的因素。我们得出结论，仅根据表皮或真皮内的淋巴细胞异型性无法区分蕈样肉芽肿和海绵状皮炎。
