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. 2022 Jun 29;12(7):1582.
doi: 10.3390/diagnostics12071582.

TOX Expression in Mycosis Fungoides and Sezary Syndrome

Alessandro Pileri  1   2 , Martina Cavicchi  3 , Clara Bertuzzi  4   5 , Simona Righi  4   5 , Corrado Zengarini  1   2 , Elena Sabattini  4   5 , Giovanna Roncador  6 , Claudio Agostinelli  4   5
Affiliations

TOX Expression in Mycosis Fungoides and Sezary Syndrome

Alessandro Pileri et al. Diagnostics (Basel). .

Abstract

Mycosis fungoides (MF) and Sezary syndrome (SS) are the two most common type of cutaneous T-cell lymphoma (CTCL). Currently, no markers can be clearly related to prognosis or to differential diagnosis between early stages and inflammatory benign diseases (IBD). The thymocyte selection-associated high mobility group box factor (TOX), has been proposed as a possible marker in differential diagnosis between early CTCL stages and IBD. Recently TOX has been related to prognosis. We aimed to investigate whether TOX may be a diagnostic or prognostic marker. MF and SS biopsies between 2010 and 2020 were retrieved. New tissues slides were stained with an anti-TOX antibody, (Clone NAN448B). On each slide, 5 fields were examined at high magnification (400×), to evaluate the percentage of marker-positivity in a quantitative way. Thirty-six patients (12 females and 24 males) and 48 biopsies were collected. Nine patients had multiple biopsies. TOX expression in MF/SS cases showed an increase from early to advanced phases. TOX was not regarded as a prognostic marker due to the absence of significant changes by comparing early MF cases with reactive conditions. TOX statistical significance increased in patients alive with disease and in those dead of disease (p = 0.013 and = 0.0005, respectively) as compared with patients in complete remission. Our results show that TOX should be regarded more as a prognostic than a diagnostic marker.

Keywords: Sezary syndrome; TOX; mycosis fungoides.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Paradigmatic example of score 1 of Tox expression in two cases.
Figure 2
Figure 2
Paradigmatic example of score 2 of Tox expression in different cases.
Figure 3
Figure 3
Score 3 Tox expression in early and advanced cases.
Figure 4
Figure 4
Tox expression in control group versus early MF, Late MF and Sézary Syndrome. In the columns: the number of biopsies evaluated in each group.
Figure 5
Figure 5
TOX expression in A− (alive without disease) versus A+ (alive with disease) and DOD (dead of disease) patients.
Figure 6
Figure 6
TOX expression in biopsies of A−, A+ and DOD patients considering separately the three groups of early MF, late stage MF and Sézary Syndrome.
Figure 7
Figure 7
Tox expression in different biopsies of male patients performed during the clinical follow up of the disease.
See this image and copyright information in PMC

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