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Giornale Italiano di Dermatologia e Venereologia 2003 June;138(3):243-6


language: Italian

Lichen sclerosus with histopathologic features simulating early mycosis fungoides

Citarella L. 1, 2, Massone C. 1, 3, Chimenti S. 2, Kerl H. 1, Cerroni L. 1

1 Dipartimento di Dermatologia Università degli Studi di Graz, Graz, Austria 2 Clinica Dermatologica Università degli Studi di Roma «Tor Vergata», Roma 3 DISEM, Sezione di Dermatologia Università degli Studi di Genova, Genova


Aim. Mycosis fungoides (MF) is a cutaneous T-cell lymphoma characterized in early stages by a superficial band-like infiltrate with epidermotropism of lymphocytes without particular atypical features. Although in typical cases the clinicopathologic presentation is diagnostic, some reactive inflammatory skin disorders may simulate the histopathologic features of early MF. The best known among these benign cutaneous diseases are actinic reticuloid, lymphomatoid contact dermatitis, lymphomatoid drug eruption, T-cell type, and lymphomatoid keratosis.
Methods. In this study we present data on 3 patients with clinically clear-cut aspect of lichen sclerosus (LS) (M:F=3:0; mean age: 22.6; median: 8; range: 7-53), who presented with histopathologic features simulating early lesions of MF.
Results. The histopathologic picture was characterized in all cases by a dense, band-like infiltrate within the superficial dermis, with exocytosis of lymphocytes within the lower part of the epidermis. Some of the intraepidermal lymphocytes showed so-called “haloed” nuclei, and were focally arranged aligned along the basal membrane of the epidermis, in a manner similar to that described for MF. In one case the intraepidermal features were reminiscent of those of pagetoid reticulosis. The papillary dermis was expanded and showed coarse bundles of collagen, probably representing sclerotic changes masked by a dense inflammatory infiltrate, but at the same time simulating the coarse bundles of collagen seen in long-standing lesions of MF. The typical signs of LS were either absent or present only focally. Molecular analyses of the TCRg gene rearrangement performed with the polymerase chain reaction (PCR) technique revealed a polyclonal smear in 2 cases and a monoclonal band in one. This results confirm previous reports describing the presence of monoclonal population of T lymphocytes within typical lesion of LS.
Conclusion. We describe 3 patients with a histopathologic variant of LS simulating early MF. Especially in cases revealing a monoclonal population of T lymphocytes by PCR, the correct diagnosis may be missed without proper clinical informations and clinicopathologic correlation. LS should be added to the list of cutaneous T-cell pseudolymphomas.

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