Patch stage of mycosis fungoides
MMHRC, Lake Area, Melur Road, Madurai-625107
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Mavarkar L. Patch stage of mycosis fungoides. Indian J Dermatol Venereol Leprol 2001;67:98-99
AbstractParapsoriasis is aeon troversial topic. There are many studies regarding the relationship of parapsoriasis to lymphoma\ but no correlation between histology and clinical appearance. Parapsoriasis satisfies histologic criteria for mycosis fungoides and therefore it should be considered as patch stage of mycosis fungoides. A 30-year-old man presented with scaly skin lesions over the trunk since 4 years. Routine blood and urine investigations were normal. Skin biopsy from the lesion revealed atypical lymphocytes within the epidermis without spongiosis.
Mycosis fungoides is a condition characterised by the infiltration of the skin with plaques and nodules composed of T-lymphocytes. Patch stage of mycosis fungoides was first described by Sanchez and Ackerman in 1979. But this term is not well accepted by many dermatologists. Here is the report of such a case on a controversial topic.
A 30-year-old-man presented with scaly skin lesions over the trunk since 4 years. There was history of hyperpigmentation as well as atrophy of the skin at a few places. Cutaneous examination revealed multiple ill defined large scaly patches with hyperpigmentation and epidermal atrophy at a few places without telangiectasia. Other systems were normal. There was no significant lymphadenopathy. Routine blood and urine investigations were normal. Skin biopsy from the lesion revealed atypical lymphocytes within the epidermis without spongiosis.
Since the introduction of the term parapsoriasis by Brocq in 1902, many terminologies have been proposed, resulting in controversies and confusion. It is recommended that the use of the term parapsoriasis be discontinued. There are many studies regarding relationship of parapsoriasis to lymphoma, but no correlation between histology and clinical appearance. Histology of early patch lesions of mycosis fungoides reveal an increased number of mononuclear cells distributed singly or in small collections within an epidermis devoid of spongiotic microvesiculation. Other important features are lacunae surrounding intraepidermal mononuclear cells which gives them the appearance of "haloed cells". Atypical mononuclear cells are not necessary for the diagnosis of early patch lesions of mycosis fungoides. Ackerman feels that parapsoriasis is the patch stage of mycosis fungoides. The use of the term parapsoriasis should be discontinued and it should be considered as patch stage of mycosis fungoides.
Sanchez JL, Ackerman AB. The patch stage of mycosis fungoides. Criteria for histologic diagnosis. Am J Dermatopathol 1979 ; 1 : 5-26.[Google Scholar]
Brocq L. Les Parapsoriasis. Ann Dermatol Syphiligr 1902 ; 3: 433-468.[Google Scholar]
Mackie RM. Lymphomas and leukaemias. In ; Rook A, Wilkinson DS, Ebling FJG, eds. Textbook of Dermatology, 5th ed, Oxford, England: Blackwell Scientific Publications. 1992; 3: 2107- 2134.[Google Scholar]
Samman PD. The natural history of parapsoriasis en plaques and prereticulotic poikiloderma. Br J Dermatol 1972; 87: 405-411.[Google Scholar]
Ackerman AB. If small plaque parapsoriasis is a cutaneous T - cell lymphoma, even an "abortive" one, it must be mycosis fungoides. Arch Dermatol 1996; 132 : 562-566.[Google Scholar]