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Jin MF, Ali NS, Davis DMR, Johnson EF, Gibson LE. An update on long-term outcomes of pediatric follicular mucinosis over a 20-year period: a retrospective cohort study. Int J Dermatol 2023. [PMID: 36919978 DOI: 10.1111/ijd.16639] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2022] [Revised: 01/13/2023] [Accepted: 02/21/2023] [Indexed: 03/16/2023]
Abstract
BACKGROUND Follicular mucinosis (FM) is a rare disease characterized by mucin accumulation in the follicular unit. FM's etiology is still widely debated since its first description in 1957. Follicular mucinosis is usually reported to be benign in children, although reports of malignant transformation, most commonly mycosis fungoides, exist. The present project aims to demonstrate that children with a diagnosis of follicular mucinosis have positive long-term outcomes and do not develop mycosis fungoides. MATERIALS AND METHODS This is a retrospective cohort study where patients with a diagnosis of follicular mucinosis ages 22 years and below were identified. Data surrounding the patient's diagnosis of FM, differential diagnosis, treatments, and long-term outcomes were collected. Patients who were lost to follow-up were contacted by phone for an update on the status of their skin and overall health. RESULTS Out of 14 patients with follow-up information, none developed subsequent mycosis fungoides or other hematologic malignancies. CONCLUSION Pediatric patients with follicular mucinosis will likely present with limited disease and not experience malignant transformation.
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Affiliation(s)
- Mauricio F Jin
- Mayo Clinic, Alix School of Medicine, Rochester, MN, USA
| | - Nora S Ali
- Department of Dermatology, Mayo Clinic, Rochester, MN, USA
| | - Dawn M R Davis
- Department of Dermatology, Mayo Clinic, Rochester, MN, USA.,Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, MN, USA
| | - Emma F Johnson
- Department of Dermatology, Mayo Clinic, Rochester, MN, USA.,Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA
| | - Lawrence E Gibson
- Department of Dermatology, Mayo Clinic, Rochester, MN, USA.,Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA
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Geller S, Gomez CJ, Myskowski PL, Pulitzer M. Follicular mucinosis in patients with hematologic malignancies other than mycosis fungoides: A clinicopathologic study. J Am Acad Dermatol 2019; 80:1704-1711. [PMID: 30716405 DOI: 10.1016/j.jaad.2019.01.062] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2018] [Revised: 01/08/2019] [Accepted: 01/26/2019] [Indexed: 11/30/2022]
Abstract
BACKGROUND Follicular mucinosis (FM), which is defined by mucin accumulation within follicular epithelium, may occur in mycosis fungoides (MF). FM without MF is occasionally reported in systemic hematologic malignancies and may be diagnostically challenging. OBJECTIVE To describe clinicopathologic characteristics of FM in patients with hematologic malignancies other than MF. METHODS Clinical data and histopathology features were analyzed in patients with FM and hematologic malignancies diagnosed between 1994 and 2017. RESULTS A total of 18 patients with FM and systemic hematologic malignancies without cutaneous T-cell lymphoma (CTCL) were identified; 9 of them were discovered after hematopoietic stem cell transplantation. No patients with non-CTCL-associated FM (n = 46 [37 biopsy specimens]) developed CTCL during a mean follow-up of 4.3 years. Of the cases of CTCL associated with FM (n = 44 [31 biopsy specimens]), MF was the most common subtype (n = 38), although other CTCLs were identified. FM in patients with non-CTCL hematologic malignancies differed clinically from those with MF-associated FM, presenting most frequently with erythematous papules (P < .0001), without plaques (P <.0001), without alopecia (P = .001), and without histopathologically identified epidermal exocytosis (P = .013). LIMITATIONS A retrospective study in a single cancer center. CONCLUSIONS FM can present in systemic hematologic malignancies, including after hematopoietic stem cell transplantation. Papular lesional morphologic and histopathologic features may help to distinguish these cases from MF.
