Even when the clinical appearance of the lesions strongly suggests MF, a biopsy may not papillomatous epidermal hyperplasia histologic proof in favor of this diagnosis. The reasons may include, among others, the paucity and low frequency of anecdotic histopathologic criteria associated with MF, namely epidermotropism, Pautrier microabscesses and lymphocytes with cerebriform nuclei, the possibility that the biopsy site might be unrepresentative for the whole rash, or even the fact that MF infiltrates can masquerade as different reactive conditions that share similar patterns of inflamation, such as psoriasiform, lichenoid or eczematous diseases.
Vice versa, even when classical clues of MF are present in a given specimen, their interpretation has to be carefully made, since various reactive inflammatory conditions have been reported to share similar histopathologic features with early MF, such as drug-induced T-cell pseudolymphoma 89lichen sclerosus et atrophicus 10persistent pigmented purpuric dermatoses 11actinic reticuloid 12eczematous papillomatous epidermal hyperplasia 1314lymphomatoid contact dermatitis 15benign lichenoid keratosis 16connective tissue disease 17and skin infections and infestations 1819among others.
In our study, we tried to papillomatous epidermal hyperplasia assess the frequency of occurrence of different histopathologic criteria in biopsies from early lesions of MF, respectively from various entities that microscopically mimick MF.
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In the category of epidermal reaction Figure 1 we investigated the appearance of spongiosis, psoriasiform hyperplasia, flatulenta bebe dermatitis, epidermal atrophy and the presence of elongated mounds of parakeratosis. A significant difference between MF and mimickers group was recorded for the presence of psoriasiform hyperplasia In our opinion, this finding signifies a relative lack of epidermal reactivity as a response to the presence of lymphomatous infiltrate.
When occured in MF cases, psoriasiform hyperplasia was rather irregular, lichen simplex chronicus-like, and was associated in a large proportion with a dense, band-like dermal infiltrate, finding which represents a combined psoriasiform and lichenoid pattern, as previousely described for MF Parakeratosis, manifested as a thin, long band on top of the affected epidermis, was observed more frequently with MF biopsies Focal spots of parakeratosis manifested as isolated columns and mounds of parakeratosis were papillomatous epidermal hyperplasia oftenly seen in the control group, but this feature was not recorded when parakeratosis band was not continuous over at least one quarter of biopsy section.
In other words, spongiosis was a rather common event in early MF. This finding suggests that, when detected in biopsies for clinical suspicion of early MF, a low degree of spongiosis papillomatous epidermal hyperplasia not be the papillomatous epidermal hyperplasia criterion for MF exclusion.
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Figure 1. To be able to quantify the degree of epidermotropism, we looked for various patterns described before in patch and plaque-type MF 2122like the presence of lymphocytes aligned along the basal layer of the epidermis basilar lymphocytesa diffuse spread of lymphocytes into the epidermis pagetoid lymphocytesthe presence of lymphocytes in clusters larger than 3 cells Pautrier microabscesses and areas of spongiosis where exocytosis papillomatous epidermal hyperplasia lymphocytes overwhelms the degree of intercellular edema usually seen with spongiotic dermatitides dysproportionate exocytosis Figure 2.
A noteworhty feature was the occurrence of dysproportionate exocytosis in MF cases as compared to mimickers This finding correlates with the frequency of spongiosis detected in MF cases. In the same time it confirms that spongiosis may not be a truly exceptional event in early MF, but when joined by a dysproportionate number of lymphocytes papillomatous epidermal hyperplasia the epidermis, it may even be a feature of MF. Another notable observation regards the presence of Pautrier microasbscesses, defined as collections of intraepidermal lymphocytes devoid of spongiosis.
Their presence correlates well with MF, papillomatous epidermal hyperplasia this feature was recorded in none of the control cases.
They represent clusters of Langerhans cells that have been described before as pseudo-Pautrier abscesses, and usually appear in association with inflammatory papillomatous epidermal hyperplasia Their occurrence should not be regarded as a histopathologic clue for MF.
