Cutaneous T-cell lymphoma. Evaluation of pretreatment skin biopsy specimens by a panel of pathologists

Olerud, John E.; Kulin, Pamela A.; Chew, Deanna E.; Carlsen, Ray A.; Hammar, Samuel P.; Weir, Thomas W.; Patterson, Susan D.; Bolen, John W.; Kadin, Marshall E.; Barker, Edward A.; Kidd, Pamela; McNutt, Michael A.; Piepkorn, Michael

doi:10.1001/archderm.128.4.501

Cited by 43 publications

(26 citation statements)

References 19 publications

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“…4,[6][7][8][9][10][11] The histopathologic features of early MF vary from person to person, over time, and even between multiple sites in a single patient. 12,13 In addition, Figure 1.…”

Section: Commentmentioning

confidence: 99%

“…4,14 These difficulties are highlighted by reported false-negative and false-positive rates as high as 40%, 15 in addition to low concordance and reproducibility rates. 4,[8][9][10] Because of these diagnostic challenges in early MF, during the past decades, several authors have attempted to identify the most-reliable diagnostic criteria for distinguishing MF from benign dermatoses. 4,5,7,[10][11][12][13][14]16,17 Characteristic histopathologic features of early MF include the presence of enlarged epidermal lymphocytes with cerebriform nuclei within the epidermis and minimal associated spongiosis (epidermotropism), larger lymphocytes in the epidermis than in the dermis, lymphocytes with perinuclear clearing (halo), and a linear arrangement of basilar epidermal lymphocytes along the dermal-epidermal junction (tagging) (Figure 2, B through D).…”

Section: Commentmentioning

confidence: 99%

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Selected Inflammatory Imitators of Mycosis Fungoides: Histologic Features and Utility of Ancillary Studies

Arps

Chen

Fullen

et al. 2014

Archives of Pathology &Amp; Laboratory Medicine

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Mycosis fungoides is the most common primary cutaneous lymphoma; however, it remains a significant diagnostic challenge, in part because of the overlap with several inflammatory dermatoses. Despite advances in immunohistochemistry and molecular diagnostics, false-positive, false-negative, and indeterminate diagnoses are not uncommon. In most cases, the overall balance of morphologic, immunophenotypic, and genetic features must be considered carefully because there are few sensitive and specific clues to the diagnosis. Moreover, an appropriate clinical presentation is essential to the diagnosis and helps to favor or exclude inflammatory/reactive processes. Herein, we discuss 3 important inflammatory dermatoses that may closely simulate mycosis fungoides, and we review the use of ancillary studies in these challenging cases.

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“…4,[6][7][8][9][10][11] The histopathologic features of early MF vary from person to person, over time, and even between multiple sites in a single patient. 12,13 In addition, Figure 1.…”

Section: Commentmentioning

confidence: 99%

Section: Commentmentioning

confidence: 99%

Selected Inflammatory Imitators of Mycosis Fungoides: Histologic Features and Utility of Ancillary Studies

Arps

Chen

Fullen

et al. 2014

Archives of Pathology &Amp; Laboratory Medicine

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“…Diagnostic accuracy and the reliability of conventional histopathologic features of CTCL, especially in the initial stages of the disease, have been reported to be extremely limited, even in the hands of experienced and well-trained pathologists. 8,27,28 In addition, investigations have documented that major interrater variability and intrarater variability among pathologists and dermatopathologists were common when evaluating skin biopsy specimens for the diagnosis of CTCL. 8,28 However, the real extent of the problem is not presently known, since studies dealing with the histologic diagnosis of CTCL have almost always been biased by several major problems.…”

Section: Discussionmentioning

confidence: 99%

“…8,27,28 In addition, investigations have documented that major interrater variability and intrarater variability among pathologists and dermatopathologists were common when evaluating skin biopsy specimens for the diagnosis of CTCL. 8,28 However, the real extent of the problem is not presently known, since studies dealing with the histologic diagnosis of CTCL have almost always been biased by several major problems. First, the real nature of the diseases featured in the slides was not determined-in fact, study cases did not generally have longterm follow-up data documenting the progression of the diseases or death of the patient caused by the diseases, leaving doubt as to the neoplastic nature of the lymphoproliferative disorder.…”

Section: Discussionmentioning

confidence: 99%

Accuracy, Concordance, and Reproducibility of Histologic Diagnosis in Cutaneous T-Cell Lymphoma<subtitle>An EORTC Cutaneous Lymphoma Project Group Study</subtitle>