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Affiliation(s)
- Shamir Geller
- Dermatology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York, New York; Department of Dermatology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel.
| | - Christian J Gomez
- Dermatology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York, New York; Drexel University College of Medicine, Philadelphia, Pennsylvania
| | | | - Melissa Pulitzer
- Department of Pathology, Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York, New York
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3
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Abstract
Background: Alopecia mucinosa has been shown to be associated with many benign and malignant conditions. It can be seen in childhood but is seen more commonly in adulthood. Alopecia mucinosa is generally felt to occur in three settings: a primary idiopathic form, a form associated with malignancy, and a form secondary to inflammatory conditions. The histologic hallmark is the accumulation of mucin in the follicular epithelium, called follicular mucinosis. Therapy for alopecia mucinosa remains problematic. Objective: We present a representative case of alopecia mucinosa and discuss the etiology, histology, epidemiology, treatment, and prognosis. Conclusion: We report a case of idiopathic alopecia mucinosa that responded to minocycline with a complete remission and we review the literature on alopecia mucinosa.
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Affiliation(s)
- Bryan E. Anderson
- Department of Dermatology, Penn State College of Medicine, Penn State Milton S Hershey Medical Center, Hershey, Pennsylvania, USA
| | - Christine L. Mackley
- Department of Dermatology, Penn State College of Medicine, Penn State Milton S Hershey Medical Center, Hershey, Pennsylvania, USA
| | - Klaus F. Helm
- Department of Dermatology, Penn State College of Medicine, Penn State Milton S Hershey Medical Center, Hershey, Pennsylvania, USA
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Jefferson J, Taube J, Grossberg A. Follicular Mucinosis in a Male Adolescent with a History of Acute Myelogenous Leukemia and Graft-versus-Host Disease. Pediatr Dermatol 2016; 33:e34-5. [PMID: 26645410 DOI: 10.1111/pde.12724] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Although many cases of follicular mucinosis are idiopathic, numerous others are associated with mycosis fungoides or, rarely, other neoplastic or inflammatory disorders. There are only three reported cases, all in adults, of follicular mucinosis arising in association with acute myelogenous leukemia, two of which involved mycosis fungoides-associated follicular mucinosis, including one case in which the patient had a preceding bone marrow transplant. We present the first reported case of follicular mucinosis arising in an adolescent with acute myelogenous leukemia and acute graft-versus-host disease after an allogeneic bone marrow transplantation.
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Affiliation(s)
- Julie Jefferson
- Department of Dermatology, School of Medicine, Johns Hopkins University, Baltimore, Maryland
| | - Janis Taube
- Department of Dermatology, School of Medicine, Johns Hopkins University, Baltimore, Maryland
| | - Anna Grossberg
- Department of Dermatology, School of Medicine, Johns Hopkins University, Baltimore, Maryland
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León-Martínez G, Meillón-García L, Morales-Polanco M, Soler-Montecinos L, Ortiz-Hidalgo C. Unusual Morphologic Presentations of Blastic Plasmacytoid Dendritic Cell Neoplasm. Int J Surg Pathol 2013; 22:76-82. [DOI: 10.1177/1066896913481056] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
We present 2 cases of blastic plasmacytoid dendritic cell neoplasm (BPDCN) showing unusual histological features. One patient, a 73-year-old male, presented with a nonpruritic macular erythema of the skin on the anterior and posterior chest wall, the biopsy of which was originally diagnosed as malignant melanoma. The neoplastic cells were negative for S100 and HMB45 and strongly positive for CD45, CD4, CD56, and CD123. The final diagnosis was a BPDCN associated with abundant melanin pigment and numerous melanophages. The second patient was a 73-year-old male with a 5-month history of small, slowly enlarging, bruise-like plaques on his limbs and chest. Histologic examination of the skin biopsy revealed an atypical cellular/myxoid infiltrate with numerous macrophages, which was originally diagnosed as consistent with lepromatous leprosy. The atypical cells were immersed in an alcian blue–positive myxoid matrix at pH 2.5. The Fite-Faraco stain was negative. Positive immunoreactivity was demonstrated for CD4, CD56, and CD123. Based on the histopathology and immunohistochemistry findings, a diagnosis of BPDCN with prominent myxoid matrix was rendered.