Besides their cytologic features, the pseudo-Pautrier collections commonly develop in a background of papillomatous epidermal hyperplasia, a feature that may help in their discrimination from real Pautrier microabscesses, which are devoid of spongiosis.
Although traditionally linked to cutaneous lym- Figure 2. Atypical MF lymphocytes have been clasically described as having a convoluted, cerebriform nucleus, sometimes large, hyperchromatic, with a perinuclear halo.
We tried to independently asses all these features in our papillomatous epidermal hyperplasia, and observed that less than one quarter of MF cases showed at least one form of lymphoid atypia Figure 3.
The single most frequent atypical feature in the control group was the perinuclear halo, which can be possibly interpreted as a processing artefact.
Condyloma acuminata cmu with hyperchromasia, it had no discriminatory value between MF and mimicker groups. Cerebriform cells, despite being classicaly related to MF, were spotted in just two cases of our study, suggesting that their appearance is an exceptionally rare event in practice.
One reason for that may be of technical nature, since cell morphology can papillomatous epidermal hyperplasia influenced by section thickness, tissue processing protocol, staining etc. The occurrence of hypertrophic lymphocytes was the most reliable feature of papillomatous epidermal hyperplasia, reaching statistical significance Lymphocyte atypia in MF: a Hypertrophic and hyperchromatic tumoral lymphocytes at the dermalepidermal junction; b Cerebriform lymphocytes in dermal infiltrate.
We defined dermal reaction as changes induced by the presence of lymphoid infiltrate and included in this category some features such as papillary dermal fibrosis, papillary dermal edema, purpura and pigmented macrophages melanophages and siderophages Figure 4.
It might be determined by the interaction of tumoral cells and their cytokine secretion with matrix proteins and matrix remodelation Edema of the papillary dermis was deemed unusual in MF by other investigators, although it was recorded in some of our MF cases.
For example, in the largest series of MF cases to date, Massone et al. The presence of papillary dermal edema in All other dermal reaction changes did not reach statistical significance between the groups. An interesting finding is the occurence of extravazated erythrocytes and siderophages in some early MF cases, usually those cases with poikilodermatous changes.
Purpura was seen with similar frequency in both our groups. When attempting a histopathologic diagnosis, the presence of siderophages naturally brings into question the possibility of a pigmented purpuric dermatosis PPD. In some patients, MF and PPD have been shown to coexist 29a finding challenged by other investigators 11 MF in appropriate clinical setting.
But similar patterns of inflamation can be manifested in cutaneous biopsies papillomatous epidermal hyperplasia secondary syphilis, actinic reticuloid, lichen papillomatous epidermal hyperplasia chronicus among others, thus the architectural criteria alone are insufficient for the diagnosis of MF On the other hand, a strictly perivascular infiltrate is rather common in reactive dermatoses and make MF unlikely, unless epidermotropic features or atypical lymphocytes are obvious.
When looking at the composition of dermal infiltrate, there were 6 biopsies in MF group Similarly, eosinophils were recorded in There was no statistical difference between gropus, meaning that the presence of low numbers of eosinophils in the dermal infiltrate could not be used as a histopathologic criterion to certainly rule out early MF.
None of the mimicker cases showed higher number of eosinophils. A reason for the relative paucity of eosinophils in the mimickers group might be the fact that cases with overtly more eosinophils in the infiltrate were not selected, because they papillomatous epidermal hyperplasia not fulfill the criteria of histopathological mimickers of MF.
Contrary to our finding, Dalton et al. An argument for the presence of eosinophils in some of our early MF lesions might be unknown previous treatment of lesions with topical agents, Figure 4.
Regarding the distribution of the dermal infiltrate Figure 5the lichenoid pattern defined as a dense, band-like infiltrate in the upper dermis correlated well with MF papillomatous epidermal hyperplasia The presence of a dense lichenoid infiltrate usually explains the palpable nature of the plaquetype MF lesions, and when seen in biopsies along with other architecutral changes, like psoriasiform epidermal hyperplasia, can be highly indicative of Figure 5. All subtypes of epidermotropism gained high specificity for early MF, but their sensitivity was usually low to be used as pivotal diagnostic criteria.
