The Hypochromic Variant of Mycosis Fungoides in Medical Daily Life
Abstract
Introduction: Our objective was to briefly review the literature on the hypochromic variant of mycosis fungoides and highlight common differential diagnoses.
Methods: This article consists of a literature review, and the search for references was performed in the Virtual Health Library (VHL) in Portuguese, English and Spanish, with a total of 47 references retrieved.
Results: The hypochromic variant of mycosis fungoides is a rare form of this chronic cutaneous T-cell lymphoma, whose clinical presentation is diversified, giving a challenging and late diagnosis to the disease. As the clinical aspects are similar to common dermatoses such as leprosy and pityriasis alba, this hypochromic variant of mycosis fungoides is underdiagnosed or its diagnosis is delayed.
Conclusion: The importance of conducting a detailed anamnesis and physical examination at medical appointments is highlighted for the correct diagnosis of unusual diseases, such as the one described, and to enable primary care to detect common cases ac- curately, referring the others to the dermatologist.
Downloads
References
Amorim GM, Niemeyer-Corbellini JP, Quintella DC, Cuzzi T, Ramos-e-Silva M. Hypopigmented mycosis fun- goides: a 20-case retrospective series. Int J Dermatol. 2018; 57: 306-12.
Furlan FC. Micose fungoide hipocromiante: estu- do epidemiológico e análise patogenética dos me- canismos da hipopigmentação [Tese de doutorado]. São Paulo: Universidade de São Paulo; 2013. doi: 10.11606/T.5.2013.tde-08082013-094811.
Ardigó M, Borroni G, Muscardin L, Kerl H, Cerroni L. Hypopigmented mycosis fungoides in Caucasian pa- tients: A clinicopathologic study of 7 cases. J Am Acad Dermatol. 2003; 49: 264-71. doi:10.1067/S0190- 9622(03)00907-1
Duquia RP, Souza PRM, Gervini RL, Schwartz J, Prochnau A, Almeida HL. Micose fungóide hipopigmentar com 20 anos de evolução. An Bras Dermatol. 2005; 80: 189-91.
Azulay DR, Azulay L, Azulay RD. Dermatologia. 7a ed. Rio de Janeiro: Guanabara Koogan; 2017.
Ponte P, Serrão V, Apetato M. Efficacy of narrowband UVB vs PUVA in patients with early-stage mycosis fungoides. J Eur Acad Dermatol Venereol. 2010; 24 : 716-21.
Furlan FC, Sanches JA. Hypopigmented mycosis fun- goides: a review of its clinical features and pathophy- siology. An Bras Dermatol. 2013; 88: 954-960. doi: 10.1590/abd1806-4841.20132336
Pereira HC, Tanaka RM, Goulart AO, Mazzoccato AT. Micose fungóide: relato de caso. Vittalle. Rev C S. 2002; 14: 87-96.
Kasper D, Fauci A, Hauser S, Longo D, Jameson L, Los- calzo J. Cânceres de células linfoides. In: Harrison Me- dicina Interna. 17a ed. São Paulo: McGraw Hill; 2008. p. 697.
Willemze R, Jaffe ES, Burg G, Cerroni L, Berti E, Swer- dlow SH, et al. WHO-EORTC classification for cuta- neous lymphomas. Blood. 2005;105:3768-85.
Rupoli S, Goteri G, Pulini S, Filosa A, Tassetti A, Mar- che Regional Multicentric Study Group of Cutaneous Lymphomas, et al. Long-term experience with low-dose interferon-alpha and PUVA in the management of early mycosis fungoides. Eur J Haematol. 2005; 75: 136-45.
Swerdlow SH, Campo E, Pileri SA, Harris NL, Stein H, Siebert R, et al. The 2016 revision of the World Heal- th Organization classification of lymphoid neoplasms. Blood. 2016; 127: 2375-90. doi: 10.1182/blood- 2016-01-643569
Weaver J, Mahindra AK, Pohlman B, Jin T, Hsi ED. Non- -mycosis fungoides cutaneous T-cell lymphoma: Reclas- sification according to the WHO-EORTC classification. J Cutan Pathol. 2010;37:516–24.
