Mycosis fungoides natural history, complications and prognosis: Difference between revisions
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{{CMG}}; {{AE}} {{ | {{Mycosis fungoides}} | ||
{{CMG}}; {{AE}} {{S.G.}} | |||
==Overview== | ==Overview== | ||
If left untreated, [[cutaneous T cell lymphoma|mycosis fungoides]] may progress to develop [[cutaneous]] [[Patched|patches]], [[plaque]], and [[Tumor|tumors]]. Depending on the extent of the [[lymphoma]] at the time of [[diagnosis]], the [[prognosis]] may vary. | |||
==Natural History== | |||
*The [[Symptom|symptoms]] of mycosis fungoides usually develop as non-specific, [[Indolent ulcer|indolent]] inflammation such as etopic [[dermatitis]], nonspecific [[Chronic (medical)|chronic]] [[dermatitis]], or [[parapsoriasis]] ( large-[[plaque]] [[parapsoriasis]]).<ref name="QuaglinoPimpinelli20123">{{cite journal|last1=Quaglino|first1=Pietro|last2=Pimpinelli|first2=Nicola|last3=Berti|first3=Emilio|last4=Calzavara-Pinton|first4=Piergiacomo|last5=Alfonso Lombardo|first5=Giuseppe|last6=Rupoli|first6=Serena|last7=Alaibac|first7=Mauro|last8=Bottoni|first8=Ugo|last9=Carbone|first9=Angelo|last10=Fava|first10=Paolo|last11=Fimiani|first11=Michele|last12=Mamusa|first12=Angela Maria|last13=Titli|first13=Stefano|last14=Zinzani|first14=Pier Luigi|last15=Bernengo|first15=Maria Grazia|title=Time course, clinical pathways, and long-term hazards risk trends of disease progression in patients with classic mycosis fungoides|journal=Cancer|volume=118|issue=23|year=2012|pages=5830–5839|issn=0008543X|doi=10.1002/cncr.27627}}</ref> | |||
*The majority of [[Patient|patients]] have early stage (77.9% : IA stage IA 38.8%, stage IB 39.1% ), and [[Patient|patients]] with stage IIB diagnosed in 5.5% and stage III observed in 6.6%. The majority of patients of mycosis fungoides are not diagnosed and end stage not be observed.<ref name="QuaglinoPimpinelli20123" /> | |||
*Mycosis fungoides in early stage is characterized by non-specific [[dermatitis]] or consistent [[Patched|patches]] observed on the lower [[trunk]] and [[buttocks]].<ref name="QuaglinoPimpinelli20123" /> | |||
* Mycosis fungoides initiates as an [[Indolent ulcer|indolent]] [[lymphoma]] that may later develop peripheral [[lymphadenopathy]] and may finally progress to widespread visceral involvement.<ref name="radio">Mycosis fungoides. Radiopaedia.http://radiopaedia.org/articles/mycosis-fungoides Accessed on January 20, 2016</ref> | |||
* [[Patient|Patients]] often have a history of several years of [[Eczema|eczematous]] or [[dermatitis]] [[skin]] [[Lesion|lesions]] before the diagnosis is finally established.<ref name="QuaglinoPimpinelli20123" /> | |||
* The [[skin]] [[Lesion|lesions]] then progress from the patch stage to the [[plaque]] stage to [[cutaneous]] [[Tumor|tumors]].<ref name="QuaglinoPimpinelli20123" /> | |||
==Complications== | |||
*Common complications of mycosis fungoides include:<ref name="pmid28832009">{{cite journal |vauthors=Cengiz FP, Emiroğlu N, Onsun N |title=Frequency and Risk Factors for Secondary Malignancies in Patients with Mycosis Fungoides |journal=Turk J Haematol |volume=34 |issue=4 |pages=378–379 |date=December 2017 |pmid=28832009 |pmc=5774354 |doi=10.4274/tjh.2017.0234 |url=}}</ref><ref name="LawTeicher2003">{{cite journal|last1=Law|first1=Meng|last2=Teicher|first2=Noah|last3=Zagzag|first3=David|last4=Knopp|first4=Edmond A.