REASSESSMENT OF HISTOLOGIC PARAMETERS IN THE DIAGNOSIS OF MYCOSIS-FUNGOIDES
REASSESSMENT OF HISTOLOGIC PARAMETERS IN THE DIAGNOSIS OF MYCOSIS-FUNGOIDES
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DOI：
10.1097/00000478-199512000-00009
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发表时间：
1995-12-01
影响因子：
5.6
通讯作者：
HENDRICKSON, M
中科院分区：
文献类型：
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作者：
SMOLLER, BR;BISHOP, K;HENDRICKSON, M
蕈样肉芽肿（MF）的组织学诊断可能难以建立，并且基于对许多细微变化的解释，其中大多数可能在某种程度上存在于许多炎症和肿瘤性皮肤疾病中。为了重新评估MF组织学诊断的诊断标准，我们回顾性分析了64例蕈样肉芽肿（MF +）患者的组织学切片，并与47例活检排除MF并显示无疾病（MF -）的患者的切片结果进行了比较。根据至少3年随访和免疫表型结果的临床病程，选择MF +或MF -患者，与组织学结果无关。在患者选择后，至少有两名观察员在不了解最终诊断的情况下审查每个载玻片，并对大约25个组织学参数的强度进行分级。在单变量分析中，以下参数在超过p = 0.01水平时具有显著性：Pautrier's淋巴细胞、晕圈淋巴细胞、胞吐、不成比例的向表皮性、表皮淋巴细胞大于真皮淋巴细胞、超卷曲表皮内淋巴细胞和基底层内排列的淋巴细胞。在多变量分析中，卤代淋巴细胞被证明是MF与非MF的最稳健的鉴别。这些发现表明，尽管许多先前描述的特征确实可以区分MF和炎症模拟物，但其他特征的特异性要小得多。此外，很少有病例表现出所有的组织学特征;例如，在我们的病例中，仅37.5%的病例中观察到了Pautrier氏微血管瘤。我们的结论是，特定的组织学参数的组合，可用于建立一个显微镜下诊断MF，而无需在绝大多数情况下，确认免疫表型。
The histologic diagnosis of mycosis fungoides (MF) can be difficult to establish and is based on interpretation of numerous subtle changes, most of which may be present to some degree in many inflammatory and neoplastic cutaneous conditions. To reassess the diagnostic criteria for making a histologic diagnosis of MF, we retrospectively reviewed histologic sections from 64 patients with mycosis fungoides (MF +) and compared the findings with sections from 47 patients who were biopsied to exclude MF and were shown not to have the disease (MF -). Patients were selected as MF + or MF - independent of histologic findings based on the clinical course with at least 3 years of follow-up and immunophenotyping results. Following patient selection, at least two observers reviewed each slide without knowledge of final diagnosis and graded the intensity of approximately 25 histologic parameters. On univariate analysis, the following parameters were significant at beyond the p = 0.01 level: Pautrier's abscesses, haloed lymphocytes, exocytosis, disproportionate epidermotropism, epidermal lymphocytes larger than dermal lymphocytes, hyperconvoluted intraepidermal lymphocytes, and lymphocytes aligned within the basal layer. Haloed lymphocytes proved to be the most robust discriminator of MF from non-MF on multivariate analysis. These findings show that whereas many previously described features do discriminate between MF and inflammatory mimics, others are much less specific. Furthermore, few cases demonstrate all histologic features; for example, Pautrier's microabscesses were seen in only 37.5% of our cases. We conclude that a combination of specific histologic parameters can be used to establish a microscopic diagnosis of MF without the necessity of confirmatory immunophenotyping in the vast majority of cases.