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Alexander-Savino C, Boye-Doe A, Bowers E, Beaven A. Oral Mycosis Fungoides: Report of 2 Cases and Review of the Literature. Case Rep Dermatol 2023; 15:1. [PMID: 37497305 PMCID: PMC10368101 DOI: 10.1159/000530935] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2022] [Accepted: 04/20/2023] [Indexed: 07/28/2023] Open
Abstract
Oral and laryngeal cutaneous T-cell lymphoma (CTCL) is rare and usually associated with poor prognosis. Here, we discuss 2 cases of oral CTCL that developed in heavily pretreated patients and provide a review of the literature. The first case is of a 46-year-old African American male with rapidly progressive disease, presenting with a lesion on his hard palate 6 months after being diagnosed with a CD4+CD8+ CTCL. His cutaneous disease was widespread with tumors on >80% of his body surface area. Unfortunately, the patient died 2 ½ years after his CTCL diagnosis and 7 months after developing the oral CTCL lesion. The second case is of a 38-year-old African American male with stage IIb CD3+CD4+CD30+ mycosis fungoides (MF), who developed a tumor on the hard palate 6 months after diagnosis. He received palliative radiation to the oral lesion and multiple lines of systemic therapy for pulmonary, laryngeal, esophageal, and gastric involvement. Biopsy of the gastric lesions showed a CD30+ T-cell lymphoma with the same clonal peak as in his skin but with large cell transformation. Brentuximab vendoin was started, and the patient is now in complete remission, 30 months later. From the 76 cases of oral CTCL that have been reported in the English language, six were of transformed MF. The most common sites affected were the tongue and palate, and the most common presentation were erythematous or ulcerated tumors, plaques, or nodules associated with dysphagia and pain. Oral CTCL typically occurs years after the initial diagnosis of CTCL and portend a poor prognosis with an average survival of just over 1 year after development of oral lesions.
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Affiliation(s)
- Carolina Alexander-Savino
- Department of Dermatology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- Norton College of Medicine, SUNY Upstate Medical University, Syracuse, NY, USA
| | - Alexandra Boye-Doe
- Division of Hematology, Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Edith Bowers
- Department of Dermatology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Anne Beaven
- Division of Hematology, Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
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2
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Rosebush MS, Allen CM, Accurso BT, Baiocchi RA, Cordell KG. Oral Mycosis Fungoides: A Report of Three Cases and Review of the Literature. Head Neck Pathol 2018; 13:492-499. [PMID: 29700722 PMCID: PMC6684724 DOI: 10.1007/s12105-018-0923-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2018] [Accepted: 04/20/2018] [Indexed: 10/17/2022]
Abstract
Mycosis fungoides (MF) and Sézary syndrome are clonal T-cell proliferations that exhibit skin homing and represent the majority of cutaneous T-cell lymphomas. Early MF is a diagnostic challenge as both the clinical and microscopic features often mimic benign inflammatory conditions. Oral MF is very rare and has been associated in the past with advanced disease and a poor prognosis. Skin lesions are present for an average of > 6 years before oral involvement occurs. The clinical appearance is highly variable with tongue, palate and gingiva most often affected. We report 3 additional cases of oral MF, including one in which oral lesions are the initial disease presentation. Survival in patients presenting with oral MF is improving and can be attributed to advances in therapy.
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Affiliation(s)
- Molly S. Rosebush
- 0000 0001 0662 7451grid.64337.35Louisiana State University, 1100 Florida Avenue, New Orleans, LA 70119 USA
| | - Carl M. Allen
- Central Ohio Skin & Cancer, Inc., Westerville, OH USA ,0000 0001 2285 7943grid.261331.4The Ohio State University, Columbus, OH USA
| | | | - Robert A. Baiocchi
- 0000 0001 2285 7943grid.261331.4Division of Hematology, The Ohio State University College of Medicine, Columbus, OH USA
| | - Kitrina G. Cordell
- 0000 0001 0662 7451grid.64337.35Louisiana State University, 1100 Florida Avenue, New Orleans, LA 70119 USA
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3
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Sultan AS, Mostoufi B, Papadimitriou JC, Koka R, Basile J, Younis RH. Large Cell Transformation of Oral Mycosis Fungoides. Head Neck Pathol 2017; 12:247-251. [PMID: 28741231 PMCID: PMC5953864 DOI: 10.1007/s12105-017-0840-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2017] [Accepted: 07/20/2017] [Indexed: 01/15/2023]
Abstract
Mycosis fungoides (MF) accounts for approximately 50% of all primary cutaneous lymphomas. MF occurrence in the oral cavity is extremely rare with approximately 45 cases reported to date. We present a case of a 68 year-old man with a raised nodular lesion of the ventral tongue with clinical impression of irritational fibroma. Histopathologic and immunohistochemical (IHC) examination revealed a phenotype consistent with MF with large cell transformation in the context of Sezary syndrome. The histological diagnosis of oral MF requires a high index of suspicion and IHC panel to rule out large cell transformation. To our knowledge, only four cases of large cell transformation of oral MF have been reported in the English literature. The clinical and histopathologic features of a rare case of intra-oral MF with large cell transformation are exemplified in this article.
