Kandolf Sekulović L, Cikota B, Stojadinović O, Basanović J, Skiljević D, Medenica Lj, Pavlović M, Magić Z
Department of Dermatology and Venereology, Military Medical Academy, 17 Crnotravska, 11000 Belgrade, Serbia.
Acta Dermatovenerol Alp Pannonica Adriat. 2007 Dec;16(4):149-55.
Diagnosing mycosis fungoides (MF) can be challenging in the early stage of the disease because histopathological features may simulate a variety of benign inflammatory skin diseases. Assessment of T-cell clonality was found to be useful in diagnosis and follow-up of patients.
In this study, PCR-based TCRgamma gene rearrangement analysis was performed in skin and peripheral blood samples of patients with MF treated at the two largest referral centers in Serbia, and the results obtained were correlated with clinical and follow-up data.
Skin and peripheral blood samples were obtained with informed consent from 37 patients treated at the Department of Dermatology of the Military Medical Academy and the Medical Center of Serbia from 2001 to 2006. The median time of follow-up was 4 years. Multiplex PCR was used for TCRgamma gene rearrangement analysis in skin and peripheral blood samples. Clonality results were correlated with the clinical data and disease course data.
Monoclonality was detected in skin samples of 30/37 patients (81%), in 2/5 patients with large-plaque parapsoriasis (LPP), in 28/32 (88%) patients with histologically proven MF, and in 1/16 (6%) patients with benign inflammatory dermatoses. A monoclonal pattern in both skin and peripheral blood was detected in 7/16 (44%) patients in the late stage of the disease, and in 1/7 (14%) patients in the early stage of the disease. A dominant clone was found in both skin and peripheral blood in 1/4 patients in remission, 2/5 with a stable disease, and 4/9 (44%) with disease progression.
TCR-gamma gene rearrangement analysis can be regarded as a useful adjunct to diagnosis of epidermotropic lymphoproliferative disorders. The presence of a dominant clone in both the skin and peripheral blood was more frequently detected in late stages and in patients with disease progression, confirming the usefulness of clonality detection by TCR-gamma gene rearrangement analysis in follow-up of patients with primary cutaneous T-cell lymphomas.
蕈样肉芽肿（MF）在疾病早期的诊断具有挑战性，因为组织病理学特征可能类似于多种良性炎症性皮肤病。T细胞克隆性评估被发现对患者的诊断和随访有用。
在本研究中，对塞尔维亚两个最大的转诊中心接受治疗的MF患者的皮肤和外周血样本进行基于PCR的TCRγ基因重排分析，并将获得的结果与临床和随访数据相关联。
2001年至2006年期间，在获得知情同意后，从军事医学科学院皮肤科和塞尔维亚医疗中心治疗的37例患者中获取皮肤和外周血样本。随访的中位时间为4年。采用多重PCR对皮肤和外周血样本进行TCRγ基因重排分析。克隆性结果与临床数据和疾病病程数据相关联。
在30/37例患者（81%）的皮肤样本中检测到单克隆性，在2/5例大斑块副银屑病（LPP）患者中，在28/32例（88%）组织学证实为MF的患者中，以及在1/16例（6%）良性炎症性皮肤病患者中检测到单克隆性。在疾病晚期的7/16例（44%）患者和疾病早期的1/7例（14%）患者中，在皮肤和外周血中均检测到单克隆模式。在1/4例缓解期患者、2/5例病情稳定患者和4/9例（44%）病情进展患者的皮肤和外周血中均发现了优势克隆。
TCR-γ基因重排分析可被视为诊断亲表皮性淋巴增殖性疾病的有用辅助手段。在疾病晚期和病情进展的患者中，更频繁地在皮肤和外周血中检测到优势克隆，证实了通过TCR-γ基因重排分析检测克隆性在原发性皮肤T细胞淋巴瘤患者随访中的有用性。
