1/14. Recalcitrant tinea corporis as the presenting manifestation of patch-stage mycosis fungoides.mycosis fungoides is a cutaneous T-cell lymphoma. Its presence, which denotes an altered immune system, may make treatment of otherwise simple cutaneous infections difficult. In the case presented here, a patient with widespread tinea corporis poorly responsive to several oral antifungals was noted as having a background poikilodermatous slightly scaly eruption. Results of a skin biopsy during therapy with oral antifungal medications showed evidence of tinea corporis; atrophy of the epidermis; a superficial, perivascular, and interstitial lymphocytic infiltrate with numerous atypical lymphocytes; and exocytosis of atypical lymphocytes into the epidermis with formation of microabscesses-findings consistent with the diagnosis of mycosis fungoides. Treatment with PUVA (oral psoralen and UVA light) and oral itraconazole led to long-term remission of the mycosis fungoides and the associated tinea corporis. Immune suppression may have contributed to the recalcitrant nature of our patient's dermatophyte infection. Underlying cutaneous, systemic, or iatrogenic disorders associated with immune dysfunction should be considered in patients with recalcitrant dermatophyte infections.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |
2/14. Purely follicular mycosis fungoides without mucinosis: report of two cases with review of the literature.Follicular lesions can either associate with typical patch-/plaque-type mycosis fungoides or, more rarely, be the only clinical manifestation of the disease. We describe 2 adult patients who presented with alopecia and disseminated follicular erythematous papules, and comedones and cysts, respectively. In both patients, histology showed a folliculotropic infiltrate of atypical lymphocytes that spared the epidermis, in the absence of follicular mucinosis. Molecular genetic analysis confirmed the oligo/monoclonal nature of the T-cell infiltrate. Reported cases of purely follicular mycosis fungoides without mucinosis are reviewed.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |
3/14. lymphomatoid papulosis associated with recurrent cutaneous T-cell lymphoma.INTRODUCTION: lymphomatoid papulosis is a chronic benign disease which may be associated with malignant lymphomas. This case illustrates the relapsing and remitting nature of both lymphomatoid papulosis and its potential of developing cutaneous T-cell lymphoma and narrow-band ultraviolet B (NB-UVB) phototherapy as a new modality of treatment of early-stage mycosis fungoides in these patients. CLINICAL PICTURE: A 44-year-old woman has had recurrent crops of papules and nodules of lymphomatoid papulosis on the limbs for 15 years. Histological features are consistent with the type B lesions of lymphomatoid papulosis. Eight years after the initial onset of these lesions she developed cutaneous T-cell lymphoma (mycosis fungoides). Since then, she has had recurrence of mycosis fungoides following the cessation of phototherapy, but had no evidence of systemic involvement. TREATMENT: The lesions of lymphomatoid papulosis responded to intermittent courses of oral methotrexate. mycosis fungoides was treated with oral psoralen and ultraviolet A phototherapy with good response. Unfortunately, the lesions relapsed, whenever phototherapy was discontinued. The most recent recurrence of mycosis fungoides was treated with NB-UVB therapy. OUTCOME: The papules of lymphomatoid papulosis continue to appear but she remains free of lesions of mycosis fungoides, 10 months after cessation of NB-UVB therapy. CONCLUSION: Long-term surveillance is essential in all cases of lymphomatoid papulosis as accurate predictors for the development of malignant lymphoma in these individuals are still lacking.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |
4/14. mycosis fungoides-type cutaneous T-cell lymphoma and neutrophilic dermatosis.BACKGROUND: mycosis fungoides (MF) is the most common type of cutaneous T-cell lymphoma (CTCL). patients with limited patch and/or plaque disease have a normal life expectancy. Neutrophilic dermatosis (ND) may be associated with various hematologic disorders. However, its association with CTCL is exceptional and has been reported only twice with leukemic forms of CTCL. OBSERVATIONS: Three patients with MF developed ND resistant to conventional therapies and responsible for an impaired quality of life due to constitutional symptoms and painful cutaneous lesions. All patients underwent an aggressive treatment course despite their varying initial clinical stages of MF, and all experienced a fatal outcome less than 18 months after the onset of ND. CONCLUSIONS: The association of MF with ND is exceptional and carries a poor prognosis, but the pathophysiologic nature of this association remains unclear. It may involve neutrophil chemoattractant cytokine production by tumor cells. A triggering role of interferon alfa is also possible.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |
