GRANULOMATOUS VARIANTS OF CUTANEOUS T-CELL LYMPHOMA - THE HISTOPATHOLOGY OF GRANULOMATOUS MYCOSIS-FUNGOIDES AND GRANULOMATOUS SLACK SKIN
GRANULOMATOUS VARIANTS OF CUTANEOUS T-CELL LYMPHOMA - THE HISTOPATHOLOGY OF GRANULOMATOUS MYCOSIS-FUNGOIDES AND GRANULOMATOUS SLACK SKIN
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DOI：
10.1097/00000478-198802000-00002
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发表时间：
1988-02-01
影响因子：
5.6
通讯作者：
WHITE, CR
中科院分区：
文献类型：
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作者：
LEBOIT, PE;ZACKHEIM, HS;WHITE, CR
肉芽肿性蕈样肉芽肿是蕈样肉芽肿的一种不常见的组织学变异，蕈样肉芽肿通常是无痛的。肉芽肿性松弛皮肤，如肉芽肿性蕈样肉芽肿，表现为向表皮性，肉芽肿性炎症，克隆性T辅助细胞群，在某些情况下进展为系统性淋巴瘤。与肉芽肿性蕈样肉芽肿不同，其临床特征是皮肤皱褶大而下垂。这两种情况之间的相似性促使我们比较组织学特征。我们回顾了10例蕈样肉芽肿性真菌病患者的24例活检。这些显示了几种不同的组织学模式，包括3例模仿环状肉芽肿。我们还回顾了四例肉芽肿性皮肤松弛患者的活检标本。这些标本具有更典型的外观，淋巴细胞渗透整个真皮和皮下组织，明显的向表皮性，浸润内肉芽肿和巨细胞分布更均匀。肉芽肿性松弛皮肤的充分发展病变的活检显示弹性蛋白溶解，涉及真皮的整个厚度-这在我们的任何肉芽肿性蕈样肉芽肿性真菌病病例中都没有发现。蕈样肉芽肿性真菌病和肉芽肿性松弛皮肤的活检标本可能被误认为非肿瘤性肉芽肿性皮炎，但它们通常可以通过嗜表皮性或非典型淋巴细胞的存在而与之区分。由于我们的几例肉芽肿性蕈样肉芽肿病患者在病程不长的情况下死亡，肉芽肿的存在似乎不太可能总是与比非肉芽肿性蕈样肉芽肿病更良性的病程相关。
Granulomatous mycosis fungoides is an unusual histologic variant of mycosis fungoides, a condition that is ordinarily indolent. Granulomatous slack skin, like granulomatous mycosis fungoides, shows epidermotropism, granulomatous inflammation, a clonal T-helper cell population, and progression to systemic lymphoma in some cases. Unlike granulomatous mycosis fungoides, it is characterized clinically by bulky, pendulous skin folds. The similarities between the two conditions prompted us to compare the histologic features. We reviewed 24 biopsies from 10 patients with granulomatous mycosis fungoides. These showed several distinct histologic patterns, including three cases that mimicked granuloma annulare. We also reviewed biopsy specimens from four patients with granulomatous slack skin. These specimens had a more stereotypic appearance, with permeation of the entire dermis and subcutis by lymphocytes, marked epidermotropism, and a more even distribution of granulomas and giant cells within the infiltrate. Biopsies of fully developed lesions of granulomatous slack skin showed elastolysis involving the full thickness of the dermis - a feature not seen in any of our granulomatous mycosis fungoides cases. Biopsy specimens from granulomatous mycosis fungoides and granulomatous slack skin may be mistaken for nonneoplastic granulomatous dermatitides, but they can usually be distinguished from these by the presence of epidermotropism or atypical lymphocytes. Because several of our patients with granulomatous mycosis fungoides died after courses of unremarkable length, it seems unlikely that the presence of granulomas is invariably correlated with a more benign course than nongranulomatous mycosis fungoides.