Although, in theory, lymphocyte atypia is traditionally considered a valid histopathologic clue for cutaneous lymphoma, the occurrence of cytologic features may vary depending on tissue processing and staining protocols.
Additionally, our study showed that morphologic criteria routinely assigned to reactive conditions, such as spongiosis, eosinophils and enterobius vermicularis reservoir with siderophages, were present in similar degrees in both case groups and may not allow differentiation of MF from mimickers.
Despite recent advancements in the field of cutaneous lymphoma, evaluating biopsies from suspected cases of MF in its early stages and rendering a definitive diagnosis remain challenging tasks. Provided the biopsy is accompanied by comprehensive clinical history, good description of the lesions, clinical pictures and efficient communication with reffering physician, we believe that a diagnosis of MF can be made with confidence.
In certain cases, intraductal papilloma male, relying just on histopathologic criteria might prove erroneous, since there is no single criterion sensitive and specific enough to discriminate between early MF and a pletora of reactive inflammatory rashes.
This work is licensed under a Creative Commons Papillomatous epidermal hyperplasia 4. Cutaneous lymphoma incidence patterns in the United States: a population-based study of cases.
Stage I mycosis fungoides: frequent association with a favourable prognosis but disease progression and disease-specific mortality may occur. Br J Dermatol. Mycosis fungoides: a dermatological masquerader. Br J Dermatol ; 4. Am J Clin Pathol ; 5.
Curs Engleza Partea 2 Corectat.lari
Regarding the algorithm papillomatous epidermal hyperplasia the diagnosis of early mycosis fungoides proposed by the International Society for Cutaneous Lymphomas: suggestions from routine histopathology practice. J Cutan Pathol ; 6. Defining early mycosis fungoides. J Am Acad Dermatol. Early-stage mycosis fungoides variants: case-based review. Ann Diagn Pathol ; 8. Mycosis fungoides-like reaction in a patient treated with Gleevec.
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Mycosis fungoides-like lesions associated with phenytoin therapy. Arch Dermatol ; Lichen sclerosus with histopathologic features simulating early mycosis fungoides. Am J Dermatopathol ; Persistent pigmented purpuric dermatitis and mycosis fungoides: simulant, precursor, or both? A study by papillomatous epidermal hyperplasia microscopy and molecular methods.
Differentiation between actinic reticuloid and cutaneous T cell lymphoma by T cell receptor gamma gene rearrangement analysis and immunophenotyping. J Clin Pathol ; Spongiotic simulants papillomatous epidermal hyperplasia mycosis fungoides. Fisher AA.
Allergic contact dermatitis mimicking mycosis fungoides. Cutis ; Lymphomatoid contact dermatitis: a syndrome produced by epicutaneous hypersensitivity with clinical features and a histopathologic picture similar to that of mycosis fungoides.
Contact Dermatitis ; 2: Benign lichenoid keratoses with histologic features of mycosis fungoides: clinicopathologic description of papillomatous epidermal hyperplasia clinically significant histologic pattern.
J Cutan Pathol ; Atypical lymphoid infiltrates arising in cutaneous lesions of connective tissue disease. Mycosis on mycosis fungoides: zoophilic dermatophytosis selectively superimposed on preexisting cutaneous T-cell lymphoma mycosis fungoides plaques.
Mycoses ; Br J Dermatol ; The patch stage of mycosis fungoides: criteria for histologic diagnosis. Am J Surg Pathol.
Histopathologic features of early patch lesions of mycosis fungoides: a morphologic study on biopsy specimens from patients. Nonlymphoid intraepidermal mononuclear papillomatous epidermal hyperplasia collections pseudo-Pautrier abscesses : a morphologic and immunophenotypical characterization. Am J Dermatopathol. Efficacy of histologic criteria for diagnosing early mycosis fungoides: an EORTC cutaneous lymphoma study group investigation.
European Organization for Research and Treatment of Cancer. Reassessment of histologic parameters in the diagnosis of mycosis fungoides.
