Basaloid folliculolymphoid hyperplasia: a distinctive finding in follicular mycosis fungoides

Follicular mycosis fungoides is an increasingly recognized subtype of mycosis fungoides. There is great variability in the clinical and histologic presentation of this variant of mycosis fungoides. Epithelial hyperplasia may occur in cutaneous lymphomas, and basaloid induction of the epidermis is a recognized phenomenon in cutaneous neoplasms. We have identified three patients with follicular mycosis fungoides with basaloid folliculolymphoid hyperplasia, a finding that has received little attention in the literature. The patients were all men with prominent follicular papules on the face. We believe that these changes are a distinctive histologic pattern of follicular mycosis fungoides. Hence, we describe the clinical-pathologic findings of basaloid folliculolymphoid hyperplasia in these three patients with follicular mycosis fungoides.     

CD8+ mycosis fungoides clinically masquerading as alopecia areata

A 33‐year‐old female with a 7‐year history of CD8‐positive hypopigmented mycosis fungoides (MF) involving the trunk and extremities presented with a large well‐defined alopecic patch on her frontal scalp. Clinically, this area resembled alopecia areata (AA) and was without hypopigmentation or erythema. A scalp biopsy revealed a non‐scarring inflammatory alopecia and a superficial band‐like atypical lymphoid infiltrate with prominent epidermotropism. Atypical, predominately CD8‐positive lymphocytes were seen surrounding and infiltrating the bulb portion of several hair follicles. Treatments for her MF lesions have included topical bexarotene, topical corticosteroids and phototherapy. Her alopecia has been treated with high potency topical corticosteroids and multiple intralesional triamcinolone injections with very minimal hair regrowth to date. Alopecia due to cutaneous lymphoma is an uncommon phenomenon but can occur in erythrodermic MF or Sezary syndrome. AA‐like changes have most often been reported in conventional patch/plaque stage MF and folliculotropic MF. In these cases, the atypical lymphoid infiltrate is comprised predominately of CD4‐positive lymphocytes. This is a rare report of a CD8‐positive MF causing AA‐like changes. This case highlights the importance of a scalp biopsy in patients with a history of cutaneous lymphoma presenting with alopecia in order to evaluate the nature of their hair loss.     

Ichthyosiform mycosis fungoides with alopecia and atypical membranous nephropathy

We describe here a rare case of variant of mycosis fungoides (MF): ichthyosiform MF with alopecia and atypical membranous nephropathy. The diagnosis was made based on the following findings: generalized ichthyosis-like eruption, alopecia, enlarged superficial lymph nodes, proteinuria, and hematuria, the histological features of the skin biopsy from both ichthyotic and alopecic lesions with immunohistochemical staining, and the renal biopsy examination with immunofluorescence. The histological examination of ichthyotic and alopecic lesions displayed a predominant infiltration of atypical lymphocytes in the upper dermis with the characteristics of epidermotropism and folliculotropism. Immunohistochemical studies demonstrated that most infiltrated atypical lymphocytes were CD3, CD4, and CD45RO positive, whereas negative for CD5, CD7, CD20, CD30, and CD56. A renal biopsy examination revealed atypical membranous nephropathy with deposition of immunoglobulin G (IgG), IgM, IgA, C1q, and C3. In this case atypical membranous nephropathy was involved, which is very uncommon and has never been presented in the literature to date. Although ichthyosiform MF usually features a relatively favorable course, diffuse alopecia and the renal involvement in this case might indicate aggressive disease and poor prognosis.     

Pilotropic mycosis fungoides presenting with multiple cysts, comedones and alopecia

We report a 45-year-old man with mycosis fungoides (MF) who presented with multiple epidermoid cysts, comedones and alopecia and who responded to treatment with intravenous and oral cyclophosphamide. The pilotropic variant of MF, characterized histologically by follicular lesions and pilotropism without mucinosis, is uncommon and often resistant to treatment.     

以弥漫性秃发为首发表现的亲毛囊性蕈样肉芽肿一例

亲毛囊性蕈样肉芽肿属于蕈样肉芽肿的一种亚型，侵袭性较强，预后差，早期诊断尤为重要。本文报道一例免疫组化联合TCR基因重排确诊的以弥漫性秃发为首发表现亲毛囊性蕈样肉芽肿一例。     

Granulomatous mycosis fungoides presenting as an acquired ichthyosis

We report a case of a 69-year-old gentleman who presented with a 3-month history of unexplained fevers and malaise who developed generalized pruritus, alopecia and an ichthyosiform erythematous eruption on his forearms, legs, chest and back. Skin histology, immunophenotyping and molecular features were consistent with granulomatous mycosis fungoides. He has been successfully treated with twice weekly PUVA photochemotherapy.     

Lymphomatoid papulosis terminating as cutaneous T cell lymphoma (mycosis fungoides)

The 26-year-course of a T cell dysplasia is described in a patient who during his illness showed an evolution from the clinical features of lymphomatoid papulosis to tumor-stage mycosis fungoides with dissemination to nodes and viscera.     

Granulomatous mycosis fungoides presenting as poikiloderma

Granulomatous mycosis fungoides (MF) is a rare subtype of MF, characterized by the histological presence of a granulomatous reaction, but distinct clinical characteristics are not present. A 41-year-old healthy man presented with poikiloderma, ichthyosis and erythematous scaly plaque. Histological examination of a biopsy taken from poikilodermic skin showed a granulomatous reaction to epidermotropic atypical lymphocytes. However, in other areas there were only findings of conventional MF without granuloma. Granulomatous MF may be associated with poikiloderma.     

Immunohistochemical expression of IL-10 in mycosis fungoides

Abstract Immunoreactivity of the cytokine IL-10 has been investigated in situ in mycosis fungoides (MF). Expression of IL-10 was detected using immunohistochemistry in skin biopsies (n=8) and T-cell lines (n= 2) from mycosis fungoides patients. IL-10 positivily was seen in the dermal cell infiltrates and in T-cell lines in mycosis fungoides. The dermal IL-10 reaction in a skin biopsy from an active lesion in MF indicates the possibility for disease progression.     

Unilesional (segmental) mycosis fungoides presenting in childhood

Mycosis fungoides is rare in children, and a unilesional presentation is also rare. A 13-year-old Kuwaiti boy with unilesional mycosis fungoides is described. Clinically he had a single indurated large plaque on the left shoulder with histopathologic features typical of cutaneous T-cell lymphoma. The diagnosis was further supported by the presence of a T-cell clone discovered through molecular biology studies of paraffin-embedded material. No other lesions were detected. The lesion showed a favorable response to local radiotherapy.