Hypopigmented Mycosis Fungoides: A Clinicopathological Review of 32 Patients

Abstract

Background: Hypopigmented mycosis fungoides (hMF) is gradually acknowledged by more dermatologists, yet a consensus regarding its characteristics is not reached. The profile of Chinese hMF patients has not been deeply reviewed previously. Our research may contribute to the understanding of hMF, especially the Chinese patients with Fitzpatrick phototypes of III and IV. Aim: To have a better understanding of hMF in terms of clinical, histopathological and immunohistochemical features in the Chinese population and to determine if there are differences between the Chinese population and other ethnic groups. Methods: We made a retrospective analysis of clinical, histopathological and immunohistochemical features of 32 hMF patients in our hospital from 2010 to 2020. These features were then summarized and compared with previous reports. Results: All patients belonged to Fitzpatrick phototypes of III or IV. Twenty-one male (65.63%) patients and 11 female (34.37%) patients were analyzed, and the male to female ratio was 1.9:1. The age at diagnosis of patients ranged from 4 to 39 years, and the average age at diagnosis of these patients was 18 years, the median age was 16.5. Back was the most frequent site (34.37%). The clinical and histological results of lesions had no distinctive points. Immunohistochemically, among these 32 patients, there were 30 patients whose information was complete, there was 19 patients (63.33%) who were CD8 positive lymphocytes predominance, 9 patients (30%) had CD8 and CD4 positive lymphocyte mixed infiltration, and other 2 patients (6.67%) had CD4 positive lymphocytes predominance. Partial loss of CD7 was only observed in 1 patient (3.33%). Nearly all patients adopted topical nitrogen mustard and topical steroid and most of them had an excellent prognosis. Conclusion:The clinical profiles of hMF in Chinese population shared differences with other ethnic groups, but its histopathological, immunohistochemical results and prognosis condition were resembled with other previous reports. Hence, more patients were needed to find the characteristics of hMF.

Real-World Clinical Characteristics, Management, and Outcomes of 44 Paediatric Patients with Hypopigmented Mycosis Fungoides

“…The current study confirmed that hMF affected mainly younger patients, with a median age at onset of 8.5 years and a median age at definitive diagnosis of 11 years. This was also corroborated by previous groups ( 5 , 13 – 15 , 19 ). Different groups have reported different intervals between disease onset and diagnosis ( 4 , 9 , 15 – 17 , 19 ).…”

“…In the current study, the interval from disease onset to diagnosis ranged from 2 months to 16 years, with a median of 24 months. In comparison with previous reports (4,9,13,14,(16)(17)(18)(19)(20), patients treated for hMF at our cutaneous lymphoma centre were younger and had improved diagnosis and treatment outcomes.…”

“…As erythematous lesions usually have a deeper and denser infiltration of atypical lymphoid cells than hypopigmented lesions ( 15 ), we postulated that the latency period was correlated with the severity of hMF; that is, the longer the latency period, the more likely the patient was to show more progressive clinical manifestations of Group III lesions. The diversity in the manifestations of hMF has been reported in many studies ( 4 , 13 , 16 , 19 ), but no study has performed an in-depth analysis of lesion morphology.…”

“…hMF is histopathologically similar to classical MF, but IHC reveals a predominance of CD8+ T cells. There have been some cohort studies of hMF in recent years (Table III) (4,5,9,(13)(14)(15)(16)(17)(18)(19)(20). The current study retrospectively summarized the clinical characteristics and treatment regimens of 44 patients diagnosed with hMF in childhood at our centre.…”