Anetodermic mycosis fungoides: a new clinicopathological variant of mycosis fungoides

Abstract

Mycosis fungoides is the most common type of primary cutaneous T-cell lymphoma. Several rare clinicopathological variants of mycosis fungoides have been described. Patients with these variants often also have classic mycosis fungoides at other sites of the body. Anetoderma is a cutaneous disorder in which multiple, oval lesions or atrophic plaques with wrinkled surface develop progressively due to loss of the dermal elastic tissue. Primary anetoderma occurs when there is no underlying associated disease and it arises on clinically normal skin, whereas secondary anetoderma appears in the same site as a previous specific skin lesion. There is a large list of heterogeneous dermatoses associated with secondary anetoderma. Two patients developed areas of secondary anetoderma on plaque stage lesions of mycosis fungoides. The lesions consisted of exophytic nodular lesions, with very soft consistency on palpation, scattered over the hyperpigmented plaques in one patient and violaceous indurated plaques with overlying epidermal atrophy and mild scale in the other. Histopathological study demonstrated that the cells involving the dermis were mainly T-helper lymphocytes, with few histiocytes and some multinucleate giant cells engulfing distorted elastic fibres. Elastic tissue stain demonstrated that elastic fibres were almost completely absent in the dermis of the anetodermic lesions. Anetodermic mycosis fungoides should be added to the list of clinicopathological variants of mycosis fungoides and mycosis fungoides should also be considered as a possible disease causing secondary anetoderma. Anetodermic mycosis fungoides shows clinical and histopathological features different from those of granulomatous slack skin.

Mycosis fungoides and Sézary syndrome: clinical, histopathological and immunohistochemical review and update

“…5 It is suggested that the bullous originates from the confluence of Pautrier's microabscesses and the accumu-lation of lymphocytes in the basal layer, thus missing the dermal-epidermal cohesion. 5,49-51 …”

Mycosis fungoides presenting as a pustular eruption

“…Although some of them have been identified as distinct entities, they are now interpreted as being merely clinicopathological variants of MF. 4 Moreover, transitional periods of different clinical variants are possible, as we have seen in our patient who had a 6-month period of generalized pustulation at the onset of her MF. We believe that the generalized pustulation in MF might be an immunological phenomenon, i.e.…”

Mycosis Fungoides

“…Examination reveals a band-like infiltrate in the upper dermis with epidermotropism of solitary lymphocytes. 60 Histopathologically, the anetodermic lesions demonstrate a dense lymphocytic infiltrate with some histiocytes or havy band-like infiltrate of small lymphocytes in the papillary dermis (Fig. 59 Immunohistology revealed a predominance of CD3 + T lymphocytes admixed with clusters of CD20 + B cells in most reported cases; only a small portion of the infiltrate was CD8 + .…”

“…58,59 Anetodermic MF Anetoderma describes a cutaneous disorder characterized by progressive loss of dermal elastic tissue, which manifests clinically as atrophic plaques on the skin with a wrinkled surface (Fig. 60 In a report of 2 cases, patients with MF developed secondary anetoderma on areas of previous lesions of plaque-stage MF.…”