Cutaneous T-Cell Lymphoma: Clues to Diagnosis in Early Lesions
The correct identification of cutaneous T-cell lymphomas and their differentiation from both inflammatory dermatoses and reactive lymphoid hyperplasias represent a vexing problem when dealing with the initial phases of a lymphomatous process. Even advanced diagnostic techniques, like immunophenotyping, quantitative DNA cytophotometry, and molecular genetic analysis, have proven to be unsuitable for solving the problem; thus, light microscopy remains the basic, gold standard diagnostic procedure. In order to make a definite diagnosis of lymphoma from early lesions, the most important and cardinal feature is the presence of lymphocytes with extremely convoluted (cerebriform), medium-large-sized (7–9 μm) nuclei (medium-large cerebriform celis), singly or in clusters in the epidermis and in discrete collections in the dermis. Additional histologic features are: (i) epidermotropism, manifested as single cells lining up along the basal keratinocytes near the dermal-epidermal junction; (ii) tendency of medium-large cerebriform cells within the epidermis to congregate and seemingly to touch one another; (iii) absence of spongiotic microvesiculation; (iv) little or no edema of the papillary dermis; slight to moderate fibrosis in some cases; and (v) a tendency of the dermal infiltrate, which as a rule is rather monomorphous in composition, to assume a lichenoid configuration.
KeywordsMycosis Fungoides Early Lesion Papillary Dermis Cutaneous Lymphoma Inflammatory Dermatosis
Unable to display preview. Download preview PDF.
- Bignon YL and P Souteyrand, 1990. Genotyping of cutaneous T-cell lymphomas and pseudolymphomas, In: WA van Vloten, R Willemze, G Lange Vejlsgaard and K Thomsen, Eds. Cutaneous Lymphoma, Current Problems in Dermatology, vol. 19 (H Honigsmann, Ed:), Karger, Basel.Google Scholar
- Burg G and P Kaudewitz, 1990. Where are we today in the diagnosis of cutaneous lymphoma?, In: WA van Vloten, R Willemze, G Lange Vejlsgaard and K Thomsen, Eds., Cutaneous Lymphoma, Current Problems in Dermatology, vol. 19 (H Honigsmann, Ed.), Karger, Basel, 1990.Google Scholar
- Burg G, M Santucci, AC Feller and É Szabó, 1992. Diagnostic problems in minimal lymphoproliferative skin infiltrates. Am. J. Dermatopathol., 14Google Scholar
- Everett MA, 1986. Questions to the Editorial Board and Other Authorities. Am. J. Dermatopathol., 8: 536.Google Scholar
- Freeman RG, 1986. Questions to the Editorial Board and Other Authorities. Am. J. Dermatopathol., 8: 536.Google Scholar
- Graham JH, Johnson WC, and Helwig EB, 1972. Dermal Pathology, Harper & Row, Hagerstown, MD.Google Scholar
- Jones RE, 1986. Questions to the Editorial Board and Other Authorities. Am. J. Dermatopathol., 8: 536.Google Scholar
- Lever WF, and G Schaumburg-Lever, 1987. Histopathology of the Skin, 6th ed., JB Lippincott Co., Philadelphia.Google Scholar
- Montgomery H, 1967. Dermatopathology, Harper & Row, New York.Google Scholar
- Reed R, 1986. Questions to the Editorial Board and Other Authorities. Am. J. Dermatopathol., 8: 536.Google Scholar