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Aldayhum MS, Alshahrani MS, Hussein MRA, Alshahrani AS, Hussein TMR. Folliculotropic mycosis fungoides associated with follicular mucinosis: A case report and mini review. Clin Case Rep 2024; 12:e8731. [PMID: 38585584 PMCID: PMC10996046 DOI: 10.1002/ccr3.8731] [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: 10/04/2023] [Revised: 01/27/2024] [Accepted: 03/11/2024] [Indexed: 04/09/2024] Open
Abstract
Key Clinical Message F-MF is a rare non-classic variant of MF. In the case of hair loss, this should be a diagnostic consideration. The essence of the diagnosis of F-MF is a careful medical history, physical examination, and a combination of immunohistological and molecular analyses (Cureus. 2022; 14:e21231, Ann Saudi Med. 2012; 32:283, Oman Med J. 2012; 27:134, Int J Dermatol. 2016; 55:1396, Saudi Med J. 2018; 39:994 and Case Rep Oncol. 2018; 11:436). Abstract Mycosis fungoides (MF) is a primary cutaneous T-cell lymphoma with multiple subtypes. Follicular MF (F-MF) is a non-classic variant of MF. Histological features entail folliculotropism and damage of the epithelium lining of the hair follicles with or without mucin deposition. A 52-year-old male patient complained of recurrent skin lesions on the scalp over 8 months. The lesions appeared suddenly, enlarged over time, and became itchy. A skin punch biopsy was performed. Histological features included mucin deposits in the epithelium of the hair follicles and dense, predominantly perifollicular atypical lymphocytes infiltrating the follicular epithelium. The lymphoid cells were composed of CD3-positive T cells (CD4/CD8-positive T cells) with a shift in favor of the former. The case was diagnosed as F-MF on an immunohistological basis. The diagnosis of F-MF is often difficult for dermatologists and dermatopathologists alike. Not only clinicopathological correlations but also immunohistochemical and molecular analysis are required.
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Affiliation(s)
- Majed Saleh Aldayhum
- Department of DermatologyArmed Forces Hospitals Southern regionKhamis MushaiteKingdom of Saudi Arabia
| | - Mohammed Saad Alshahrani
- Department of DermatologyArmed Forces Hospitals Southern regionKhamis MushaiteKingdom of Saudi Arabia
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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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3
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Weiner DM, Clark AK, Moon AT, Haun PL, Samimi SS. A case of nevoid follicular mucinosis in a child. JAAD Case Rep 2021; 18:29-32. [PMID: 34805468 PMCID: PMC8590035 DOI: 10.1016/j.jdcr.2021.10.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Affiliation(s)
- David M. Weiner
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Ashley K. Clark
- Department of Dermatology, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Amanda T. Moon
- Division of Pediatrics, Section of Dermatology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Paul L. Haun
- Department of Dermatology, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Sara S. Samimi
- Department of Dermatology, University of Pennsylvania, Philadelphia, Pennsylvania
- Correspondence to: Sara S. Samimi, MD, Department of Dermatology, University of Pennsylvania, 3400 Civic Center Blvd, Philadelphia, PA 19104.
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Wohlmuth-Wieser I. Primary cutaneous T-cell lymphomas in childhood and adolescence. J Dtsch Dermatol Ges 2021; 19:563-581. [PMID: 33861015 DOI: 10.1111/ddg.14509] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2021] [Accepted: 03/09/2021] [Indexed: 12/12/2022]
Abstract
Primary cutaneous lymphomas are extranodal non-Hodgkin lymphomas of T- or B- cell origin, that predominantly affect older patients but have been reported in all age groups and as early as in the first years of life. Diagnosis of cutaneous lymphomas is challenging and requires high clinical suspicion and close collaboration between dermatologists, pediatric oncologists and pathologists. Skin involvement of non-Hodgkin lymphomas in children or adolescents can either be primary cutaneous or secondary due to an underlying nodal lymphoma. The most common primary cutaneous lymphomas encountered in children are of T-cell origin, with mycosis fungoides being the most prevalent cutaneous T-cell lymphoma, followed by CD30+ lymphoproliferative disorders. While cutaneous lymphomas share clinicopathologic characteristics between juvenile and adult forms, there are important differences in terms of clinical presentation, diagnosis and treatment. The hypopigmented variant of mycosis fungoides seems to be overrepresented in the pediatric age group. Prognosis and treatment of mycosis fungoides are stage dependent. The majority of children present with early-stage disease and respond well to topical corticosteroids and phototherapy.
