Mycosis Fungoides Lesions Research Articles

Ultrastructural features of mycosis fungoides.

The ultrastructural features of lymphocytes, polymorphonuclear leukocytes, plasma, reticulum, and so-called mycosis cells were similar in the cutaneous infiltrates from patients with the plaque, tumor, eczematous or premycotic, poikilodermic, and erythrodermic forms of mycosis fungoides. The distinction of mycosis cells from reticulum cells appears to depend upon the greater degree of nuclear irregularity and lobulation in the former cell type. The lack of more objective, qualitative differences between the two suggests that the mycosis cell represents a histologic variant of the reticulum cell. The diagnostic specificity of the mycosis cell is limited, since cells with comparable ultrastructural features were encountered, albeit rarely, in biopsies of two of five patients with such banal dermatoses as chronic nonspecific dermatitis and psoriasis. No electron microscopic information which might affirm or deny the specificity of mycosis fungoides as a clinicopathologic entity was evident from this study. Although reticulum cells in lesions of mycosis fungoides were similar to those encountered in nodal examples of reticulum cell sarcoma, mycosis cells were dissimilar from Reed-Sternberg cells encountered in nodal Hodgkin’s disease. The latter cells were considerably larger and possessed more prominent nucleoli than were observed in mycosis cells. Intranuclear inclusions were noted in reticulum and mycosis cells in the lesions of mycosis fungoides, nonneoplastic dermatoses, nodal Hodgkin’s disease, reticulum cell sarcoma, and occasional normal epidermal and endothelial cells. At least some of these bodies in the patients with mycosis fungoides are artifactual, representing entrapped cytoplasmic material. It is concluded that the diagnosis of mycosis fungoides can be made more assuredly on the basis of its histopathologic rather than ultrastructural features.

The Skin and Internal Disease

The physician who seeks facts about the cutaneous lesions accompanying a systemic disease will probably find them either in this book or in the long lists of references following most of its 14 chapters. Good descriptions abound, but the text, comprising subject matter from 18 contributors, lacks cohesion. Nonetheless, this book packs a lot of information into a small space. The chapter devoted to pigmentary changes clearly outlines the metabolic errors and describes the clinical findings in phenylketonuria and alkaptonuria. Pellagra and acanthosis nigricans also receive appropriate emphasis. And an interesting section discusses and illustrates the cutaneous lesions of mycosis fungoides, leukemia, lymphoma, and Kaposi's sarcoma. The other chapters describe the appearances of the skin in a variety of diseases ranging from porphyrinuria to endocrine disorders. Though usually noting physiologic and pathologic changes, sometimes in considerable detail, the contributors emphasize mostly clinical findings. Many of their illustrations are good and

Treatment of Mycosis Fungoides

A suppressive effect on early and moderately advanced lesions of mycosis fungoides was obtained by the use of fluocinolone acetonide cream (Synalar) in concentrations of 0.2% and 1.0% applied under plastic film occlusion. Less dependable, although at times favorable, results were noted with the 0.025% and 0.01% strengths. Clinical improvement was accompanied by involutionary histological changes. Evidence suggesting a direct influence of the steroid compound on the growth of the neoplastic cells has been presented.

Alterations of lesions of mycosis fungoides lymphoma by direct imposition of delayed hypersensitivity reactions.

Plaque lesions of mycosis fungoides lymphoma in six patients sensitized to both 2-4 dinitrochlorobenzene (DNCB) and S, 2-aminoethylisothiuronium (AET) were treated topically with varying doses of the chemicals to evoke delayed hypersensitivity reactions. Complete or partial clearing of lesions, lasting several months, was observed in 22 of 31 plaques treated. No clinical benefit was observed following applications of a cutaneous irritant, sodium lauryl sulfate, nor with four chemical congeners of DNCB not cross-antigenic with DNCB. Cutaneous lymphoma lesions of one patient anergic to DNCB did not regress following large topical doses of the chemical. This evidence indicates that lesions of the lymphoma mycosis fungoides may be altered significantly by delayed hypersitivity responses, an event of seeming importance to understanding the pathogenesis of this disease.