|title=Dynamic contrast enhanced perfusion MRI in mycosis fungoides|journal=Journal of Magnetic Resonance Imaging|volume=18|issue=3|year=2003|pages=364–367|issn=1053-1807|doi=10.1002/jmri.10361}}</ref><ref name="BassunerMiranda2016">{{cite journal|last1=Bassuner|first1=Juri|last2=Miranda|first2=Roberto N.|last3=Emge|first3=Drew A.|last4=DiCicco|first4=Beau A.|last5=Lewis|first5=Daniel J.|last6=Duvic|first6=Madeleine|title=Mycosis Fungoides of the Oral Cavity: Fungating Tumor Successfully Treated with Electron Beam Radiation and Maintenance Bexarotene|journal=Case Reports in Dermatological Medicine|volume=2016|year=2016|pages=1–7|issn=2090-6463|doi=10.1155/2016/5857935}}</ref><ref name="pmid6640491">{{cite journal |vauthors=Price NM, Hoppe RT, Deneau DG |title=Ointment-based mechlorethamine treatment for mycosis fungoides |journal=Cancer |volume=52 |issue=12 |pages=2214–9 |date=December 1983 |pmid=6640491 |doi= |url=}}</ref><ref name="pmid3722479">{{cite journal |vauthors=Abel EA, Sendagorta E, Hoppe RT |title=Cutaneous malignancies and metastatic squamous cell carcinoma following topical therapies for mycosis fungoides |journal=J. Am. Acad. Dermatol. |volume=14 |issue=6 |pages=1029–38 |date=June 1986 |pmid=3722479 |doi= |url=}}</ref> | |||
**Mycosis Fungoides increases risk of secondary [[malignancies]] such as primary [[malignancy]], especially [[Hodgkin's lymphoma|Hodgkin lymphoma]], [[Chronic (medical)|chronic]] [[leukemia]], and [[lung]] [[cancer]]. | |||
**[[Neurologic]] involvement (intracerebral mycosis fungoides) | |||
**[[Oral]] involvement | |||
**[[Hypersensitivity]] reaction with [[topical]] HN2 [[therapy]] | |||
**[[Hypopigmentation]] or [[hyperpigmentation]] of treated areas | |||
==Prognosis== | ==Prognosis== | ||
* Cutaneous T cell lymphoma is usually a slow-growing (indolent) lymphoma | * Cutaneous T cell lymphoma is usually a slow-growing (indolent) [[lymphoma]].<ref name="canadiancancer">Cutaneous T cell lymphoma. Canadian Cancer Society. http://www.cancer.ca/en/cancer-information/cancer-type/non-hodgkin-lymphoma/non-hodgkin-lymphoma/types-of-nhl/cutaneous-t-cell-lymphoma/?region=on Accessed on January 19, 2016</ref> | ||
* The prognosis for people with cutaneous T cell lymphoma is based on the extent of disease and how the person responds to treatment | * The [[prognosis]] for people with [[cutaneous T cell lymphoma]] is based on the extent of [[disease]] and how the person responds to treatment. | ||
* Although more advanced stages of [[cutaneous T cell lymphoma]] may not be cured, the [[Lymphomas|lymphoma]] can still be controlled with treatment | |||
===Favorable prognosis=== | |||
* Although more advanced stages of cutaneous T cell lymphoma may not be cured, the lymphoma can still be controlled with treatment | * Early stage [[disease]] | ||
* [[Lymphoma]] is confined to the [[skin]] | |||
===Unfavorable prognosis=== | |||
* More advanced [[disease]] | |||
* [[Lymphoma]] has spread to [[Lymph node|lymph nodes]] | |||
* [[Lymphoma]] has spread to other [[Organ (anatomy)|organs]] | |||
==References== | ==References== | ||
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Sogand Goudarzi, MD [2]
Overview
If left untreated, mycosis fungoides may progress to develop cutaneous patches, plaque, and tumors. Depending on the extent of the lymphoma at the time of diagnosis, the prognosis may vary.
