Mycosis fungoides overview
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Cutaneous T cell lymphoma Microchapters |
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Sowminya Arikapudi, M.B,B.S. [2]
Overview
Cutaneous T-Cell lymphoma (CTCL) is a class of non-Hodgkin's lymphoma, which is a type of cancer of the immune system. Cutaneous T cell lymphoma arises from T-cell lymphocytes, which are normally involved in the cell mediated immune response. The malignant T cells in the body are pushed to the surface of the skin in a biological process used to rid the body of offending material, causing various lesions to appear on the skin. These lesions change shape as the disease progresses, typically beginning as what appears to be a rash and eventually forming plaques and tumors before metastatizing to other parts of the body. There are 3 classification methods used to classify cutaneous T cell lymphoma into several subtypes. Mycosis Fungoides was first described in 1806 by French dermatologist Jean-Louis-Marc Alibert. Sézary's disease was first described by Albert Sézary. On microscopic histopathological analysis, atypical lymphoid cells, polymorphous inflammatory infiltrate in the dermis, and lymphocytes with cerebroid nuclei are characteristic findings of mycosis fungoides. Cutaneous T cell lymphoma is caused by a mutation in the T cells. Cutaneous T cell lymphoma must be differentiated from other diseases such as eczema and psoriasis. Mycosis fungoides commonly affects 45 and 55 years. Sézary syndrome commonly affects 60 years. In the United States, males are more commonly affected with cutaneous T cell lymphoma than females. In the United States, cutaneous T cell lymphoma usually affects individuals of the African American race.[1] There are no established risk factors for cutaneous T cell lymphoma. If left untreated, cutaneous T cell lymphoma may progress to develop patches , plaque, and tumors. Depending on the extent of the lymphoma at the time of diagnosis, the prognosis may vary. According to the the U.S. Preventive Service Task Force (USPSTF), there is insufficient evidence to recommend routine screening for cutaneous T cell lymphoma.[2] The staging of cutaneous T cell lymphoma is based on skin and lymph node involvement.[3]The most common symptoms of cutaneous T cell lymphoma include fever, weight loss, skin rash, night sweats, itching, chest pain, abdominal pain, and bone pain.[4] Common physical examination findings of cutaneous T cell lymphoma include fever, rash, pruritus, ulcer, chest tenderness, abdominal tenderness, bone tenderness, peripheral lymphadenopathy, and central lymphadenopathy.[4] Laboratory tests for cutaneous T cell lymphoma include complete blood count (CBC), blood chemistry studies, flow cytometry, immunohistochemistry, and immunophenotyping.[4] The definitive diagnosis of cutaneous T cell lymphoma is confirmed by either a skin biopsy or a lymph node biopsy. CT scan may be helpful in the diagnosis of cutaneous T cell lymphoma.[4] MRI may be helpful in the diagnosis of cutaneous T cell lymphoma.[4] PET scan may be helpful in the diagnosis of cutaneous T cell lymphoma.[4] Other diagnostic studies for cutaneous T cell lymphoma include bone marrow aspiration and bone marrow biopsy.[4]The predominant therapy for cutaneous T cell lymphoma is PUVA. Adjunctive chemotherapy, radiotherapy, biological therapy, retinoid therapy, and photophoresis may be required.[3]
Historical Perspective
Mycosis Fungoides was first described in 1806 by French dermatologist Jean-Louis-Marc Alibert. Sézary's disease was first described by Albert Sézary.
Classification
There are 3 classification methods used to classify cutaneous T cell lymphoma into several subtypes.
Pathophysiology
Cutaneous T cell lymphoma arises from T-cell lymphocytes, which are normally involved in the cell mediated immune response. On microscopic histopathological analysis, atypical lymphoid cells, polymorphous inflammatory infiltrate in the dermis, and lymphocytes with cerebroid nuclei are characteristic findings of mycosis fungoides.
Causes
Development of cutaneous T cell lymphoma is the result of multiple genetic mutations.
Differential Diagnosis
Cutaneous T cell lymphoma must be differentiated from other diseases such as eczema and psoriasis.
Epidemiology and Demographics
The incidence of mycosis fungoides increases with age; the median age at diagnosis is between 45 and 55 years of age. The median age at diagnosis of Sézary syndrome is between 60 years of age. In the United States, males are more commonly affected with cutaneous T cell lymphoma than females. In the United States, cutaneous T cell lymphoma usually affects individuals of the African American race.[1]
Risk Factors
There are no established risk factors for cutaneous T cell lymphoma.
Screening
According to the the U.S. Preventive Service Task Force (USPSTF), there is insufficient evidence to recommend routine screening for cutaneous T cell lymphoma.[5]
Natural History, Complications and Prognosis
If left untreated, cutaneous T cell lymphoma may progress to develop cutaneous patches and plaque. Depending on the extent of the lymphoma at the time of diagnosis, the prognosis may vary.
Diagnosis
Staging
The staging of cutaneous T cell lymphoma is based on the skin and lymph nodes involvement.[3]
Symptoms
The most common symptoms of cutaneous T cell lymphoma include fever, weight loss, skin rash, night sweats, itching, chest pain, abdominal pain, and bone pain.[4]
Physical Examination
Common physical examination findings of cutaneous T cell lymphoma include fever, rash, pruritus, ulcer, chest tenderness, abdominal tenderness, bone tenderness, peripheral lymphadenopathy, and central lymphadenopathy.[4]
Laboratory Tests
Laboratory tests for cutaneous T cell lymphoma include complete blood count (CBC), blood chemistry studies, flow cytometry, immunohistochemistry, and immunophenotyping.[4]
Biopsy
The definitive diagnosis of cutaneous T cell lymphoma is confirmed by either a skin biopsy or a lymph node biopsy.
CT
CT scan may be helpful in the diagnosis of cutaneous T cell lymphoma.[4]
MRI
MRI may be helpful in the diagnosis of cutaneous T cell lymphoma.[4]
Other Imaging Studies
PET scan may be helpful in the diagnosis of cutaneous T cell lymphoma.[4]
Other Diagnostic Studies
Other diagnostic studies for cutaneous T cell lymphoma include bone marrow aspiration and bone marrow biopsy. [4]
Treatment
Medical Therapy
The predominant therapy for cutaneous T cell lymphoma is PUVA. Adjunctive chemotherapy, radiotherapy, biological therapy, retinoid therapy, and photophoresis may be required.[3]
References
- ↑ 1.0 1.1 Mycosis fungoides. Radiopaedia.http://radiopaedia.org/articles/mycosis-fungoides Accessed on January 21, 2016
- ↑ Recommendations. U.S Preventive Services Task Force. http://www.uspreventiveservicestaskforce.org/BrowseRec/Search?s=cutaneous+T+cell+lymphoma Accessed on January 19, 2016
- ↑ 3.0 3.1 3.2 3.3 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
- ↑ 4.00 4.01 4.02 4.03 4.04 4.05 4.06 4.07 4.08 4.09 4.10 4.11 4.12 4.13 Cutaneous T cell lymphoma. Surveillance, Epidemiology, and End Results . http://seer.cancer.gov/seertools/hemelymph/51f6cf56e3e27c3994bd52f7/ Accessed on January 19, 2016
- ↑ Recommendations. U.S Preventive Services Task Force. http://www.uspreventiveservicestaskforce.org/BrowseRec/Search?s=cutaneous+T+cell+lymphoma Accessed on January 19, 2016