The histopathological picture of mycosis fungoides can be characterized by heavy reactive infiltrates. These are rarely composed of B lymphocytes with formation of reactive follicles.
Methods and study design
We collected three cases of mycosis fungoides with a reactive B-cell lymphofollicular reaction at the bottom of the epidermotropic infiltrate.
Results
Case 1 showed flat lesions (patches) with a CD4+ neoplastic phenotype; case 2 presented infiltrated lesions (plaques) with a CD8+ immonophenotype; case 3 was characterized by nodular lesions (tumors) with a CD4+ neoplastic component. In all three cases, no clonal gene rearrangement was found with the polymerase chain reaction technique.
Conclusions
Among the protean clinicopathological features which mycosis fungoides can show, we underline that a B-cell lymphofollicular component can be encountered at the base of the epidermotropic infiltrate even in clinically flat (“patchy”) lesions.
ArgenyiZ.B., GoekenJ.A., PietteW.W., MadisonK.C.: Granulomatous mycosis fungoides: Clinicopathologic study of two cases. Am J Dermatopathol, 14: 200–210, 1992.
2.
Le BoitP.E.: Granulomatous slack skin. Dermatol Clin, 12: 375–389, 1994.
3.
SuL.D., KimY.H., LeBoitP.E., SwetterS.M., KohlerS.: Interstitial mycosis fungoides, a variant of mycosis fungoides resembling granuloma annulare and inflammatory morphea. J Cutan Pathol, 29: 135–141, 2002.
4.
GeramiP., GuitartJ.: The spectrum of histopathologic and immunohistochemical findings in folliculotropic mycosis fungoides. Am J Surg Pathol, 31: 1430–1438, 2007.
5.
ScarabelloA., LeinweberB., ArdigòM., RuettenA., FellerA.C., KerlH., CerroniL.: Cutaneous lymphomas with prominent granulomatous reaction. A potential pitfall in the histopathologic diagnosis of cutaneous T- and B-cell lymphomas. Am J Surg Pathol, 26: 1259–1268, 2002.
6.
El Shabrawi-CaelenL., KerlH., CerroniL.: Lymphomatoid papulosis: reappraisal of clinicopathologic presentation and classification into subtypes A, B, and C. Arch Dermatol, 140: 441–447, 2004.
7.
TakinoH., LiC., HuS., KuoT.T., GeissingerE., Muller-HermelinkH.K., KimB., SwerdlowS.H., InagakiH.: Primary cutaneous marginal zone B-cell lymphoma: a molecular and clinicopathological study of cases from Asia, Germany, and the United States. Mod Pathol, 21: 1517–1526, 2008.
8.
SanderC.A., KaudewitzP., KutznerH., SimonM., SchirrenC.G., SioutosN., CossmanJ., PlewigG., KindJ., JaffeE.S.: T-cell-rich B-cell lymphoma presenting in skin. A clinicopathologic analysis of six cases. J Cutan Pathol, 23: 101–108, 1996.
9.
van der PutteS.C.J., ToonstraJ., van WichenD.F.: B cells and plasma cells in mycosis fungoides. A study including cases with B cell follicle formation or a monotypic plasma cell component. Am J Dermatopathol, 1: 509–516, 1989.
TokJ., SzabolcsM.J., SilversD.N., ZhongJ., MatsushimaA.Y.: Detection of clonal T-cell receptor gamma chain gene rearrangements by polymerase chain reaction and denaturing gradient gel electrophoresis (PCR/DGGE) in archival specimens from patients with early cutaneous T-cell lymphoma: correlation of histologic findings with PCR/DGGE. J Am Acad Dermatol, 38: 453–460, 1998.
KimY.H., LiuH.L., Mraz-GerhardS., VargheseA., HoppeR.T.: Long-term outcome of 525 patients with mycosis fungoides and Sézary's syndrome: clinical prognostic factors and risk for disease progression. Arch Dermatol, 139: 857–866, 2003.
15.
FerraraG., Di BlasiA., ZalaudekI., ArgenzianoG., CerroniL.: Regarding the algorithm for the diagnosis of early mycosis fungoides proposed by the International Society for Cutaneous Lymphomas: suggestions from routine histopathology practice. J Cutan Pathol, 35: 549–553, 2008.
KazakovD.V., BurgG., DummerR., KempfW.: Cutaneous lymphomas and pseudolymphomas: newly described entities. Recent Results Cancer Res, 160: 283–293, 2002.
18.
AraiE., ShimizuM., HiroseT.: A review of 55 cases of cutaneous lymphoid hyperplasia: reassessment of the histopathologic findings leading to reclassification of 4 lesions as cutaneous marginal zone lymphoma and 19 as pseudolymphomatous folliculitis. Hum Pathol, 36: 505–511, 2005.
19.
KimB.K., SurtiU., PandyaA., CohenJ., RabkinM.S., SwerdlowS.H.: Clinicopathologic, immunophenotypic, and molecular cytogenetic fluorescence in situ hybridization analysis of primary and secondary cutaneous follicular lymphomas. Am J Surg Pathol, 29: 69–82, 2005.
20.
AssafC., GellrichS., WhittakerS., RobsonA., CerroniL., MassoneC., KerlH., RoseC., ChottA., ChimentiS., HallermannC., PetrellaT., WechslerJ., BagotM., HummelM., Bullani-KerlK., BekkenkM.W., KempfW., MeijerC.J., WillemzeR., SterryW.: CD56-positive haematological neoplasms of the skin: a multicentre study of the Cutaneous Lymphoma Project Group of the European Organisation for Research and Treatment of Cancer. J Clin Pathol, 60: 981–989, 2007.
21.
SandbergY., HeuleF., LamK., LugtenburgP.J., Wolvers-TetteroI.L., van DongenJ.J., LangerakA.W.: Molecular immunoglobulin/T cell receptor clonality analysis in cutaneous lymphoproliferations. Experience with the IOMED-2 standardized polymerase chain reaction protocol. Haematologica, 88: 659–670, 2003.
22.
MoralesA.V., ArberD.A., SeoK., KohlerS., KimY.H., SundramU.N.: Evaluation of B-cell clonality using the BIOMED-2 PCR method effectively distinguishes cutaneous B-cell lymphoma from benign lymphoid infiltrates. Am J Dermatopathol, 30: 425–430, 2008.