Local therapy of mycosis fungoides with cytotoxic agents. A case report.

Mechlorethamine (nitrogen mustard) and chemically related alkylating agents have recently become part of the therapeutic armamentarium of physicians in many disciplines of medicine. Originally introduced as chemotherapeutic agents in neoplastic diseases, they have since been shown to be efficacious in hematologic, renal, arthritic, and cutaneous disorders. The systemic administration of these cytotoxic agents may precipitate gastrointestinal and hematologic changes necessitating frequent clinical and hematologic observations. Haserick et al.1recently reported on the effectiveness of mechlorethamine when applied topically to lesions of mycosis fungoides. This method of therapy essentially eliminates the dangers inherent in this group of chemicals. We wish to report our results, including histopathologic evaluation, on the use of mechlorethamine topically and cyclophosphamide (Cytoxan) injected locally and instilled by the vibrapuncture technique in a patient with mycosis fungoides. Report of a Case A 24-year-old Caucasian man was in good health until 1959, when he sustained a second

Mycosis fungoides associated with anaplastic carcinoma. Report of a case.

The following is a report of mycosis fungoides associated with a cancerous growth, a rare occurrence. History.— A man,1aged 67, presented in 1955 generalized pruritic lesions of mycosis fungoides (Figs. 1 and 2) of 31 years' duration. In 1949, he received arsenotherapy orally and parenterally for eight months. Because of a history of anginal attacks antimony treatments were not instituted.3Numerous roentgen-ray exposures were given to the various lesions irregularly from 1945 until 1954. A tumor above the right knee received 575 r units from April until August, 1953. On Jan. 6, 1954, the fungating mass was still present, the size of one inch (2.5 cm.) circular (Fig. 2). Additional roentgen-ray therapy was given to a total of 1,275 r unfiltered. The mass receded temporarily, but later became larger and began to ulcerate. On Nov. 6, 1954, the ulcerated surface measured 3 and one-half inches (8.75

Remission of Lesions in Mycosis Fungoides Following Topical Application of Nitrogen Mustard: A Case Report

Remission of Lesions in Mycosis Fungoides Following Topical Application of Nitrogen Mustard: A Case Report

Time-dose studies in irradiation of mycosis fungoides; iso-effect curve and tumor lethal dose.

Construction of iso-effect recovery curves for each type of tumor is a necessary step toward improving knowledge of irradiation dosage. It is suspected, though not demonstrated, that different types of tissue have specific recovery rates. The recovery rate is also influenced by the size of the daily fraction (1). The difficulty in constructing iso–effect curves was considered in a previous paper based on the treatment of multiple chest wall nodules of recurrent breast cancer (2). The same paper discussed Strandqvist's iso–effect curve for skin cancer and indicated potential errors when data are based on patients with a single lesion. Mycosis fungoides is a useful test object for study of the recovery rate because the multiplicity of lesions permits confirmation of each given dose by means of the corroborated dose technic (2) described below. Two cases, each with a large number of lesions (28 and 35, respectively), are reported below. This permitted the construction of a useful iso-effect curve for each patient. Furthermore, it became possible to compare the iso–effect curve of a markedly radiosensitive tumor with that of one which was only moderately radiosensitive. Case Reports CASE I: E. K., a white male aged 50 years, exhibited the first lesions of mycosis fungoides in 1945 at the age of forty-two. Severe generalized pruritus was present for a period of one and one-half years, at the end of which time numerous cutaneous lesions became apparent. Repeated biopsies of skin nodules led to a diagnosis of mycosis fungoides. Between the onset of disease and the first admission to the Radiation Therapy Department of University Hospital in August 1952, the patient had been treated with Fouadin, nitrogen mustard, ACTH, roentgen irradiation, and thorium–X. These agents had produced temporary remissions. Hospitaliza–tion became necessary because of anemia, loss of weight, and severe exacerbation of the cutaneous lesions. The patient was thin, undernourished, and showed signs of pruritus. The mycosis fungoides lesions were generalized and of three types: crusted papules, scaly plaques, and nodular tumors (Fig. 1). Twenty-eight cutaneous and subcutaneous nodular tumors were individually irradiated. The nodules ranged in diameter from 1 to 8 em., most of the irradiated nodules being from 2 to 4 em. in diameter. The factors were 200 kv; 0.75 mm. Cu and 1 mm. Al :filter; h.v.l, 1.0 mm. Cu; 25 em. target–skin distance. The portal size ranged from 9 to 50 sq. em. All doses are expressed as tumor doses measured with back–scatter. The corroborated dose technic, previously employed by the authors in the study of recurrent skin nodules of breast cancer, was used in this case to obtain iso-effect curves based on the “minimum tumorlethal dose.”

