Beiser Ian, Yim Joon, Robles-Sherman Erin, Mirkin Gene S, Hao Xingpei
Department of Podiatry, Foot and Ankle Specialists of The Mid-Atlantic, LLC, Rockville, MD, USA.
Department of Pathology, Foot and Ankle Specialists of The Mid-Atlantic, LLC, Rockville, MD, USA.
Am J Case Rep. 2020 Sep 18;21:e923361. doi: 10.12659/AJCR.923361.
BACKGROUND Mycosis fungoides palmaris et plantaris (MFPP) is a rare variant of the cutaneous T cell lymphoma mycosis fungoides (MF). Here we report the case of a middle-aged man with MF on the sole of his left foot. CASE REPORT A 54-year-old man had a diffuse, hard lesion in the middle of the arch on the sole of his left foot for 3 years. Physical examination revealed a 3-cm scaly, keratotic patch with slight erythema on the left plantar central arch. Histopathological evaluation of a punch biopsy specimen revealed infiltration of atypical lymphocytes in the upper dermis. Immunostaining of the atypical lymphocytes showed strong expression of CD3, CD4, and CD5; reduced expression of CD7 and CD8; and no expression of CD20. Periodic acid-Schiff staining was negative for fungi. The patient's lesion was diagnosed as MFPP and he was treated with topical psoralen plus ultraviolet A (PUVA) photochemotherapy. At 5-year follow-up, his condition was in complete remission. CONCLUSIONS MFPP is a rare clinical variant of MF restricted to the palmoplantar area, and is histologically characterized by upper dermal infiltration of atypical lymphocytes with preserved CD3, CD4, and CD5 expression but decreased CD7 and CD8 expression. PUVA photochemotherapy is a treatment option associated with excellent prognosis.
背景 掌跖蕈样肉芽肿（MFPP）是皮肤T细胞淋巴瘤蕈样肉芽肿（MF）的一种罕见变异型。在此我们报告一例中年男性左足底患MF的病例。病例报告 一名54岁男性左足底足弓中部出现弥漫性硬结病变3年。体格检查发现左足底中央足弓有一个3厘米大小的鳞屑性、角化性斑块，伴有轻度红斑。对穿刺活检标本进行组织病理学评估显示真皮上层有非典型淋巴细胞浸润。对非典型淋巴细胞进行免疫染色显示CD3、CD4和CD5呈强表达；CD7和CD8表达降低；CD20无表达。高碘酸 - 希夫染色真菌呈阴性。该患者的病变被诊断为MFPP，并接受了外用补骨脂素加紫外线A（PUVA）光化学疗法治疗。在5年的随访中，他的病情完全缓解。结论 MFPP是MF一种罕见的临床变异型，局限于掌跖部位，组织学特征为真皮上层有非典型淋巴细胞浸润，CD3、CD4和CD5表达保留，但CD7和CD8表达降低。PUVA光化学疗法是一种预后良好的治疗选择。
