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Dermatopathology: Practical & Conceptual October - December 2003
New Heights: “Hypopigmented mycosis fungoides” is not always mycosis fungoides!
Betina Werner, M.D.
Sonya Brown, M.D.
A. Bernard Ackerman, M.D.
The issue of hypopigmentation in mycosis fungoides
Our method for attempting to assess authenticity of a hypopigmented expression of mycosis fungoides
Definition of mycosis fungoides and criteria morphologically (clinical and histopathologic) for diagnosis of it
“Hypopigmented mycosis fungoides” in historical perspective
Our conclusions about “hypopigmented mycosis fungoides”
Summary of attributes of the patients who surely had “hypopigmented mycosis fungoides”
Photographs of clinical lesions and photomicrographs of the 19 patients with unquestionable hypopigmented mycosis fungoides
Summary of attributes of the patients who did not have “hypopigmented mycosis fungoides”
Photographs of clinical lesions and photomicrographs of the four patients who did not have hypopigmented mycosis fungoides:
Reasons we were unable to make a specific diagnosis of mycosis fungoides in some patients reputed to have it
Conclusions in the form of five questions and our own answers to them
How to differentiate, clinically and histopathologically, pityriasis alba and vitiligo from hypopigmented mycosis fungoides
A patient with stereotypical mycosis fungoides associated with hypopigmentation
A patient with stereotypical mycosis fungoides associated with both hypo- and hyperpigmentation
Figs. 1 & 2 Hypopigmented, non-scaly macules and patches of pityriasis alba
A 28-year-old Indian woman had asymptomatic, hypopigmented, non-scaly macules and patches on the upper extremities, abdomen, back, and buttocks for what she claimed was more than two decades. Apart from "eczema" in childhood, she declared her health to be good. A biopsy was performed of a hypopigmented lesion on the lower part of the back.
Figs. 3 & 4 Slight spongiotic dermatitis of pityriasis alba that was misinterpreted as mycosis fungoides
In addition to a sparse superficial perivascular infiltrate of lymphocytes, a few lymphocytes were present in the lower part of the surface epidermal spinous zone in company there with paltry spongiosis. The cornified layer was normal. The diagnosis of the original dermatopathologist was "mycosis fungoides, patch stage." We saw the patient herself in consultation at the request of her stepfather, a forensic pathologist. On the basis of correlation of the findings histopathologically with the features clinically, it became apparent that the diagnosis was pityriasis alba and not mycosis fungoides.
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