JOURNAL OF MEDICAL AND SURGICAL RESEARCH - Special Issue "Pathology", March, 2023

Pages: 1147-1147
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Granulomatous mycosis fungoides: report of three cases and review of the literature.

Author: L. Benbella, I. Elouarith, S. Sassi, O. Essadeq, Z. Loubaris, F. Zouaidia,  A. Jahid,  Z. Bernoussi, K. Znati

Category: JMSR Pathology

Abstract:

Introduction: Granulomatous mycosis fungoides (GMF) is a rare form of cutaneous T-cell lymphoma that is a major diagnostic challenge.

The objective of this work is to relate the clinical and pathological aspects of this condition and to discuss its differential diagnoses.

Case reports: The cases included 3 patients with GMF, admitted to the dermatology department of Ibn Sina Hospital in Rabat. The first one is a 35 year-old female patient, diabetic, admitted for the management of a slowly growing erythematosquamous plaque formed on the abdomen, which rapidly ulcerated.

The second one is a 46 year-old female, with no medical history, presented with erythematous plaque of the neck, evolving for 3 weeks. The 3rd case corresponds to a 63-year-old male patient, treated since 2013 for Mycosis fungoides.

Résultats: The histological study showed the same findings in the 3 patients, including the exocytosis of atypical lymphocytes in the epidermis and the presence of authentic epithelioid granulomas in the underlying dermis. The immunohistochemical study showed a negative staining of the anti-CD5 antibody (1st case), the anti-CD7 antibody (2nd case) and the anti-CD2 antibody (3rd case). The anti-CD30 antibody was negative in all 3 cases.

Discussion: Granulomatous MF, originally described in 1970, is a rare histological form, constituting 6.3% of MF described in the literature.

The clinical findings are nonspecific and the diagnosis is purely anatomo-pathological.

Histologically, the signs of classical MF are present, namely atypical lymphocytes in the dermis with epidermotropism. The granulomas are sarcoid-like, mixed with langhans giant cells.

Conclusion: To conclude, MFG is a rare histological form of cutaneous T-cell lymphoma that can histologically mimic infectious or inflammatory dermatosis and cause a delay in diagnosis. Anatomo-clinical correlation, good morphological analysis and immunohistochemical study help guide the diagnosis.

Keywords: Mycosis fungoides, T-cell lymphoma, granulomas.

Full Text:

Granulomatous mycosis fungoides: report of three cases and review of the literature

L. Benbella (1), I. Elouarith (1), S. Sassi (1), O. Essadeq (2), Z. Loubaris (2), F. Zouaidia ;(1), A. Jahid (1), Z. Bernoussi (1), K. Znati (1)

1: Department of Pathological Anatomy, 2: Department of Dermatology, Ibn Sina Hospital, Faculty of Medicine and Pharmacy, Mohammed V University, Rabat, Morocco

Introduction: Granulomatous mycosis fungoides (GMF) is a rare form of cutaneous T-cell lymphoma that is a major diagnostic challenge.

The objective of this work is to relate the clinical and pathological aspects of this condition and to discuss its differential diagnoses.

Case reports: The cases included 3 patients with GMF, admitted to the dermatology department of Ibn Sina Hospital in Rabat. The first one is a 35 year-old female patient, diabetic, admitted for the management of a slowly growing erythematosquamous plaque formed on the abdomen, which rapidly ulcerated.

The second one is a 46 year-old female, with no medical history, presented with erythematous plaque of the neck, evolving for 3 weeks. The 3rd case corresponds to a 63-year-old male patient, treated since 2013 for Mycosis fungoides.

Résultats: The histological study showed the same findings in the 3 patients, including the exocytosis of atypical lymphocytes in the epidermis and the presence of authentic epithelioid granulomas in the underlying dermis. The immunohistochemical study showed a negative staining of the anti-CD5 antibody (1st case), the anti-CD7 antibody (2nd case) and the anti-CD2 antibody (3rd case). The anti-CD30 antibody was negative in all 3 cases.

Discussion: Granulomatous MF, originally described in 1970 [1, 2], is a rare histological form, constituting 6.3% of MF described in the literature. [3]

The clinical findings are nonspecific and the diagnosis is purely anatomo-pathological. [2]

Histologically, the signs of classical MF are present, namely atypical lymphocytes in the dermis with epidermotropism. The granulomas are sarcoid-like, mixed with langhans giant cells.

Conclusion: To conclude, MFG is a rare histological form of cutaneous T-cell lymphoma that can histologically mimic infectious or inflammatory dermatosis and cause a delay in diagnosis.

Anatomo-clinical correlation, good morphological analysis and immunohistochemical study help guide the diagnosis.

Key words: Mycosis fungoides, T-cell lymphoma, granulomas.

References:

1. Gutte R, Kharkar V, Mahajan S, Chikhalkar S, Khopkar U. Granulomatous mycosis fun-goides with hypohidrosis mimicking lepromatous leprosy. Indian J Dermatol Venereol Lep-rol. 2010;76:686-90
2. Kempf W, Ostheeren-Michaelis S, Paulli M, Lucioni M, Wechsler J, Audring H, AL. Granulomatous mycosis fungoides and granulomatous slack skin. Ar Arch Derma-tol. 2008;144:1609-17.
3. Li JY, Pulitzer MP, Myskowski PL, et al. A case-control study of clinocopathologic features, prognosis, and therapeutic responses in patients with granulomatous mycosis fungoides. J Am Acad Dermatol. 2013;69:366-374.
4. Gallardo F, Garcia-Muret MP, Servitje O, et al. Cutaneous lymphomas showing prominent granulomatous component: clinicopathological features in series of 16 cases. JEADV. 2009; 23:639-647.