Selenium-induced growth reduction in Brassica land races considered for phytoremediation

The earliest or patch stage of mycosis fungoides may present diagnostic difficulty both clinically and pathologically. The present study of the polymerase chain reaction (PCR) as a diagnostic tool in early mycosis fungoides was therefore undertaken, using a rapid PCR method for the detection of gamma- and beta-chain T-cell receptor (TCR) gene rearrangements in routine formalin-fixed, paraffin-embedded histological sections. Forty-two biopsies were studied from 26 patients with mycosis fungoides. Twenty-three skin biopsies with a clinicopathological diagnosis of early, or patch stage, mycosis fungoides were investigated. Of these, 18 (78 per cent) showed TCR-gamma or both beta- and gamma-chain TCR gene rearrangements. TCR gene rearrangements were shown in seven of the 14 plaque stage lesions (50 per cent) and also in the single case of tumour stage disease. Where gene rearrangements were identified, these were identical in all biopsies from an individual patient, irrespective of the site of the lesion, the disease stage, or the time lapse between the biopsies. The PCR is therefore a highly sensitive technique, which can be performed on routine pathological material, in cases where the diagnosis of early mycosis fungoides cannot be made with certainty on conventional histopathological and immunohistochemical grounds.     

Leptomeningeal mycosis fungoides

Central nervous system involvement with mycosis fungoides complicated the clinical course of a patient at a time when his skin was clinically free of disease following systemic chemotherapy. A leptomeningeal syndrome of blurred vision and papilledema, and confusion progressing to coma, was associated with elevated spinal fluid pressure and abnormal spinal fluid cells morphologically similar to those seen in the Sezary syndrome. The symptoms were dramatically reversed by intrathecal methotrexate, brain irradiation, and steroids. Mycosis fungoides recurred in the skin, in the spinal fluid, and in both eyes. Despite continued systemic and intrathecal chemotherapy, the patient died from mycosis fungoides. This is the second patient reported with meningeal mycosis fungoides.     

Tumour progression in a patient with granulomatous mycosis fungoides

We report a patient with granulomatous mycosis fungoides whose disease transformed into a high grade blast lymphoma with angiocentric features within 12 months of the initial diagnosis. This repudiates previous claims that granulomatous inflammation is protective in cutaneous T-cell lymphoma.     

Cutaneous T-cell lymphoma associated with granulomatous slack skin

Granulomatous slack skin disease (GSS) is a rare disorder characterized by bulky cutaneous lesions and epithelioid and giant cell granulomas with destruction of the dermal elastic tissue. We detail the observation of a 29-year-old man with clinical and histological features of GSS. Pendulous skin tumors were associated with typical clinical and immunohistochemical aspects of mycosis fungoides and with clonal rearrangement of the V gamma T-cell receptor gene in lesional skin. This case report supports cutaneous T-cell lymphoma as a cause of GSS.     

Increases in levels of antibody to hepatitis B surface antigen in an immunized population

OBJECTIVE AND IMPORTANCE: Mycosis fungoides is a rare T-cell lymphoma of the skin that can, in one-half to three-quarters of patients suffering from this disease, involve the viscera in late stages of the disease. Although autopsy series performed more than 2 decades ago showed that the incidence of metastatic mycosis fungoides to the central nervous system is approximately one of seven, a total of only several dozen cases have been reported to date. As compared to meningeal involvement, intraparenchymal metastases are even rarer. We describe a biopsy-proven case of intraparenchymal central nervous system mycosis fungoides in a patient with nonprogressive skin involvement and no detectable visceral involvement, and we present a review of the relevant literature. CLINICAL PRESENTATION: A 68-year-old man, 3 years after the diagnosis of his skin disease, developed fatigue, confusion, and frontal lobe signs without the presence of cerebriform cells in the peripheral blood or any other clinical evidence of visceral involvement. Magnetic resonance imaging revealed a diffuse area of increased T2-weighted signal involving the white matter of both cerebral hemispheres as well as a focal area of T2 abnormality along the body of the corpus callosum. The radiological differential diagnosis was either leukodystrophy caused by chemotherapy, progressive multifocal leukoencephalopathy, or glioma with associated white matter changes. INTERVENTION: A stereotactic serial brain biopsy revealed diffuse perivascular infiltrates of atypical lymphocytes, as well as several large cells with cerebriform nuclei consistent with mycosis fungoides. The cells were immunoreactive for LCA, MT1, UCHL1, and CD3. CONCLUSION: We stress the importance of including mycosis fungoides as part of the differential diagnosis for a brain lesion in patients with cutaneous T-cell lymphoma, because treatments do exist, and we conclude that a serial stereotactic biopsy may be necessary to provide a definitive diagnosis.     