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6
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Alikhan A, Griffin J, Nguyen N, Davis DMR, Gibson LE. Pediatric follicular mucinosis: presentation, histopathology, molecular genetics, treatment, and outcomes over an 11-year period at the Mayo Clinic. Pediatr Dermatol 2013; 30:192-8. [PMID: 23278316 DOI: 10.1111/pde.12019] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Follicular mucinosis (FM) and folliculotropic mycosis fungoides (MF) are rare in children, and data regarding long-term outcomes are limited. We sought to describe clinical and histopathologic findings of children with FM with and without MF, as well as treatments administered and clinical outcomes. We conducted a retrospective chart review of patients younger than 22 years (at time of diagnosis) with a biopsy demonstrating FM who were seen in the Dermatology Department at the Mayo Clinic from September 1, 1999, to September 1, 2010. Eleven patients (six male, five female) ages 11 to 19 years at the time of diagnosis met the inclusion criteria. Follow-up data were available for 10 patients, with a mean duration of 4.9 years. The head, neck, and extremities were the most common sites of involvement, and lesions were follicular-based papules (18%), scaly alopecic patches and plaques (45%), or a combination of the two (36%). Overall, three patients were confirmed to have MF. T-cell receptor gene rearrangement demonstrated clonality in two cases and was equivocal in one case. Treatments included topical corticosteroids, topical retinoids, oral minocycline, and, in patients with MF, ultraviolet light and topical bexarotene. Lesions resolved completely in seven patients, partially in one, and not at all in two (no follow-up data on one patient). Of the three patients with MF, two had complete resolution, and one has intermittent flares. To our knowledge, no patients developed other lymphoproliferative disorders. FM in children is rare. A histopathologic diagnosis of FM does not equate to folliculotropic MF in all cases. Most patients responded to treatment with topical steroids, topical retinoids, or phototherapy. In our series of patients, the disease ran a benign course.
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Affiliation(s)
- Ali Alikhan
- Department of Dermatology, Mayo Clinic, Rochester, Minnesota 55905, USA.
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7
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Camp B, Horwitz S, Pulitzer MP. Adult T-cell leukemia/lymphoma with follicular mucinosis: an unusual histopathological finding and a commentary. J Cutan Pathol 2012; 39:861-5. [DOI: 10.1111/j.1600-0560.2012.01953.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Brendan Camp
- Memorial Sloan Kettering Cancer Center; New York; NY; USA
| | - Steven Horwitz
- Memorial Sloan Kettering Cancer Center; New York; NY; USA
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8
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Stewart FA, Andea A, Hughey LC. Mycosis fungoides–associated follicular mucinosis after bone-marrow transplantation. J Am Acad Dermatol 2012; 66:e240-1. [DOI: 10.1016/j.jaad.2011.07.017] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2010] [Revised: 06/28/2011] [Accepted: 07/18/2011] [Indexed: 10/28/2022]
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9
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Cho HH, Kim SH, Seo SH, Jung DS, Ko HC, Kim MB, Kwon KS. Oral hairy leukoplakia which occurred as a presenting sign of acute myeloid leukemia in a child. Ann Dermatol 2010; 22:73-6. [PMID: 20548888 DOI: 10.5021/ad.2010.22.1.73] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2009] [Revised: 05/11/2009] [Accepted: 07/06/2009] [Indexed: 11/08/2022] Open
Abstract
Oral hairy leukoplakia (OHL) is caused by the reactivation of a previous Epstein-Barr virus (EBV) infection in the epithelium of the tongue. Most lesions are characterized by corrugated whitish patches on the lateral border of the tongue. It is frequently associated with AIDS, but cases in patients with other immunosuppressed states have also been reported. In leukemia patients, OHL is rarely encountered, and appears only after chemotherapy. We report a case of OHL which occurred as a presenting sign of acute myeloid leukemia (AML) in a previously healthy 15-year-old child. A 15-year-old boy presented with a whitish patch on the left lateral border of the tongue. The biopsy specimen revealed papillomatosis, hyperkeratosis, acanthosis and ballooning degeneration in the stratum spinosum. The patient was EBV seropositive, and PCR analysis of EBV DNA in the lesional tissue was positive. After the diagnosis of OHL in dermatologic department, the patient was referred to pediatrics due to the abnormal peripheral blood smear, and was diagnosed with AML.
