title: Invisible mycosis fungoides: A diagnostic challenge.
abstract: We describe a 76-year-old woman who presented persistent generalized pruritus as the only cutaneous manifestation of a cutaneous T-cell lymphoma (mycosis fungoides). No cutaneous lesions were observed throughout the patient's course. Skin biopsies obtained from normal-looking pruritic skin revealed a discrete perivascular lymphocytic infiltrate in the upper dermis and focal intraepidermal clusters of atypical lymphoid cells (Pautrier's microabscesses). PCR analysis of TCR-gamma gene disclosed a monoclonal T-cell rearrangement. Sequencing of the PCR monoclonal product identified the J(8)V(2)C(2) TCR gene rearrangement. This observation illustrates the existence of a peculiar and exceedingly rare form of mycosis fungoides characterized only by persistent pruritus unresponsive to several therapeutic approaches. The diagnostic difficulties of this rare variant are stressed.
authors.affiliation: Hospital Princeps d'Espanya, Barcelona, Spain. rmpujol@usa.net
authors.forename: R M
authors.initials: RM
authors.lastname: Pujol
authors.forename: F
authors.initials: F
authors.lastname: Gallardo
authors.forename: E
authors.initials: E
authors.lastname: Llistosella
authors.forename: A
authors.initials: A
authors.lastname: Blanco
authors.forename: L
authors.initials: L
authors.lastname: Bernadó
authors.forename: R
authors.initials: R
authors.lastname: Bordes
authors.forename: J F
authors.initials: JF
authors.lastname: Nomdedeu
authors.forename: O
authors.initials: O
authors.lastname: Servitje
mesh_terms: D000368:Aged; D005260:Female; D006801:Humans; D007150:Immunohistochemistry; D009182:Mycosis Fungoides / Q000150:complications / Q000175:diagnosis* / Q000378:metabolism / Q000473:pathology; D016133:Polymerase Chain Reaction; D011537:Pruritus / Q000209:etiology; D012867:Skin / Q000473:pathology; D012878:Skin Neoplasms / Q000150:complications / Q000175:diagnosis* / Q000378:metabolism / Q000473:pathology