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Affiliation(s)
- Ahmed S. Sultan
- 0000 0001 2175 4264grid.411024.2Department of Oncology and Diagnostic Sciences, School of Dentistry, University of Maryland, Baltimore, MD 21201 USA
| | - Behzad Mostoufi
- 0000 0001 2175 4264grid.411024.2Department of Oral and Maxillofacial Surgery, School of Dentistry, University of Maryland, Baltimore, MD 21201 USA
| | - John C. Papadimitriou
- 0000 0001 2175 4264grid.411024.2Department of Pathology, University of Maryland School of Medicine, Baltimore, MD 21201 USA
| | - Rima Koka
- 0000 0001 2175 4264grid.411024.2Department of Pathology, University of Maryland School of Medicine, Baltimore, MD 21201 USA
| | - John Basile
- 0000 0001 2175 4264grid.411024.2Department of Oncology and Diagnostic Sciences, School of Dentistry, University of Maryland, Baltimore, MD 21201 USA ,University of Maryland Greenebaum Cancer Center, Baltimore, MD 21201 USA
| | - Rania H. Younis
- 0000 0001 2175 4264grid.411024.2Department of Oncology and Diagnostic Sciences, School of Dentistry, University of Maryland, Baltimore, MD 21201 USA ,University of Maryland Greenebaum Cancer Center, Baltimore, MD 21201 USA
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4
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Mycosis Fungoides of the Oral Cavity: Fungating Tumor Successfully Treated with Electron Beam Radiation and Maintenance Bexarotene. Case Rep Dermatol Med 2016; 2016:5857935. [PMID: 28074163 PMCID: PMC5198150 DOI: 10.1155/2016/5857935] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2016] [Revised: 10/26/2016] [Accepted: 11/06/2016] [Indexed: 11/17/2022] Open
Abstract
Oral involvement in mycosis fungoides is unusual and portends a poor prognosis. The clinical findings of three new cases are described along with a differential diagnosis and review of the literature. For brevity, only one patient is discussed in detail below whereas the other two cases are solely described in table form. The patient had a four-year history of mycosis fungoides before developing an exophytic tongue tumor. He was treated with local electron beam radiation and is disease-free to date while being on maintenance therapy with oral bexarotene. Analysis of the data collected from our review of the literature and the present cases reveal key insights.
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Emge DA, Bassuner J, Lewis DJ, Duvic M. A Rare Case of Mycosis Fungoides in the Oral Cavity and Small Intestine Complicated by Perforation. Case Rep Dermatol 2016; 8:294-302. [PMID: 27920681 PMCID: PMC5126588 DOI: 10.1159/000452326] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2016] [Accepted: 10/09/2016] [Indexed: 11/19/2022] Open
Abstract
Extracutaneous involvement in mycosis fungoides (MF) carries a poor prognosis. Oral and gastrointestinal (GI) tract lesions are both rare locations of disease. We describe the clinical findings of one case with oral and GI MF complicated by perforation after systemic antineoplastic treatment, and review the relevant literature. The patient had a 1-year history of MF before development of tongue and palate tumors. He was treated with local electron beam radiation, but re-presented to the hospital after what was found to be small intestine perforation following systemic antineoplastic therapy. The case reveals key insights into the progression and complications of lymphomas with GI tract involvement.