Transient blindness associated with reversible occipital white matter abnormalities: two patients studied by MR, CT, and 18F-FDG PET imaging

We report the case of a patient with mycosis fungoides, stage II B with generalized plaques and ulcerated tumors in a severely reduced general condition, with anemia and extremely poor compliance, who was successfully treated with total-skin electron-beam radiotherapy with a less severe relapse after more than three years.     

Mycosis fungoides palmaris et plantaris

BACKGROUND: Mycosis fungoides primarily localized to the palms and soles is rare and has been previously reported as cutaneous lymphoma in four patients or as Woringer-Kolopp disease in eight patients. OBSERVATIONS: Four patients were initially diagnosed and treated unsuccessfully for various palmoplantar dermatitides until histopathologic findings revealed mycosis fungoides. Each case exhibited a clonal rearrangement of T-cell receptor gamma genes and immunohistochemical studies consonant with mycosis fungoides. All patients had limited skin involvement without evidence of extracutaneous involvement. CONCLUSIONS: Mycosis fungoides palmaris et plantaris is an uncommon expression of mycosis fungoides that manifests primarily on the palms and soles and clinically may mimic various inflammatory palmoplantar dermatoses. A biopsy is recommended in the evaluation of recalcitrant palmoplantar dermatoses.     

Calcium and magnesium deficiency-induced atrophy of muscle and calcium accumulation in the spinal cord

Four consecutive patients with mycosis fungoides received cyclic chemotherapy using cyclophosphamide, vincristine, and prednisone (COP). In one case, there was complete remission of disease for 15 months. In another, there was 50% regression of tumors with healing of the ulcerated surfaces. The third patient showed complete clearing of scaling and redness of the skin. In the fourth patient, the lesions progressed.     

Aggressive cutaneous T-cell lymphoma associated with the presence of Epstein-Barr virus. 2 cases

INTRODUCTION: The factors of prognosis of the cutaneous T-cell lymphomas are less well known as those of the B-cell lymphomas and the role of the Epstein-Barr virus (EBV) is not yet definitively evaluated. CASE REPORTS: Two male patients aged 62 and 82 years had a mycosis fungoides with a lethal outcome. The first patient had mutilating facial tumors; the RNA m of EBV and the genome of EBV were demonstrated in the diseased skin. The second patient had an erythrodermic course with enlarged peripheral lymph nodes and circulating Sézary's cells; the genome of EBV was demonstrated by PCR in the diseased skin. DISCUSSION: The role of the EBV has already been demonstrated in peripheral aggressive T-cell lymphomas. In the mycosis fungoides, the EBV is associated with the lesions in 0 to 32 p. cent according to the published series. EBV associated T-cell lymphomas have a poor survival rate and the EBV infection may be associated with the expression of the multidrug resistant gene-1 (MDR-1) and the risk of a terminal hemophagocytosis. In our both patients the presence of the EBV in the lymphocytes of the skin lesions is also an argument in favour of the pathogenic role of the virus.     

Immunoregulatory events in the skin of patients with cutaneous T-cell lymphoma

BACKGROUND: Involved skin of patients with cutaneous T-cell lymphoma, mycosis fungoides type, contains an increased number of bone marrow-derived epidermal cells that express class II major histocompatibility complex molecules and an infiltrate of both activated non-malignant and malignant T cells. However, the mechanism by which the T cells achieve and maintain their activated state is uncertain. The aim of this article is, therefore, to review recent studies from the literature dealing with immunoregulatory events in patients with mycosis fungoides and Sézary syndrome. OBSERVATIONS: The nonmalignant T cells seem to be activated through the T-cell receptor by lesional epidermal CD1a+CD36+ macrophagelike cells that, on a cell per cell basis, are more potent antigen-presenting cells than normal CD1a+ Langerhans' cells present in uninvolved epidermis. In contrast, the malignant T cells have different activation requirements, because they can only be stimulated through antigen independent pathways, such as CDw60, CD28, and CD2. The malignant T cells produce T-helper (Th)-2 cytokines, and because interferon gamma (IFN-gamma)-producing Th1 cells are present in the early lesions of mycosis fungoides, nonmalignant tumor-infiltrating T cells may represent Th1 cells. Because Th1 cytokines counteract Th2 cytokines, tumor-infiltrating T cells may potentially have the capacity to downregulate the growth of the malignant cells. CONCLUSION: The balance between progression vs remission in mycosis fungoides is related to complex interactions between the malignant T cells, nonmalignant T cells, and hyperstimulative antigen-presenting cells present within the skin.     