Pavlotsky F, Barzilai A, Kasem R. UVB in the management of early stage mycosis fungoides. J Eur Acad Derma- tol Venereol. 2006; 20:565-72. doi: 10.1111/j.1468- -3083.2006.01557.x
El-Shabrawi-Caelen L, Cerroni L, Medeiros LJ, McCal- mont TH. Hypopigmented mycosis fungoides: frequent expression of a CD8+ T-cell phenotype. Am J Surg Pa- thol. 2002; 26:450-7. doi: 10.1034/j.1600-0560.2001.028004174.x
Singh ZN, Tretiakova MS, Shea CR, Petronic-Rosic VM. Decreased CD117 expression in hypopigmented my- cosis fungoides correlates with hypomelanosis: lessons learned from vitiligo. Mod Pathol. 2006; 19:1255-60. 19. El-Shabrawi-Caelen L, Kerl H, Cerroni L. Lymphoma- toid papulosis. Reappraisal of clinicopathologic pre- sentation and classification into subtypes A, B and C. Arch Dermatol. 2004; 140:441-7. doi:10.1001/arch-derm.140.4.441
Whittam LR, Calonje E, Orchard G, Fraser-Andrews EA,
Woolford A, Russell-Jones R. CD8-positive juvenile onset mycosis fungoides: an immunohistochemical and geno- typic analysis of six cases. Br J Dermatol. 2000; 143: 1199-204 doi:10.1046/j.1365-2133.2000.03888.x
Werner B, Brown S, Ackerman AB. "Hypopigmented my- cosis fungoides" is not always mycosis fungoides! Am J Dermatopathol. 2005; 27:56-67. doi: 10.1097/01. dad.0000144161.49294
Ben-Amitai D, Michael D, Feinmesser M, Hodak E. Ju- venile mycosis fungoides diagnosed before 18 years of age. Acta Derm Venereol. 2003; 83:451-6.
Wain EM, Orchard GE, Whittaker SJ, Spittle M, Sc MF, Russell-Jones R. Outcome in 34 patients with juvenile- -onset mycosis fungoides: a clinical, immunophenoty- pic, and molecular study. Cancer. 2003; 98:2282-90.
Kim ST, Sim HJ, Jeon YS, Lee JW, Roh HJ, Choi SY, et al. Clinicopathological features and T-cell receptor gene rearrangement findings of mycosis fungoides in pa- tients younger than age 20 years. J Dermatol. 2009; 36:392-402.
Neuhaus IM, Ramos-Caro FA, Hassanein AM. Hypopig- mented mycosis fungoides in childhood and adolescen- ce. Pediatr Dermatol. 2013; 17:403-6.
Yamashita T, Abbade LPF, Marques MEA, MSA. Mycosis fungoides and Sézary syndrome: clinical, histopatholo- gical and immunohistochemical review and update. An Bras Dermatol. 2012; 87: 817-30.
Cerroni L, Gatter K, Kerl H. Cutaneous Manifestations of Hodgkin Lymphoma. In: Skin lymphoma. The illustra- ted guide. 3th ed. Cambridge: Wiley-Blackwell; 2009. p. 11-56.
Kempf W, Sander CA. Classification of cutaneous lym- phomas - an update. Histopathology. 2010; 56:57-70. 29. Massone C, Kodama K, Kerl H, Cerroni L. Histopatho- logic features of early (patch) lesions of mycosis fun- goides: a morphologic study on 745 biopsy specimens from 427 patients. Am J Surg Pathol. 2005; 29: 550-
Khopkar U, Doshi BR, Dongre AM, Gujral S. A study of 60.
clinicopathologic profile of 15 cases of hypopigmented mycosis fungoides. Indian J Dermatol Venereol Leprol. 2011; 77:167-73. doi: 10.4103/0378-6323.77456
Guitart J, Kennedy J, Ronan S, Chmiel JS, Hsiegh YC, Va- riakojis D. Histologic criteria for the diagnosis of mycosis fungoides: proposal for a grading system to standardize pathology reporting. J Cutan Pathol. 2001; 28:174-83.
Fung MA, Murphy MJ, Hoss DM, Grant-Kels JM. Practi- cal evaluation and management of cutaneous lympho- ma. J Am Acad Dermatol. 2002; 46: 325-57; 358-60.
