Nickoloff B J
Department of Pathology, University of Michigan Medical School, Ann Arbor 48109-0602.
Am J Dermatopathol. 1988 Dec;10(6):469-77. doi: 10.1097/00000372-198812000-00001.
The light-microscopic recognition of patch/plaque stages of mycosis fungoides is difficult, but remains as the "gold standard" for the diagnosis of mycosis fungoides (MF). A review of previous publications concerning the light-microscopic histological criteria for recognition of MF is followed by a summary of our recent histological findings involving 100 patients. The quantitative histological assessment included 13 different parameters for each case of patch/plaque-stage disease. The different criteria included parakeratosis, acanthosis, density of upper dermal mononuclear cell infiltrate, degree of lymphocyte atypia, degree of epidermotropism, Pautrier microabscess formation, band-like pattern, presence of basal vacuolar change, spongiosis, papillary dermal fibrosis, presence of eosinophils, and presence of plasma cells. The most significant histological features of patch/plaque-stage MF are: 1. Broad zones of epidermis in which lymphocytes, which are usually not markedly atypical, are in close apposition to basal and lower-level keratinocytes predominantly as single cells in a somewhat linear configuration on the epidermal side of the dermal-epidermal junction. In general, the surrounding keratinocytes do not display any cytopathic changes, i.e., basal vacuolar degeneration or apoptosis. 2. The papillary dermis contains a variably dense mono-nuclear cell infiltrate that is usually polymorphous and in which there is papillary dermal fibrosis with plasma cells and eosinophils. 3. Pautrier microabscesses are only present in the minority of cases of MF. Representative "threshold" cases of the earliest recognizable diagnostic cases of MF are illustrated. A pragmatic diagnostic approach to patients presenting with a clinical picture suggesting MF is outlined. The potential usefulness of additional ancillary diagnostic techniques such as immunoperoxidase frozen-section stains and T-cell-receptor gene rearrangements are briefly reviewed.
蕈样肉芽肿斑块/斑片期的光镜识别具有一定难度，但仍是蕈样肉芽肿（MF）诊断的“金标准”。本文先回顾了以往有关MF光镜组织学诊断标准的文献，随后总结了我们近期对100例患者的组织学研究结果。对斑块/斑片期疾病的每例患者进行了13项不同参数的定量组织学评估。不同的标准包括角化不全、棘层肥厚、真皮浅层单核细胞浸润密度、淋巴细胞异型程度、亲表皮程度、Pautrier微脓肿形成、带状模式、基底空泡改变、海绵形成、乳头真皮纤维化、嗜酸性粒细胞的存在以及浆细胞的存在。斑块/斑片期MF最显著的组织学特征为：1. 表皮的广泛区域，其中淋巴细胞通常无明显异型性，主要以单细胞形式在真皮 - 表皮交界处的表皮侧与基底及较低层角质形成细胞紧密相邻，呈某种线性排列。一般来说，周围的角质形成细胞不显示任何细胞病变改变，即基底空泡变性或凋亡。2. 乳头真皮含有密度不一的单核细胞浸润，通常呈多形性，其中存在伴有浆细胞和嗜酸性粒细胞的乳头真皮纤维化。3. Pautrier微脓肿仅在少数MF病例中出现。文中展示了最早可识别的MF诊断病例的代表性“阈值”病例。概述了对临床表现提示为MF患者的实用诊断方法。简要回顾了免疫过氧化物酶冰冻切片染色和T细胞受体基因重排等其他辅助诊断技术的潜在用途。
