Kaya Terzi Neslihan
Pathology, Canakkale Onsekiz Mart University, Canakkale, TUR.
Cureus. 2024 Apr 3;16(4):e57545. doi: 10.7759/cureus.57545. eCollection 2024 Apr.
Primary cutaneous lymphomas, notably mycosis fungoides (MF), present diagnostic challenges in recognizing early mycosis fungoides (eMF) due to their diverse clinical and histopathologic manifestations. The aim of our study was to use adjunctive histopathologic and immunohistochemical methods in eMF cases to make an early diagnosis and to facilitate differentiation from other dermatoses.
This retrospective study analyzed 35 cases of eMF diagnosed at a single center. Demographic and clinicopathologic data were collected, and histopathologic features were assessed. Comparative analyses were conducted with conditions mimicking eMF, including large plaque parapsoriasis (LPP), psoriasis, and chronic dermatitis. Immunohistochemistry for T-cell markers (CD3, CD4, CD8, CD2, CD7) was performed.
With the scoring we applied in our study, a sensitivity of 91.43% (95% CI; 76.94% to 98.20%) and specificity of 85.71% (95% CI; 69.74% to 95.19%) for distinguishing eMF from LPP. Epidermotropism emerged as a crucial histopathologic marker, with a notable absence in most cases of cutaneous dermatitis (81.6% and 80% for CD and psoriasis, respectively) (P < 0.001). Immunohistochemistry revealed a T-helper phenotype (CD4+/CD8-) in the majority of eMF cases (78.1%), while CD4+/CD8+ and CD8+/CD4- patterns were less common (28.5% and 8.5%, respectively).
This study underscores the complexities in distinguishing eMF from inflammatory skin diseases, advocating for a comprehensive diagnostic approach.
原发性皮肤淋巴瘤，尤其是蕈样肉芽肿（MF），由于其多样的临床和组织病理学表现，在识别早期蕈样肉芽肿（eMF）时面临诊断挑战。我们研究的目的是在eMF病例中使用辅助组织病理学和免疫组织化学方法进行早期诊断，并促进与其他皮肤病的鉴别。
这项回顾性研究分析了在单一中心诊断的35例eMF病例。收集了人口统计学和临床病理数据，并评估了组织病理学特征。对模拟eMF的疾病进行了比较分析，包括大斑块状副银屑病（LPP）、银屑病和慢性皮炎。进行了T细胞标志物（CD3、CD4、CD8、CD2、CD7）的免疫组织化学检测。
根据我们在研究中应用的评分，区分eMF与LPP的敏感性为91.43%（95%CI；76.94%至98.20%），特异性为85.71%（95%CI；69.74%至95.19%）。亲表皮现象成为一个关键的组织病理学标志物，在大多数皮肤皮炎病例中明显缺乏（分别为81.6%和80%的CD和银屑病）（P<0.001）。免疫组织化学显示，大多数eMF病例（78.1%）为T辅助表型（CD4+/CD8-），而CD4+/CD8+和CD8+/CD4-模式较少见（分别为28.5%和8.5%）。
本研究强调了区分eMF与炎症性皮肤病的复杂性，提倡采用综合诊断方法。