Natural History
- The symptoms of mycosis fungoides usually develop as non-specific, indolent inflammation such as etopic dermatitis, nonspecific chronic dermatitis, or parapsoriasis ( large-plaque parapsoriasis).[1]
- The majority of patients have early stage (77.9% : IA stage IA 38.8%, stage IB 39.1% ), and patients with stage IIB diagnosed in 5.5% and stage III observed in 6.6%. The majority of patients of mycosis fungoides are not diagnosed and end stage not be observed.[1]
- Mycosis fungoides in early stage is characterized by non-specific dermatitis or consistent patches observed on the lower trunk and buttocks.[1]
- Mycosis fungoides initiates as an indolent lymphoma that may later develop peripheral lymphadenopathy and may finally progress to widespread visceral involvement.[2]
- Patients often have a history of several years of eczematous or dermatitis skin lesions before the diagnosis is finally established.[1]
- The skin lesions then progress from the patch stage to the plaque stage to cutaneous tumors.[1]
Complications
- Common complications of mycosis fungoides include:[3][4][5][6][7]
- Mycosis Fungoides increases risk of secondary malignancies such as primary malignancy, especially Hodgkin lymphoma, chronic leukemia, and lung cancer.
- Neurologic involvement (intracerebral mycosis fungoides)
- Oral involvement
- Hypersensitivity reaction with topical HN2 therapy
- Hypopigmentation or hyperpigmentation of treated areas
Prognosis
- Cutaneous T cell lymphoma is usually a slow-growing (indolent) lymphoma.[8]
- The prognosis for people with cutaneous T cell lymphoma is based on the extent of disease and how the person responds to treatment.
- Although more advanced stages of cutaneous T cell lymphoma may not be cured, the lymphoma can still be controlled with treatment
Favorable prognosis
Unfavorable prognosis
- More advanced disease
- Lymphoma has spread to lymph nodes
- Lymphoma has spread to other organs
References
- ↑ 1.0 1.1 1.2 1.3 1.4 Quaglino, Pietro; Pimpinelli, Nicola; Berti, Emilio; Calzavara-Pinton, Piergiacomo; Alfonso Lombardo, Giuseppe; Rupoli, Serena; Alaibac, Mauro; Bottoni, Ugo; Carbone, Angelo; Fava, Paolo; Fimiani, Michele; Mamusa, Angela Maria; Titli, Stefano; Zinzani, Pier Luigi; Bernengo, Maria Grazia (2012). "Time course, clinical pathways, and long-term hazards risk trends of disease progression in patients with classic mycosis fungoides". Cancer. 118 (23): 5830–5839. doi:10.1002/cncr.27627. ISSN 0008-543X.
- ↑ Mycosis fungoides. Radiopaedia.http://radiopaedia.org/articles/mycosis-fungoides Accessed on January 20, 2016
- ↑ Cengiz FP, Emiroğlu N, Onsun N (December 2017). "Frequency and Risk Factors for Secondary Malignancies in Patients with Mycosis Fungoides". Turk J Haematol. 34 (4): 378–379. doi:10.4274/tjh.2017.0234. PMC 5774354. PMID 28832009.
- ↑ Law, Meng; Teicher, Noah; Zagzag, David; Knopp, Edmond A. (2003). "Dynamic contrast enhanced perfusion MRI in mycosis fungoides". Journal of Magnetic Resonance Imaging. 18 (3): 364–367. doi:10.1002/jmri.10361. ISSN 1053-1807.
- ↑ Bassuner, Juri; Miranda, Roberto N.; Emge, Drew A.; DiCicco, Beau A.; Lewis, Daniel J.; Duvic, Madeleine (2016). "Mycosis Fungoides of the Oral Cavity: Fungating Tumor Successfully Treated with Electron Beam Radiation and Maintenance Bexarotene". Case Reports in Dermatological Medicine. 2016: 1–7. doi:10.1155/2016/5857935. ISSN 2090-6463.
- ↑ Price NM, Hoppe RT, Deneau DG (December 1983). "Ointment-based mechlorethamine treatment for mycosis fungoides". Cancer. 52 (12): 2214–9. PMID 6640491.
- ↑ Abel EA, Sendagorta E, Hoppe RT (June 1986). "Cutaneous malignancies and metastatic squamous cell carcinoma following topical therapies for mycosis fungoides". J. Am. Acad. Dermatol. 14 (6): 1029–38. PMID 3722479.
- ↑ Cutaneous T cell lymphoma. Canadian Cancer Society. http://www.cancer.ca/en/cancer-information/cancer-type/non-hodgkin-lymphoma/non-hodgkin-lymphoma/types-of-nhl/cutaneous-t-cell-lymphoma/?region=on Accessed on January 19, 2016