BACKGROUNDMastocytosis is a clonal disorder characterized by the accumulation of abnormal
mast cells in the skin and/or in extracutaneous organs. OBJECTIVESTo present all cases of mastocytosis seen in the Porto Hospital Center and
evaluate the performance of World Health Organization diagnostic criteria for
systemic disease. METHODSThe cases of twenty-four adult patients with mastocytosis were reviewed. Their
clinical and laboratorial characteristics were assessed, and the properties of the
criteria used to diagnose systemic mastocytosis were evaluated. RESULTSThe age of disease onset ranged from 2 to 75 years. Twenty-three patients had
cutaneous involvement and 75% were referred by dermatologists. Urticaria
pigmentosa was the most common manifestation of the disease. One patient with
severe systemic mast cell mediator-related symptoms showed the activating V560G
KIT mutation. The bone marrow was examined in 79% of patients, and mast cell
immunophenotyping was performed in 67% of the participants. Systemic disease was
detected in 84% of cases, and 81% of the sample had elevated serum tryptase
levels. All the diagnostic criteria for systemic mastocytosis had high specificity
and positive predictive value. Bone marrow biopsy had the lowest sensitivity,
negative predictive value and efficiency, while the highest such values were
observed for mast cell immunophenotyping. Patients were treated with regimens
including antihistamines, sodium cromoglycate, alpha-interferon, hydroxyurea and
phototherapy. CONCLUSIONSCutaneous involvement is often seen in adult mastocytosis patients, with most
individuals presenting with indolent systemic disease. Although serum tryptase
levels are a good indicator of mast cell burden, bone marrow biopsy should also be
performed in patients with normal serum tryptase, with flow cytometry being the
most adequate method to diagnose systemic disease.