Invisible mycosis fungoides: a diagnostic challenge.
We describe a 76-year-old woman who had 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 biopsy specimens 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.
Department of Dermatology, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain. rmpujol@usa.net
Ramon M
RM
Pujol
Fernando
F
Gallardo
Enric
E
Llistosella
Aurora
A
Blanco
Lluís
L
Bernadó
Ramon
R
Bordes
Josep F
JF
Nomdedeu
Octavio
O
Servitje
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