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Affiliation(s)
- Hyun-Ho Cho
- Department of Dermatology, School of Medicine, Pusan National University, Busan, Korea
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10
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Parker SRS, Murad E. Follicular mucinosis: clinical, histologic, and molecular remission with minocycline. J Am Acad Dermatol 2009; 62:139-141. [PMID: 19632741 DOI: 10.1016/j.jaad.2009.01.031] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2008] [Revised: 12/23/2008] [Accepted: 01/21/2009] [Indexed: 11/18/2022]
Abstract
Follicular mucinosis is an uncommon inflammatory disorder characterized histologically by mucin accumulation in the follicular epithelium. The condition is generally divided into primary and secondary forms, the latter being frequently associated with mycosis fungoides. Lesional skin T-cell clonality has been documented in some patients with follicular mucinosis, even those with no histologic evidence of cutaneous lymphoma. In this report, we describe a patient with clonal idiopathic primary follicular mucinosis who had complete clinical, histologic, and molecular remission with minocycline therapy.
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Affiliation(s)
- Sareeta R S Parker
- Department of Dermatology, Emory University School of Medicine, Atlanta, Georgia.
| | - Emma Murad
- Department of Dermatology, Emory University School of Medicine, Atlanta, Georgia
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12
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Abstract
UNLABELLED The cicatricial alopecias encompass a diverse group of disorders characterized by permanent destruction of the hair follicle and irreversible hair loss. Destruction of the hair follicle can result from primary, folliculocentric disease or as a secondary result. This article focuses on the former, or primary cicatricial alopecias. The cause and pathogenesis of many of these disorders are largely unknown. Although unique clinicopathologic features allow for accurate diagnosis in some cases, diagnostic certainty is often elusive and reflects the limits of present understanding. Classification of the primary cicatricial alopecias on the basis of pathology provides a diagnostic and investigational framework and, it is hoped, will facilitate future enlightenment. Details of classification, etiopathogenesis, clinicopathologic features, differential diagnosis, and practical management of the primary cicatricial alopecias will be discussed. LEARNING OBJECTIVES Upon completion of this learning activity, participants should be familiar with the following aspects of the primary cicatricial alopecias: (1) the new, consensus-issued classification scheme, (2) current understanding about etiopathogenesis, (3) salient clinicopathologic features, (4) differential diagnosis, and (5) therapeutic management.
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Affiliation(s)
- Elizabeth K Ross
- Department of Medicine, University of British Columbia, Vancouver Coastal Health Research Insitute, Vancouver, British Columbia, Canada
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13
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Affiliation(s)
- Benjamin N Lockshin
- Division of Dermatology, Georgetown University Medical Center, Washington, DC 20007, USA
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14
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Abstract
Follicular mucinosis is a rare chronic inflammatory disease of unknown aetiology, presenting as mucin deposits around the follicles and sebaceous glands. It can progress to alopecia of the scalp and other hairy areas. Follicular mucinosis may be a benign primary idiopathic disorder or secondary to malignant lymphoproliferative disorders. It can present with shiny papules or sharply marginated infiltrated erythematous scaling plaques, with follicular accentuation on the scalp, neck, trunk and limbs. There are many local and systemic treatments. This paper discusses the case of an adult with an uncommon acneiform follicular mucinosis controlled with systemic corticosteroids.
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Affiliation(s)
- E M C Passaro
- Department of Dermatology, Hospital do Servidor Público do Estado de São Paulo, Brazil.
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15
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Abstract
Confusion abounds regarding the terms "follicular mucinosis" and "alopecia mucinosa," not only concerning definition and essential character, but of relationships between themselves on one hand and between themselves and mycosis fungoides on the other. We address here those issues in methodical fashion, first in historical perspective by review, scrupulously and critically, of what has been said in the many articles devoted to the subject; we next tell how the terms "alopecia mucinosa" and "follicular mucinosis" came to be and how they are employed currently; we then set forth our own observations pertinent to clinical, histopathologic, and biologic aspects of the condition called, conventionally, "alopecia mucinosa," those observations based on our own findings in sections of tissue cut from 54 biopsy specimens taken from 45 patients, all of them having been signed out previously as "follicular mucinosis;" we proceed to forge clinico-pathologic correlation of lesions in 14 of those 45 patients, utilizing assessments, by examination grossly and microscopically, of attributes in the very same lesion. Last, we propose a concept, and a terminology that derives from it, that synthesizes all that is known now about "alopecia mucinosa" and "follicular mucinosis," in particular the relationship of "alopecia mucinosa" to mycosis fungoides, including "follicular," "syringotropic," and erythrodermic manifestations of it. In short, we affirm that so-called alopecia mucinosa is but one of many morphologic manifestations of mycosis fungoides.
