Foo Christopher C I, Tang Mark B Y, Chong Tina K L, Sun Yong-Jiang, Tan Suat-Hoon
National Skin Centre, 1 Mandalay Road, Singapore 308205.
Australas J Dermatol. 2007 Aug;48(3):156-60. doi: 10.1111/j.1440-0960.2007.00370.x.
The diagnosis of cutaneous T-cell lymphoma is often a challenge for the dermatopathologist. Early stages can mimic inflammatory dermatoses. Our aim was to explore the applicability of a standard T-cell receptor-gamma polymerase chain reaction in various subtypes of cutaneous T-cell lymphomas. Ninety-six biopsy specimens from 38 patients were selected. These included 72 specimens of mycosis fungoides, 12 specimens of non-mycosis fungoides T-cell lymphomas, and 12 specimens in which histology was non-specific or equivocal in patients who were later diagnosed to have lymphoma. T-cell clones were detected in 53 of 72 specimens of mycosis fungoides and eight of 12 specimens of non-mycosis fungoides lymphomas. Of the 72 specimens of mycosis fungoides, T-cell clones were detected in eight of 10 specimens of mycosis fungoides-associated follicular mucinosis and pigmented purpura-like mycosis fungoides. Four specimens from the 12 prediagnostic for cutaneous T-cell lymphomas showed presence of T-cell clones, identical to subsequent clones detected when lymphoma was fully established. In specimens where histology is not diagnostic and T-cell receptor-gamma gene analysis is positive, patients should be followed up closely. T-cell receptor-gamma gene analysis is a useful adjunct to histological diagnosis of early stage and variant types of mycosis fungoides.
皮肤T细胞淋巴瘤的诊断对皮肤病理学家来说常常是一项挑战。早期阶段可能类似于炎症性皮肤病。我们的目的是探讨标准T细胞受体γ聚合酶链反应在各种亚型皮肤T细胞淋巴瘤中的适用性。从38例患者中选取了96份活检标本。其中包括72份蕈样肉芽肿标本、12份非蕈样肉芽肿T细胞淋巴瘤标本，以及12份组织学表现为非特异性或不明确的标本，这些患者后来被诊断为淋巴瘤。在72份蕈样肉芽肿标本中的53份以及12份非蕈样肉芽肿淋巴瘤标本中的8份检测到了T细胞克隆。在72份蕈样肉芽肿标本中，10份蕈样肉芽肿相关滤泡性粘蛋白病和色素性紫癜样蕈样肉芽肿标本中的8份检测到了T细胞克隆。12份皮肤T细胞淋巴瘤诊断前标本中的4份显示存在T细胞克隆，与淋巴瘤完全确诊时检测到的后续克隆相同。在组织学诊断不明确且T细胞受体γ基因分析呈阳性的标本中，应对患者进行密切随访。T细胞受体γ基因分析是早期和变异型蕈样肉芽肿组织学诊断的有用辅助手段。
