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Invisible Mycosis Fungoides: Not to be Missed in Chronic Pruritus.

Deen K, O'Brien B, Wu J - Dermatol Ther (Heidelb) (2015)

Bottom Line: Pruritus without visible dermatoses may be the first manifestation of hematological malignancies such as Hodgkin disease, chronic lymphocytic leukemia and mycosis fungoides (MF) and may precede the definitive diagnosis by weeks to years.We present a case of 'invisible' MF associated with chronic generalized pruritus in an elderly patient.This can prompt the clinician to consider possible underlying malignancy, such as 'invisible' MF.

View Article: PubMed Central - PubMed

Affiliation: Department of Dermatology, Princess Alexandra Hospital, Brisbane, QLD, Australia. kristyn.deen@gmail.com.

ABSTRACT

Introduction: Pruritus without visible dermatoses may be the first manifestation of hematological malignancies such as Hodgkin disease, chronic lymphocytic leukemia and mycosis fungoides (MF) and may precede the definitive diagnosis by weeks to years.

Case report: We present a case of 'invisible' MF associated with chronic generalized pruritus in an elderly patient.

Conclusion: Our case highlights the importance of performing skin biopsies in patients with chronic unexplained pruritus, especially in the absence of cutaneous lesions. This can prompt the clinician to consider possible underlying malignancy, such as 'invisible' MF.

No MeSH data available.


Related in: MedlinePlus

a Histology showing Pautrier Microabscesses (H&E, 20×). b Epidermotropism (H&E, 20×). c Atypical lymphocytes (H&E, 40×). d Immunophenotyping showing CD4 positivity (20×). H&E Hematoxylin and eosin stain
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Fig2: a Histology showing Pautrier Microabscesses (H&E, 20×). b Epidermotropism (H&E, 20×). c Atypical lymphocytes (H&E, 40×). d Immunophenotyping showing CD4 positivity (20×). H&E Hematoxylin and eosin stain

Mentions: As a result of these normal tests, two punch biopsies from normal-appearing skin on the abdomen were taken (Fig. 1). Histology showed acanthosis with several collections of lymphocytes in the basal layer forming small Pautrier microabscesses (Fig. 2a). Epidermotropism was also evident (Fig. 2b). The superficial dermis showed fibrosis with a perivascular infiltrate of lymphocytes, some of which had hyperchromatic nuclei. On deeper levels, some of the lymphocytes appeared large and atypical with apoptotic lymphocytes also present (Fig. 2c). Immunophenotyping showed the majority of cells to be CD4 positive (Fig. 2d). There was some loss of CD7 and only rare CD30-positive cells. The immunofluorescence was negative. These results were consistent with a finding of CD4-positive MF.Fig. 1


Invisible Mycosis Fungoides: Not to be Missed in Chronic Pruritus.

Deen K, O'Brien B, Wu J - Dermatol Ther (Heidelb) (2015)

a Histology showing Pautrier Microabscesses (H&E, 20×). b Epidermotropism (H&E, 20×). c Atypical lymphocytes (H&E, 40×). d Immunophenotyping showing CD4 positivity (20×). H&E Hematoxylin and eosin stain
© Copyright Policy
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC4580656&req=5

Fig2: a Histology showing Pautrier Microabscesses (H&E, 20×). b Epidermotropism (H&E, 20×). c Atypical lymphocytes (H&E, 40×). d Immunophenotyping showing CD4 positivity (20×). H&E Hematoxylin and eosin stain
Mentions: As a result of these normal tests, two punch biopsies from normal-appearing skin on the abdomen were taken (Fig. 1). Histology showed acanthosis with several collections of lymphocytes in the basal layer forming small Pautrier microabscesses (Fig. 2a). Epidermotropism was also evident (Fig. 2b). The superficial dermis showed fibrosis with a perivascular infiltrate of lymphocytes, some of which had hyperchromatic nuclei. On deeper levels, some of the lymphocytes appeared large and atypical with apoptotic lymphocytes also present (Fig. 2c). Immunophenotyping showed the majority of cells to be CD4 positive (Fig. 2d). There was some loss of CD7 and only rare CD30-positive cells. The immunofluorescence was negative. These results were consistent with a finding of CD4-positive MF.Fig. 1

Bottom Line: Pruritus without visible dermatoses may be the first manifestation of hematological malignancies such as Hodgkin disease, chronic lymphocytic leukemia and mycosis fungoides (MF) and may precede the definitive diagnosis by weeks to years.We present a case of 'invisible' MF associated with chronic generalized pruritus in an elderly patient.This can prompt the clinician to consider possible underlying malignancy, such as 'invisible' MF.

View Article: PubMed Central - PubMed

Affiliation: Department of Dermatology, Princess Alexandra Hospital, Brisbane, QLD, Australia. kristyn.deen@gmail.com.

ABSTRACT

Introduction: Pruritus without visible dermatoses may be the first manifestation of hematological malignancies such as Hodgkin disease, chronic lymphocytic leukemia and mycosis fungoides (MF) and may precede the definitive diagnosis by weeks to years.

Case report: We present a case of 'invisible' MF associated with chronic generalized pruritus in an elderly patient.

Conclusion: Our case highlights the importance of performing skin biopsies in patients with chronic unexplained pruritus, especially in the absence of cutaneous lesions. This can prompt the clinician to consider possible underlying malignancy, such as 'invisible' MF.

No MeSH data available.


Related in: MedlinePlus