5/14. Lesions resembling Langerhans cell histiocytosis in association with other lymphoproliferative disorders: a reactive or neoplastic phenomenon?Langerhans cell histiocytosis (LCH) has been described in association with a variety of neoplasms preceding, after, or synchronous with the other tumor. In some cases, a neoplasm may arise as a complication of therapy for LCH, and in others, the association may be coincidental. Synchronous occurrence has been reported most commonly in association with malignant lymphoma in which discrete proliferations of langerhans cells (LCs) histologically indistinguishable from LCH are seen. In most cases, these LCs are closely related to or intermingling with the primary pathology. The nature of LCs in this context remains elusive with debate as to whether they represent a true clonal neoplasm or an exaggerated reactive phenomenon. The lack of evidence for LCH progression or disease elsewhere strongly supports the latter. We have encountered 5 examples of LCH-like proliferations occurring in the context of other lymphoproliferative disorders. These include 2 cases of mycosis fungoides and 1 of cutaneous B-cell pseudolymphoma, associations that to our knowledge have not been described before. Two patients were female, and the clonality of the LC proliferation was assessed using laser capture microdissection and the human androgen receptor. The results showed that the LCs forming discrete nodules in a case of cutaneous B-cell pseudolymphoma and a case of Hodgkin's lymphoma were polyclonal. This suggests that, at least in a proportion of cases, the aggregates of LCs occasionally identified within other lymphoproliferative lesions represent a reactive proliferation rather than a potentially aggressive second neoplasm.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |
6/14. Cutaneous B-cell lymphoma. An unusual presentation.A patient presented with the clinical and some of the histopathologic findings consistent with a cutaneous T-cell lymphoma. immunophenotyping, however, clearly demonstrated the B-cell nature of the proliferation. This report emphasizes the importance of immunophenotyping in these lesions, particularly since only these studies can definitely characterize these proliferations. Of greater importance is that therapy, clinical course, and prognosis will vary according to the true nature of the lymphoma. The differential diagnosis of pseudolymphoma, B-cell lymphoma, and T-cell lymphoma is also discussed.- - - - - - - - - - ranking = 2keywords = nature (Clic here for more details about this article) |
7/14. Altered CSF protein pattern in a case of mycosis fungoides with nervous system involvement.We report the clinical, neurophysiological and CSF study in a case of mycosis fungoides with nervous system involvement. The CSF contained an abnormal protein of molecular weight 22000 that was not in the patient's serum or in the CSF of control subjects and that disappeared after intrathecal immunosuppressive therapy. The nature of this protein is discussed in the light of hypothesis regarding the pathogenesis of the disease.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |
8/14. pagetoid reticulosis (Woringer-Kolopp disease).Two patients with solitary lesions of pagetoid reticulosis are presented. A third case with disseminated lesions and similar microscopic detail is also reported. Lighg microscopic findings include an abnornal cell infiltrate confined to the epidermis and distributed diffusely in a pagetoid pattern. In ultrathin sections, the abnormal cells are seen to have an abundant cytoplasm with numerous organelles and a convoluted nucleus, often with a prominent nucleolus. The nature of the abnormal cells is discussed. The infiltrate is differentiated from that of mycosis fungoides.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |
9/14. A morphologic study of intracerebral hemorrhage in a case of acute leukemia.Morphologic studies have thus far failed to demonstrate the nature of the vessel involved in the brain hemorrhages of patients with acute leukemia. A detailed study of such hemorrhages was carried out in a patient with leukemic phase of mycosis fungoides. Plastic-embedded lesions showed that blast cells blocked the lumen of the capillary, leading to severe dilation and rupture of the vessel. The rheologic properties of blast cells in vessels of critical diameters seem to be an important factor in the pathogenesis of intracerebral hemorrhages.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |
10/14. Woringer-Kolopp disease: pagetoid reticulosis.A typical clinical and histologic case of so-called 'pagetoid reticulosis' or Woringer-Kolopp disease is reported. This is a chronic cutaneous condition usually with a single focus or at most with a few patches confined to a circumscribed region. A disseminated form has been described as Dupont-Vandaele type, but its relationship to the classic Woringer-Kolopp disease is uncertain. The nosological location of pagetoid reticulosis has not been established, but there are reasons to regard it as a particular and well-defined entity. In relation to the nature of this condition and to the origin of the 'pagetoid cells', it is tempting to consider the possibility that Woringer-Kolopp disease might be a lymphoproliferative epidermotropic disorder, classifiable as a benign form of 'cutaneous T-cell lymphoma', but the early histologic changes are rather indicative of an epidermal origin.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |
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