Mycosis Fungoides: A Clinicopathological Study of 60 Cases from a Tertiary Care Center

Abstract

Background: Mycosis fungoides (MF) is the most common primary cutaneous lymphoma. It affects usually the covered areas of the body in elderly males in 6^th and 7^th decades of life. Atypical dermal lymphoid infiltrate is seen along with epidermotropism. Nuclei of neoplastic cells are convoluted. The neoplastic cells demonstrate positivity for CD3 (Pan T) immunohistochemical stain. Majority show increased CD4 to CD8 ratio. The present study was done to study the clinicopathological features, which might be of help in reaching a correct diagnosis in these cases.

Materials and methods: A retrospective descriptive study was conducted on 60 reported cases of MF. The retrieved slides were reviewed for clinical and histopathological features and immunohistochemical profile.

Results: The ages ranged from 20-84 years, mean age was 47 years. Majority (75%) of patients were male. Trunk and extremities were the sites most commonly affected. There was significant inverse correlation between epidermal thickness and tumor stage (P = 0.02). Thickened epidermis was seen in patch stage and thickness reduced with progressing stage. The intensity of dermal infiltrate and cell size was also statistically significantly linked to stage progression (P < 0.001 each). In addition, proliferation index also correlated significantly with tumor stage (P = 0.002).

Conclusion: Clinical information and histological features are equally important in the accurate diagnosis of MF. Papillary dermal fibrosis is a useful diagnostic clue. CD4:CD8 ratio is not increased in all cases; it may be decreased or remain unchanged.

Keywords: Histologic features; immunohistochemical profile; mycosis fungoides.

Figure 1

Epidermal acanthosis with epidermotropism of lymphocytes (H and E, ×10)

Figure 2

Pattern of epidermotropism with clusters and individual cells (H and E, ×20)

Figure 3

Papillary dermal fibrosis with moderate dermal infiltrate (H and E, ×10)

Figure 4

Dermal infiltrate of lymphocytes with scattered eosinophils (H and E, ×20)

Figure 5

Folliculotropic MF with lymphoid infiltrate around hair follicles (H and E, ×4)

Figure 6

Follicular mucinosis and perifollicular lymphoid infiltrate (H and E, ×20)

Figure 7

CD4 predominant dermal infiltrate (CD4 stain, ×10)

Figure 8

CD8 of the case depicted in Figure 7 (CD8 stain, ×10)

Figure 9

CD8 predominant population in another case (CD8, ×10)