The value of morphometry in the ultrastructural diagnosis of Mycosis fungoides.

To assess the value of morphometry in the ultrastructural diagnosis of Mycosis Fungoides (MF), skin biopsy specimens from 43 patients with established MF and 28 with non-MF lymphoid skin infiltration were studied by transmission electron microscopy. Morphometrical measurements were done on the nuclei of the infiltrating lymphoid cells. The study showed that the nuclear contour index (NCI) taken alone has a very poor diagnostic value. A more reliable way to assess morphometrically the nucleus of MF cells is to combine two parameters: the nuclear surface area and the NCI, as proposed by McNutt and his group. Although the sensitivity of this method is only 43% (McNutt et al. obtained a sensitivity of 63%, analyzing a smaller number of patients), it surprisingly has a highly significant prognostic value. Most of the patients classified as positive by this method had a very aggressive course of their disease or died from it, while most of the patients who were considered as negative had an indolent course of disease or were at a stage of remission. It is suggested that other cellular expressions may be of importance in the recognition of MF cells. It is therefore proposed that, in combination with ultrastructural immunocytochemistry, such parameters be assessed. It is hoped that the results of such a study will determine the number of parameters necessary to better recognize MF cells, thus making early diagnosis of the disease possible.