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Affiliation(s)
- Iris Wohlmuth-Wieser
- Department of Dermatology and Allergology, Paracelsus Medical University Salzburg, Salzburg, Austria
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Wohlmuth-Wieser I. Primär kutane T‐Zell‐Lymphome im Kindes‐ und Jugendalter. J Dtsch Dermatol Ges 2021; 19:563-583. [PMID: 33861014 DOI: 10.1111/ddg.14509_g] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2021] [Accepted: 03/09/2021] [Indexed: 12/18/2022]
Abstract
Primär kutane Lymphome sind extranodale T- oder B-Zell-Non-Hodgkin-Lymphome, die vorwiegend ältere Patienten betreffen, aber in allen Altersgruppen einschließlich der ersten Lebensjahre auftreten können. Die Diagnose kutaner Lymphome ist eine Herausforderung und erfordert einen hohen klinischen Verdacht sowie enge Zusammenarbeit zwischen Dermatologen, pädiatrischen Onkologen und Pathologen. Generell müssen primär kutane Lymphome von sekundär kutanen Lymphomen, welche meist von nodalen oder extranodalen Lymphomen ausgehen, unterschieden werden. Die häufigsten primär kutanen Lymphome im Kindesalter sind T-Zell Lymphome, wobei Mycosis fungoides das häufigste kutane T-Zell-Lymphom darstellt, gefolgt von CD30+ lymphoproliferativen Erkrankungen. Während klinisch-pathologische Merkmale kutaner Lymphome bei Jugendlichen und Erwachsenen ähnlich sind, gibt es wichtige Unterschiede bezüglich klinischer Präsentation, Diagnose und Behandlung. Die hypopigmentierte Variante der Mycosis fungoides scheint in der pädiatrischen Altersgruppe überrepräsentiert zu sein. Prognose und Behandlung der Mycosis fungoides sind stadienabhängig. Die Mehrheit der Kinder weist ein frühes Krankheitsstadium auf und spricht gut auf topische Kortikosteroide und Phototherapie an.
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Affiliation(s)
- Iris Wohlmuth-Wieser
- Klinik für Dermatologie und Allergologie, Paracelsus Medizinische Privatuniversität Salzburg, Österreich
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Esteves M, Nogueira A, Azevedo F, Mota A. Pediatric Follicular Mucinosis: A Report of Two Cases. Indian Dermatol Online J 2021; 12:172-173. [PMID: 33768046 PMCID: PMC7982017 DOI: 10.4103/idoj.idoj_64_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2020] [Revised: 02/26/2020] [Accepted: 04/05/2020] [Indexed: 11/22/2022] Open
Affiliation(s)
- Mariana Esteves
- Department of Dermatology and Venereology, Centro Hospitalar Universitário de São João EPE, Porto, Portugal
| | - Ana Nogueira
- Department of Dermatology and Venereology, Centro Hospitalar Universitário de São João EPE, Porto, Portugal
| | - Filomena Azevedo
- Department of Dermatology and Venereology, Centro Hospitalar Universitário de São João EPE, Porto, Portugal
| | - Alberto Mota
- Department of Dermatology and Venereology, Centro Hospitalar Universitário de São João EPE, Porto, Portugal
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González-Cuevas R, Peruilh-Bagolini L, Calderón P, Ortega-Peña M, Vargas-Mora P. A single plaque on the chin. Pediatr Dermatol 2021; 38:e3-e4. [PMID: 33630366 DOI: 10.1111/pde.14441] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Affiliation(s)
| | | | - Perla Calderón
- Dermatology Service, Hospital Clinico Universidad de Chile, Santiago, Chile
| | | | - Pablo Vargas-Mora
- Department of Dermatology, Facultad de Medicina, Universidad de Chile, Santiago, Chile
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Khalil J, Kurban M, Abbas O. Follicular mucinosis: a review. Int J Dermatol 2020; 60:159-165. [PMID: 32880923 DOI: 10.1111/ijd.15165] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Revised: 08/06/2020] [Accepted: 08/06/2020] [Indexed: 11/28/2022]
Abstract
Follicular mucinosis (FM) is an epithelial reaction pattern characterized by follicular mucin accumulation. It has been described in association with various inflammatory and neoplastic cutaneous disorders. FM is generally divided into a primary benign idiopathic form and a secondary form usually occurring in association with cutaneous lymphomas (especially mycosis fungoides), among other entities. Distinction between the two forms can be challenging as they share many overlapping features and the lack of a single diagnostic tool to differentiate between the two. Making the distinction may require evaluating and correlating the clinical, histologic, immunohistochemical, and molecular studies together. Long-term clinical follow-up also remains very important. In this review, we describe the different entities associated with FM, its pathogenesis, and possible therapeutic options.