Vandergriff T, Nezafati KA, Susa J, Karai L, Sanguinetti A, Hynan LS, et al. Defining early mycosis fungoides: validation of a diagnostic algorithm proposed by the In- ternational Society for Cutaneous Lymphomas. J Cutan
Pathol. 2015; 42: 318-28. doi: 10.1111/cup.12470.
Stone ML, Styles AR, Cockerell CJ, Pandya AG. Hypo- pigmented mycosis fungoides: a report of 7 cases and
review of the literature. Cutis. 2001; 67:133-8.
Lambroza E, Cohen SR, Phelps R, Lebwohl M, Braverman IM, DiCostanzo D.Hypopigmented variant of mycosis fungoides: demography, histopathology, and treatment of seven cases. J Am Acad Dermatol. 1995;32:987-93.
Ozcan D, Seçkin D, Ozdemir BH. Hypopigmented macules in na adult male patient. Clin Exp Dermatol.
; 33: 667-8.
Rizzo FA, Vilar EG, Pantaleão L, Fonseca EC, Magrin PF,
Henrique-Xavier M, et al. Micose fungóide em crianças e adolescentes: Relato de seis casos com predomínio da forma hipocromiante e revisão da literatura. Derma- tol Online J. 2012; 18:3.
Steiner D, Bedin V, Moraes MB, Villas RT, Steiner T. Vitili- go. An Bras Dermatol. 2004; 79: 335-351.
Miazek N, Michalek I, Pawlowska-Kisiel M, Olszewska M, Rudnicka, L. Pityriasis Alba - common disease, enig- matic entity: up-to-date review of the literature. Pediatr Dermatol. 2015; 32: 786-91.
Rupoli S, Goteri G, Pulini S, Filosa A, Tassetti A, Offidani M, et al. Long-term experience with low-dose interfe- ron-alpha and PUVA in the management of early myco- sis fungoides. Eur J Haematol. 2005; 75: 136-45.
Trautinger F, Knobler R, Willemze R, Peris K, Stadler R, Laroche L, D'Incan, et al. EORTC consensus recommen- dations for the treatment of mycosis fungoides/Sézary syndrome. Eur J Cancer. 2006; 42: 1014-30.
Quereux G, Marques S, Nguyen JM, Bedane C, D'incan M, Dereure O, et al. Prospective multicenter study of pegylated liposomal doxorubicin treatment in patients with advanced or refractory mycosis fungoides or Séza- ry syndrome. Arch Dermatol. 2008; 144: 727-33.
Heng YK, Koh MJA, Giam YC, Tang MBY, Chong WS, Tan SH. Pediatric mycosis fungoides in Singapore: a se- ries of 46 children. Pediatr Dermatol. 2014;31:477-82.
Neto ES. Revisão da classificação atual dos linfomas cutâneos primários. [Dissertação de Mestrado Integra- do em Medicina]. Coimbra: Faculdade de Medicina, UC; 2015.
Cerqueira, TB. Micose fungoide hipocromiante na in- fância: avaliação de um caso clínico. Rev Med Minas Gerais. 2018; 28:1943.
Hernandez C, Worobec SM, Gaitonde SS, Kiripolsky ML, Aquino K. Progression of undiagnosed cutaneous T-cell lymphoma during efalizumab therapy. Arch Der- matol. 2009; 145: 92-4.
Lafaille P, Bouffard D, Provost N. Exacerbation of un- diagnosed mycosis fungoides during treatment with eta- nercept. Arch Dermatol. 2009; 145: 94-5.
Bernardes CA, Ferreira MR, Fernandes EDCFA, Moreno MA, Velho PENF. Diagnóstico e Condutas Dermatológi- cas em uma Unidade Básica de Saúde Dermatológica. Educ Med. 2015; 39: 88-94.
Paim J, Travassos C, Almeida C, Bahia L, Macinko J. The Brazilian health system: history, advances and chal- lenges. Lancet. 2011; 377: 1778-97. doi: 10.1016/ S0140-6736(11)60054-8.
All articles in this journal are Open Access under the Creative Commons Attribution-NonCommercial 4.0 International License (CC BY-NC 4.0).