Santucci

Biggeri²,

Feller³

et al. 2000

Arch Dermatol

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“…Sie finden sich allerdings nur bei einer kleineren Zahl von Mycosis fungoides-Fällen und sind daher nicht sensitiv [11]. Als weiterer erschwerender Faktor bei der histopathologischen Begutachtung früher Mycosis fungoides-Läsionen kommt die intra-und interindividuelle Variabilität der begutachtenden Dermatopathologen hinzu [12].…”

Section: Introductionunclassified

Diagnostischer Stellenwert und klinische Bedeutung der Analyse von T-Zellrezeptor-Genumlagerungen beim kutanen T-Zell-Lymphom

Assaf¹

2004

Akt Dermatol

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ZusammenfassungKutane T-Zell-Lymphome (CTCL) stellen eine Gruppe lymphoproliferativer Hauterkrankungen dar, die durch klonale Akkumulation von T-Lymphozyten-Populationen charakterisiert sind. Die Diagnose wird in der Regel aufgrund klinischer und histologischer charakteristischer Eigenschaften der CTCL gestellt. Schwierigkeiten bereitet die Diagnosestellung insbesondere in frühen Stadien, aber auch in seltenen Varianten der CTCL. In diesen Fällen ist der Nachweis klonaler T-Zell-Populationen durch identisch umgelagerte T-Zellrezeptor-Gene eine wertvolle Hilfe. So zeigen PCR-basierende Techniken zum Nachweis klonaler T-Zell-Populationen eine hohe Sensitivität von 70 ± 90 % in Hautbiopsien früher CTCL-Stadien. Nach Diagnosestellung ist der nächste wichtige Schritt die Ausbreitungsdiagnostik des CTCL, sinkt doch die Überlebensrate drastisch bei Auftreten extrakutaner Manifestationen wie z.B. bei Infiltration der Lymphknoten oder viszeraler Organe. Ein Stadienwechsel, d.h. die Progression der Erkrankung, wird in der Regel klinisch erst spät entdeckt. Insbesondere der Lymphknotenbefall, der erfahrungsgemäû als erste extrakutane Manifestation des CTCL gilt, stellt sowohl den Kliniker als auch den Histologen vor diagnostische Probleme. Hier konnten wir in einer aktuellen Studien zeigen, dass in ca. 50 % der dermatopathischen Lymphknoten identische klonale T-ZellPopulationen wie in den CTCL-Läsionen der Haut nachweisbar sind. Des Weiteren zeigte sich, dass diese Patienten eine reduzierte Überlebensrate haben, ähnlich denen, die eine histologisch manifeste Lymphknoteninfiltration durch das CTCL haben. Diese Daten belegen, dass T-Zellrezeptor-Umlagerungsanalysen bei Patienten mit CTCL sowohl eine diagnostische als auch prognostische Bedeutung haben und somit ein akkurates Staging ermöglichen. AbstractCutaneous T-cell lymphoma (CTCL) is a clonal lymphoproliferative malignancy primarily involving the skin. Routine diagnosis of CTCL is based on its characteristic clinical and histopathologic features. However, the broad clinical and histological spectrum of the disease, especially of its early stages and rare variants, often complicates the differentiation between malignant CTCL and benign lymphoproliferative or reactive skin diseases. In these cases demonstration of a clonal T-cell population by detection of identically rearranged T-cell receptor genes (TCR) provides an adjunct. Using this approach clonality could be demonstrated in 70-90 % in CTCL biopsies of early stages by recent PCR-based studies, indicating a high sensitivity. After achieving the correct diagnosis the next important step is to stage the disease in CTCLpatients. Patients with CTCL usually have an indolent course with a 5-year survival of approximately 87%. However, in a significant number of patients the disease may progress and disseminated extracutaneous manifestations may develop involving the lymph nodes, blood and visceral organs. The prognosis for patients with widespread manifestation of CTCL beyond the skin is poor. Therefore, accurate evaluatio...

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Cutaneous T-cell lymphoma. Evaluation of pretreatment skin biopsy specimens by a panel of pathologists

Cited by 43 publications

References 19 publications

Selected Inflammatory Imitators of Mycosis Fungoides: Histologic Features and Utility of Ancillary Studies

Selected Inflammatory Imitators of Mycosis Fungoides: Histologic Features and Utility of Ancillary Studies

Accuracy, Concordance, and Reproducibility of Histologic Diagnosis in Cutaneous T-Cell Lymphoma<subtitle>An EORTC Cutaneous Lymphoma Project Group Study</subtitle>

Diagnostischer Stellenwert und klinische Bedeutung der Analyse von T-Zellrezeptor-Genumlagerungen beim kutanen T-Zell-Lymphom

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