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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
Summary of attributes of the patients who surely had "hypopigmented mycosis fungoides"
Among the 19 patients who had hypopigmented mycosis fungoides for certain,
seven were females, ten were males, and in two patients the sex was not specified. The age of the patients at the time of diagnosis ranged from 22 months to 64 years, with a mean age of 26.8 years. Four patients had fair skin and 13 had a dark complexion; in two patients the color of the skin was not mentioned. The duration of the hypopigmented macules or patches was said to be from 1 to 25 years, with a mean of 9.8 years. In one article, the authors did not provide the age or the sex of the patient reported on, or the duration of the hypopigmentation.
Nodules and tumors developed in four patients, two of them females, 64 and 56 years of age, both of whom succumbed to the disease;
the male patients were 16 and 32.
The remaining 16 patients had hypopigmented patches that sometimes were accompanied by erythema and, episodically, by papules and plaques.
The findings in photomicrographs of lesions in all of the patients in whom changes histopathologically were pictured were similar, to wit, focal parakeratosis, a variable number of lymphocytes at all levels of the viable epidermis, where they were disposed as solitary units and, sometimes, in tiny collections, little or no spongiosis, and an infiltrate of lymphocytes in the upper part of the dermis where some bundles of collagen seemed to be coarse. Even though Sigal
did not provide a photomicrograph, a diagnosis of mycosis fungoides could be made in their patient, nonetheless, on the basis of the character of the clinical lesions, the description of findings as observed by conventional microscopy, and the course biologically.
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