Non specificity of characteristic cells in mycosis fungoides. Arch Dermatol.
digitaţie epitelia-lă, epiteliul epithelial peg
Nickoloff BJ. Progression of mycosis fungoides is associated with changes in angiogenesis and expression of the matrix metalloproteinases 2 and 9. Eur J Cancer. Persistent pigmented purpuric eruption associated with mycosis fungoides: a case report and review of the literature.
J Eur Acad Dermatol Venereol. Lichen aureus: clinicopathologic features, natural history, and relationship to mycosis fungoides. Reddy K, Bhawan J. Histologic mimickers of mycosis fungoides: a review. J Cutan Pathol. Eosinophils in mycosis fungoides: an uncommon finding in the patch and plaque stages. Open Access Article Abstract Keywords: trichodystrophies, scanning electron microscopy, reflectance confocal microscopy, trichoscopy.
High resolution imaging tehniques for trichodystrophies in Netherton syndrome. This hair shaft anomaly is not constantly present and it can be associated with other anomalies like trichorrhexis nodosa or pili torti.
Methods: We retrospectively analyzed hair samples from patients diagnosed with NS over the past 10 years in the Dermatology Clinic Timisoara by papillomatous epidermal hyperplasia scanning electron microscopy.
The samples were papillomatous epidermal hyperplasia scalp hair, eyebrows, eyelashes and pubic hair.
We also evaluated some of these samples with trichoscopy and confocal microscopy. Results: The scanning electron microscopy results showed that trichorrhexis invaginata was evident in all cases, followed by trichorrhexis nodosa and pili torti respectively.
In these patients there was more than one type of trichodystrophy present at the same time. All of these modifications were perceptible with the confocal scanning microscope and by trichoscopy.
Discussion: The electron microscopy helps by supplying papillomatous epidermal hyperplasia images of the hair shaft, thus enabling the observation of the hair samples with a greater clarity and sharpness than through classical methods. Also reflectance confocal microscopy and trichoscopy have proven to be very useful in the diagnosis of hair shaft anomalies.
Introducere: Tricorexis invaginata este tricodistrofia patognomonică pentru sindromul Netherton. Aceasta nu este prezentă în mod constant și poate fi asociată cu alte anomalii ale firului de păr, cum ar fi tricorexis nodosa sau human papillomavirus of cancer torti.
Metode: Prin folosirea microscopiei electronice, am analizat mostre de fire de păr provenite de la pacienți diagnosticați cu sindrom Netherton în Clinica de Papillomatous epidermal hyperplasia Timișoara în ultimii 10 ani. Acestea au fost prelevate atat de la nivelul scalpului cat și sprâncenelor, genelor și părului pubian. Unele dintre aceste mostre au fost analizate și prin tricoscopie și microscopie confocală.
Rezultate: Tricorexis invaginata a fost prezentă la toți pacienții, fiind urmată ca frecvență de tricorexis invaginata și pili torti. Papillomatous epidermal hyperplasia acești pacienți aceste modificări s-au asociat în diferite combinații.
Toate aceste modificări au putut fi identificate și prin tricoscopie și microcopie confocală. Concluzii: Microscopia electronică de baleiaj ajută în identifica rea acestor modificări deoarece oferă o imagine tridimensională, mai clară și mai exactă decât metodele clasice.
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De asemenea, microscopia confocală și tricoscopia și-au dovedit utilitatea în diagnosticul tricodistrofiilor. Introduction Netherton syndrome NS is a rare autosomal recessive genodermatoses caused by loss-of-function mutations in a SPINK5 gene serine protease inhibitor of kazal type 5 situated on chromosome 5q This gene encodes LEKTI-1 lympho-epithelial kazal type related inhibitor expressed in stratified epithelia 1.
From the clinical point of view, it is characterized by severe skin inflammation and scaling ichthyosiform erythroderma in newborns or ichthyosis linearis circumflexaa specific hair shaft defect and atopic diathesis. The atopic manifestations are present in most cases, represented by: atopic dermatitis, asthma, angioedema, urticaria, high levels of IgE and hypereosinophilia 3,4.