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Affiliation(s)
- Joanna Khalil
- Dermatology Department, American University of Beirut Medical Center, Beirut, Lebanon
| | - Mazen Kurban
- Dermatology Department, American University of Beirut Medical Center, Beirut, Lebanon
| | - Ossama Abbas
- Dermatology Department, American University of Beirut Medical Center, Beirut, Lebanon
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Muñoz-Aceituno E, Vega-González R, Martínez-Palazuelos M, Pérez-Gala S, Llamas-Velasco M, Fraga J, Dauden E. Association between eosinophilic folliculitis and follicular mucinosis. A case series. Int J Dermatol 2020; 59:e376-e378. [PMID: 32323302 DOI: 10.1111/ijd.14890] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2020] [Revised: 03/08/2020] [Accepted: 03/27/2020] [Indexed: 11/30/2022]
Affiliation(s)
| | - Rocío Vega-González
- Department of Dermatology, Hospital Universitario de la Princesa, Madrid, Spain
| | | | - Silvia Pérez-Gala
- Department of Dermatology, Hospital Universitario de la Princesa, Madrid, Spain
| | - Mar Llamas-Velasco
- Department of Dermatology, Hospital Universitario de la Princesa, Madrid, Spain
| | - Javier Fraga
- Department of Pathology, Hospital Universitario de la Princesa, Madrid, Spain
| | - Esteban Dauden
- Department of Dermatology, Hospital Universitario de la Princesa, Madrid, Spain
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Gru AA, McHargue C, Salavaggione AL. A Systematic Approach to the Cutaneous Lymphoid Infiltrates: A Clinical, Morphologic, and Immunophenotypic Evaluation. Arch Pathol Lab Med 2020; 143:958-979. [PMID: 31339758 DOI: 10.5858/arpa.2018-0294-ra] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
CONTEXT.— The evaluation of cutaneous lymphoid infiltrates, both neoplastic and inflammatory, occurs very frequently in routine dermatopathologic examination and consultation practices. The "tough" cutaneous lymphoid infiltrate is feared by many pathologists; skin biopsies are relatively small, whereas diagnostic possibilities are relatively broad. It is true that cutaneous lymphomas can be difficult to diagnose and that in many circumstances multiple biopsies are required to establish a correct diagnostic interpretation. As a reminder, one should understand that low-grade cutaneous lymphomas are indolent disorders that usually linger for decades and that therapy does not result in disease cure. It is also important to remember that in most circumstances, those patients will die from another process that is completely unrelated to a diagnosis of skin lymphoma (even in the absence of specific therapy). OBJECTIVE.— To use a clinicopathologic, immunophenotypic, and molecular approach in the evaluation of common lymphocytic infiltrates. DATA SOURCES.— An in-depth analysis of updated literature in the field of cutaneous lymphomas was done, with particular emphasis on updated terminology from the most recent World Health Organization classification of skin and hematologic tumors. CONCLUSIONS.— A diagnosis of cutaneous lymphoid infiltrates can be adequately approached using a systematic scheme following the proposed ABCDE system. Overall, cutaneous T- and B-cell lymphomas are rare and "reactive" infiltrates are more common. Evaluation of lymphoid proliferations should start with a good sense of knowledge of the clinical presentation of the lesions, the clinical differential considerations, and a conscientious and appropriate use of immunohistochemistry and molecular tools.
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Affiliation(s)
- Alejandro A Gru
- From the Departments of Pathology (Drs Gru and Salavaggione) and Dermatology (Dr Gru), University of Virginia, Charlottesville; and the Department of Dermatology (Dr McHargue), Henry Ford Health System, Detroit, Michigan
| | - Chauncey McHargue
- From the Departments of Pathology (Drs Gru and Salavaggione) and Dermatology (Dr Gru), University of Virginia, Charlottesville; and the Department of Dermatology (Dr McHargue), Henry Ford Health System, Detroit, Michigan
| | - Andrea L Salavaggione
- From the Departments of Pathology (Drs Gru and Salavaggione) and Dermatology (Dr Gru), University of Virginia, Charlottesville; and the Department of Dermatology (Dr McHargue), Henry Ford Health System, Detroit, Michigan
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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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