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Affiliation(s)
| | - Juri Bassuner
- The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Daniel J. Lewis
- Baylor College of Medicine, Houston, TX, USA
- The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Madeleine Duvic
- The University of Texas MD Anderson Cancer Center, Houston, TX, USA
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6
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DeSesa CR, Appugounder S, Haberland C, Johnson MP. Osteonecrosis of the Jaw in Association With Chemotherapy in the Setting of Cutaneous T-Cell Lymphoma. J Oral Maxillofac Surg 2015; 74:292-301. [PMID: 26296596 DOI: 10.1016/j.joms.2015.07.019] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2015] [Revised: 07/24/2015] [Accepted: 07/24/2015] [Indexed: 01/09/2023]
Abstract
T-cell lymphomas (TCLs) account for approximately 15 to 20% of all non-Hodgkin lymphomas in the United States. The most common form of TCL is cutaneous TCL (CTCL), with Sézary syndrome and mycosis fungoides being the most prevalent subtypes. Sézary syndrome is the more aggressive form and often is referred to as a late-stage variant of mycosis fungoides. Clinically, it is characterized by diffuse erythroderma, cutaneous edema, pruritus, nonhealing cutaneous ulcers, and lymphadenopathy. Patients also can present with changes to their nails, hyperpigmentation, alopecia, palmoplantar keratoderma, ectropion, and hepatosplenomegaly. The overall prognosis for patients with Sézary syndrome is poor. The literature regarding oral manifestations of CTCL mostly report those of mycosis fungoides because it is the most common subtype of CTCL. Currently, there are only 2 reports in the scientific literature of intraoral manifestations of Sézary syndrome. This case report describes a patient with Sézary syndrome who presented with rapidly progressing erythematous lesions of the gingiva and multifocal osteonecrosis of the maxilla and mandible. This is the third reported case of an intraoral manifestation of Sézary syndrome and the first reported case of osteonecrosis in the setting of CTCL.
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Affiliation(s)
- Christopher R DeSesa
- Private Practice, West Springfield, MA; Former Chief Resident, Division of Oral and Maxillofacial Surgery, Yale-New Haven Hospital, New Haven, CT.
| | - Suganya Appugounder
- Private Practice, Maple Grove, MN; Former Chief Resident, Division of Oral and Maxillofacial Surgery, Yale-New Haven Hospital, New Haven, CT
| | - Christel Haberland
- Clinical Instructor, Division of Oral and Maxillofacial Pathology, Yale-New Haven Hospital, New Haven, CT
| | - Michael P Johnson
- Residency Program Director, Division of Oral and Maxillofacial Surgery, Yale-New Haven Hospital, New Haven, CT
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7
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Castellarin P, Pozzato G, Tirelli G, Di Lenarda R, Biasotto M. Oral lesions and lymphoproliferative disorders. JOURNAL OF ONCOLOGY 2010; 2010:202305. [PMID: 20871659 PMCID: PMC2939410 DOI: 10.1155/2010/202305] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/20/2010] [Revised: 07/13/2010] [Accepted: 07/26/2010] [Indexed: 11/17/2022]
Abstract
Lymphoproliferative disorders are heterogeneous malignancy characterized by the expansion of a lymphoid clone more or less differentiated. At the level of the oral cavity, the lymphoproliferative disorder can occur in various ways, most commonly as lymphoid lesions with extranodal externalization, but sometimes, oral lesions may represent a localization of a disease spread. With regard to the primary localizations of lymphoproliferative disorders, a careful examination of the head and neck, oral, and oropharyngeal area is necessary in order to identify suspicious lesions, and their early detection results in a better prognosis for the patient. Numerous complications have been described and frequently found at oral level, due to pathology or different therapeutic strategies. These complications require precise diagnosis and measures to oral health care. In all this, oral pathologists, as well as dental practitioners, have a central role in the treatment and long-term monitoring of these patients.
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Affiliation(s)
- P. Castellarin
- Department of Dental Science, University of Trieste, 34127 Trieste, Italy
| | - G. Pozzato
- Department of Haematology, University of Trieste, 34142 Trieste, Italy
| | - G. Tirelli
- Department of Otorhinolaryngology, Head and Neck Surgery, University of Trieste, 34127 Trieste, Italy
| | - R. Di Lenarda
- Department of Dental Science, University of Trieste, 34127 Trieste, Italy
| | - M. Biasotto
- Department of Dental Science, University of Trieste, 34127 Trieste, Italy
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8
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Wain EM, Setterfield J, Judge MR, Harper JI, Pemberton MN, Russell-Jones R. Mycosis fungoides involving the oral mucosa in a child. Clin Exp Dermatol 2003; 28:499-501. [PMID: 12950337 DOI: 10.1046/j.1365-2230.2003.01348.x] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
Involvement of the oral mucosa in cutaneous T-cell lymphoma is uncommon and is usually associated with a poor prognosis (the majority of patients dying from the disease within 3 years of the diagnosis of oral involvement). We report the first case of intraoral mycosis fungoides occurring in a child. In addition, our patient has had intraoral disease for 3 years and is currently systemically well with no evidence of cutaneous or systemic disease progression.