Simultaneous Occurrence of Ivaposi’s Sarcoma, Leukemia and Diabetes Mellitus: Report of a Case

A review of the available literature reveals few reports associating Kaposi's idiopathic hemorrhagic sarcoma with leukemia or lymphoblastoma. While Kaposi's sarcoma often progresses slowly for many years and at autopsy shows no spread beyond the cutaneous site, it is not uncommon to find sarcomatous deposits in the viscera, such as the organs of the gastrointestinal tract or respira­ tory tract, and the superficial and deep lymph nodes. Cole and Crump 2 in 1920 were the first to record an instance of idiopathic sar­ coma complicated by lymphatic leukemia, and Hufnagel and Dupont 8 reported a similar case some ten years later. Sachs and Gray 13 described a unique case of Kaposi's sarcoma and lymphatic leukemia in which biopsy of the skin revealed lesions of Kaposi's sarcoma in the upper and middle portions of the cutis, and leukemic infiltration in the lower cutis. The first report, apparently, of con­ current Kaposi's sarcoma and Hodgkin's disease was that of Greenstein. 7 In another instance reported by Lane and Greenwood 10 the patient had cutaneous lesions of both Kaposi's sarcoma and mycosis fungoides, and a blood picture of lymphatic leukemia. The present case concerns the simultaneous occurrence of Kaposi's sarcoma, lymphatic leukemia and diabetes. As far as could be determined, this combina­ tion has not heretofore been alluded to in the voluminous literature on multiple hemorrhagic sarcoma.

Mycosis fungoides with verrucous lesions; report of a case.

Milian and Périn¹in 1923 described a case of mycosis fungoides with verrucous and hyperkeratotic lesions. Jeanselme and Burnier²in 1926 reported two similar cases and pointed out the scarcity of reports of hyperkeratotic and verrucous lesions in mycosis fungoides. The verrucous lesions in these three cases were covered with large, thick, adherent scales. At times the lesions were dry and fissured, and they sometimes ulcerated with a serous discharge. Other manifestations of mycosis fundoids accompanied the verrucous lesions. In the case reported herein there were exhibited no lesions of mycosis fungoides other than verrucous plaques and nodules confined to the lower extremities. Scaling and clinically evident hyperkeratosis were not present. <h3>REPORT OF CASE</h3> H. K., a white widow aged 63, was first seen in Cleveland City Hospital Dermatology Clinic on March 16, 1950, complaining of unsightly growths of seven years' duration on the lower extremities. The individual

MYCOSIS FUNGOIDES WITH BULLOUS LESIONS

In a previous publication, 1 a case of mycosis fungoides in which the conventional infiltrative and ulcerative lesions were accompanied by bullous elements was reported. The paper dealt mainly with the clinical, pathologic and therapeutic aspects of the case. The present contribution is devoted to the interpretation of special examinations and laboratory investigations which were performed mainly for the purpose of demonstrating the existence of pathologic alterations in the adrenal glands and the relationship of the alterations to the clinical phenomena. REPORT OF A CASE D. K., aged 65, had a bullous eruption arising from lesions of mycosis fungoides. These bullae ruptured spontaneously and left raw, denuded, hemorrhagic areas. The bullae were resistant to various types of routine and of special dermatologic therapy, but they responded rapidly to androgenic medication. A noteworthy coincidence was the disappearance, or shedding, of almost all the coincidental seborrheic verrucae