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Affiliation(s)
- Almut Böer
- Department of Dermatology, Klinikum der J W Goethe Universität, Frankfurt, Germany.
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16
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Jiménez OS, Botella Estrada R, Guillén Barona C, Rodríguez Serna M, Aliaga Boniche A. Mucinosis folicular: nuevas entidades clínico-patológicas. Estudio clínico, histológico, inmunohistoquímico e inmunogenotípico de 23 pacientes. ACTAS DERMO-SIFILIOGRAFICAS 2002. [DOI: 10.1016/s0001-7310(02)79215-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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17
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Campanati A, Giangiacomi M, Goteri G, Penna L, Turtù S, Offidani AM. A case of follicular mycosis fungoides with follicular mucinosis: a rare association. Am J Dermatopathol 2002; 24:423-6. [PMID: 12357205 DOI: 10.1097/00000372-200210000-00009] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Follicular mycosis fungoides (FMF) is a rare cutaneous T cell lymphoma characterized by an atypical lymphoid infiltrate spreading within and around hair follicles without epidermotropism or follicular mucin deposits. Its occasional presentation with minimal epidermal involvement and/or follicular mucinosis suggests the need for uniform histologic criteria. We describe a new case of FMF associated with follicular mucinosis and discuss its morphologic spectrum of presentation.
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Affiliation(s)
- Anna Campanati
- Department of Dermatology, School of Medicine, Ancona, Italy.
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18
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Santa María Esguevillas MSD, Porta Aznar N, Baldellou Lasierra R. Mucinosis folicular: un caso de presentación clínica inusual. ACTAS DERMO-SIFILIOGRAFICAS 2002. [DOI: 10.1016/s0001-7310(02)79216-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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Bonta MD, Tannous ZS, Demierre MF, Gonzalez E, Harris NL, Duncan LM. Rapidly progressing mycosis fungoides presenting as follicular mucinosis. J Am Acad Dermatol 2000; 43:635-40. [PMID: 11004619 DOI: 10.1067/mjd.2000.107741] [Citation(s) in RCA: 52] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Follicular mucinosis can occur as a primary idiopathic disorder or can arise in association with benign or malignant disease, most notably mycosis fungoides. We describe a patient with an aggressive folliculotropic variant of mycosis fungoides that initially presented as follicular mucinosis with alopecia. One month after the diagnosis of follicular mucinosis, a diagnosis of mycosis fungoides was made, and 3 months later inguinal lymph node involvement with mycosis fungoides developed. A skin biopsy specimen demonstrated prominent follicular mucinosis with folliculotropism of atypical cells and intrafollicular Pautrier's microabscesses. As demonstrated in this case, follicular mucinosis can be a presenting sign of rapidly progressive mycosis fungoides. In our review of follicular mucinosis and its association with mycosis fungoides, we found that the folliculotropic variant of mycosis fungoides appears more commonly to have an aggressive course than classic mycosis fungoides.
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Affiliation(s)
- M D Bonta
- Dermatopathology Unit, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA
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Cutaneous Aspects of Leukemia. Dermatology 2000. [DOI: 10.1007/978-3-642-97931-6_62] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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Glusac EJ, Shapiro PE, McNiff JM. Cutaneous T-cell lymphoma. Refinement in the application of controversial histologic criteria. Dermatol Clin 1999; 17:601-14, ix. [PMID: 10410861 DOI: 10.1016/s0733-8635(05)70110-8] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The term cutaneous T-cell lymphoma was originally coined to encompass the spectrum of mycosis fungoides and Sézary syndrome. It has become increasingly evident that the histopathologic diagnosis of CTCL can be exceedingly challenging. A series of recent studies, however, have helped clarify the nature of the histologic findings in CTCL. Recently reported histologic data on mycosis fungoides, Sézary syndrome, and their variants is emphasized in this article, with special focus given to the findings in early lesions. A brief summary of lymphocyte immunophenotyping and the role of T-cell reception gene rearrangements in CTCL is included.
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Affiliation(s)
- E J Glusac
- Department of Dermatology, Yale Dermatopathology Laboratory, New Haven, Connecticut, USA
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