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Affiliation(s)
- E M Wain
- Skin Tumour Unit, St John's Institute of Dermatology, St Thomas' Hospital, London.
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9
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Abstract
Mycosis fungoides is a malignant T-cell lymphoproliferative disease with a predilection for cutaneous involvement. Extracutaneous disease is uncommon and oral mucosal involvement is rare. We describe a case of mycosis fungoides involving the hard palate treated with radiotherapy. The relevant literature on this topic is reviewed.
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Affiliation(s)
- Margaret S-T Chua
- Department of Radiation Oncology, Westmead Hospital, Sydney, Australia
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10
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Harman M, Akdeniz S, Arslan A, Aöyoĝlu S. Mycosis fungoides with involvement of the oral cavity. J Eur Acad Dermatol Venereol 1998. [DOI: 10.1111/j.1468-3083.1998.tb00746.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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11
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Scully C, Eveson JW, Witherow H, Young AH, Tan RS, Gilby ED. Oral presentation of lymphoma: case report of T-cell lymphoma masquerading as oral Crohn's disease, and review of the literature. EUROPEAN JOURNAL OF CANCER. PART B, ORAL ONCOLOGY 1993; 29B:225-9. [PMID: 8298427 DOI: 10.1016/0964-1955(93)90027-c] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
A 15-year-old male with labial swelling, mouth ulcers and mucosal tags is reported. While the features were clinically consistent with oral Crohn's disease the patient proved to have a fatal T-cell lymphocytic lymphoma.
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Affiliation(s)
- C Scully
- Centre for the Study of Oral Disease, University Department of Oral Medicine, Bristol Dental Hospital and School, UK
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12
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Sirois DA, Miller AS, Harwick RD, Vonderheid EC. Oral manifestations of cutaneous T-cell lymphoma. A report of eight cases. ORAL SURGERY, ORAL MEDICINE, AND ORAL PATHOLOGY 1993; 75:700-5. [PMID: 8515982 DOI: 10.1016/0030-4220(93)90426-5] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Cutaneous T-cell lymphoma rarely involves the oral cavity. Only 14 detailed cases of oral cutaneous T-cell lymphoma have been described in the English-language literature; this report describes eight additional cases observed among 824 patients evaluated at our cutaneous T-cell lymphoma center since 1968. Oral involvement occurs late in the course of cutaneous T-cell lymphoma and usually is associated with poor prognosis; most patients die of disease complications within 3 years of the diagnosis of oral involvement.
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Affiliation(s)
- D A Sirois
- Department of Oral Pathology, Biology, and Diagnostic Science, University of Medicine and Dentistry of New Jersey, New Jersey Dental School, Newark
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13
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Abstract
Oral mucous membrane involvement occurs uncommonly in mycosis fungoides and reports of it are scarce. We present two patients with severe involvement of the oral mucous membranes.
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Affiliation(s)
- A Vicente
- Department of Dermatology, Hospital Clínico, University of Barcelona, Faculty of Medicine, Spain
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14
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Evans GE, Dalziel KL. Mycosis fungoides with oral involvement. A case report and literature review. Int J Oral Maxillofac Surg 1987; 16:634-7. [PMID: 3116123 DOI: 10.1016/s0901-5027(87)80120-0] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Mycosis fungoides, also known as T-cell lymphoma, is a low-grade malignant lymphoma predominantly affecting the skin. Intraoral manifestations are infrequently seen clinically. A case of mycosis fungoides with oral involvement and a review of the literature is reported.
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Affiliation(s)
- G E Evans
- Department of Oral Medicine and Oral Pathology, University of Wales College of Medicine, Heath Park, Cardiff, UK
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Abstract
Mycosis fungoides is a cutaneous T-cell lymphoma which in its later stages affects extracutaneous sites, including the oral mucosa. A case is presented in a 69-year-old male in which oral involvement was widespread and rapidly progressive. Although gingival involvement, as seen in this patient, is relatively rare, it is useful for the periodontist to be aware of the oral manifestations of this disease since cutaneous lesions would most likely be covered if the patient were to present for consultation on an ambulatory basis.
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