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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. 57 Widespread hypopigmented non-scaly macules of pityriasis alba
A 50-year-old white woman had widespread hypopigmented macules, some of them having become confluent, especially on the upper and lower extremities. The lesions were asymptomatic and no scales could be noted. She stated that the lesions had been present for one year. A biopsy was taken of a hypopigmented macule.
Figs. 8 & 9 Slight spongiotic dermatitis of pityriasis alba misread histopathologically as mycosis fungoides
The findings histopathologically were as follows: the cornified layer was normal, a few lymphocytes were present in the lower part of the surface epidermis in association there with but a tad of spongiosis, and some lymphocytes were noticeable around venules of the superficial plexus. The patient was thought originally to have "hypopigmented mycosis fungoides" on the basis of both clinical and histopathologic attributes. When we saw the patient in consultation, it was our judgment that, clinically and histopathologically, the diagnosis was pityriasis alba and not mycosis fungoides. In the ensuing two years, the lesions had disappeared largely, a phenomenon that the patient attributed to the effects of sunbathing.
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