Bilateral periocular actinic granuloma in a patient with renal failure: a clinicopathologic study

PURPOSE: We report a 50-year-old man with end-stage renal disease who has developed bilateral inner and outer canthal nodules. METHODS: The nodules were excised, fixed in 10% formalin and 2.5% glutaraldehyde, and processed for light and electron microscopy, respectively. RESULTS: Histological examination showed elastotic changes with associated granulomatous inflammation. The granulomatous reaction was centered around elastotic fibers, and some giant cells engulfed the fibers. Areas of dystrophic calcification were identified. A diagnosis of actinic granuloma was made. The differential diagnosis and histopathology of actinic granuloma, i.e. granuloma annulare, rheumatoid nodule, and necrobiotic xanthogranuloma, are discussed. CONCLUSION: This case of an actinic granuloma originating in the sun-damaged periocular skin provides further evidence that elastotic degeneration may be associated with a giant cell reaction. It is, however, unclear which antigens are responsible for initiating the granulomatous response and whether elastotic material on its own can elicit a granulomatous reaction.     

Prognostic factors in erythrodermic mycosis fungoides and the Sézary syndrome

BACKGROUND AND DESIGN: There are no large studies evaluating patients with erythrodermic mycosis fungoides and Sézary syndrome to determine the important prognostic factors that may influence survival. This is important since new treatment modalities have been proposed as superior to existing primary therapies. We performed a retrospective cohort study of 106 patients with erythrodermic mycosis fungoides and Sézary syndrome, followed up in the Stanford (Calif) Mycosis Fungoides Clinic, to define the important prognostic factors in this group. RESULTS: Patients younger than 65 years have a more favorable survival profile than those 65 years or older (P < .005). Longer duration of symptoms before diagnosis ( > or = 10 years) tends to be associated with more favorable prognosis (p = .055). Lymph node stage is significantly correlated with survival; patients with overall stage III disease have more favorable prognosis than those with stage IV disease (P < .001). Patients with circulating Sézary cells in their blood have a significantly worse prognosis than those without (P < .005). Patient sex or race had no significant effect on overall survival outcome. Three distinct prognostic groups were identified, "favorable," "intermediate," and "unfavorable," according to the number of unfavorable prognostic factors (P < .005). The median survival in each group is 10.2, 3.7, and 1.5 years, respectively. CONCLUSIONS: In patients with erythrodermic mycosis fungoides and Sézary syndrome, the important prognostic factors are patient age at presentation, the overall stage, and peripheral blood involvement. Survival varies widely, depending on these variables. These prognostic factors should be evaluated when analyzing survival and/or treatment efficacy data of these patients.     

Mycosis fungoides presenting as keratosis lichenoides chronica

We report a patient with a 17-year history of reticulated keratotic papules on the trunk and limbs, and telangiectatic eruption on the face, in whom the diagnosis of keratosis lichenoides chronica was first established. However, the biopsies showed an epidermotropic infiltrate of small irregular CD4+ lymphocytes, and detection of a T-cell clone in the lesions by polymerase chain reaction confirmed the diagnosis of mycosis fungoides. Thus, keratosis lichenoides chronica can be an unusual and potentially misleading presentation of mycosis fungoides.     

Pulmonary involvement by mycosis fungoides. A case showing angiocentric lesions and granulomas

We describe an unusual case of pulmonary involvement by mycosis fungoides in a 31-year-old woman. Disseminated disease had developed despite cutaneous irradiation and systemic combination chemotherapy. Microscopy of biopsied tumour deposits in the lung showed a polymorphous, angiocentric lymphoid infiltrate, including atypical cells with convoluted nuclei which displayed a T-cell phenotype. Numerous epithelioid granulomas were also present. These histological appearances represent an unusual pattern of pulmonary involvement by disseminated mycosis fungoides.     

Use of voriconazole in treatment of Scedosporium apiospermum infection: case report

We report a case of disseminated Scedosporium apiospermum infection in a neutropenic patient with acute myeloid leukemia. Due to progression of the mycosis after 7 days of amphotericin B lipid complex therapy and to high susceptibility of the mold to voriconazole in vitro, the patient was treated with intravenous voriconazole. After a few days of therapy, fever disappeared and skin lesions improved. However, the patient died after 1 month due to intestinal bleeding. Despite a negative outcome, this case seems to indicate a promising role for voriconazole in the treatment of S. apiospermum infections.     

Hypopigmented mycosis fungoides in a white female

A rare case of a young Caucasian female with hypopigmented mycosis fungoides is described. We reviewed and discussed the literature.     

Variations of suicide rate in the population. Historical perspective with special reference to the 1970s and 1980s

Annular lesions with histological changes that include a sarcoidal granulomatous reaction have been observed within hydroquinone-induced ochronotic changes in some patients. The clinical and histological similarity of these lesions to actinic granuloma has been reported previously. We describe six patients with annular granulomatous lesions located within the ochronotic areas. Three of them had evidence of systemic sarcoidosis. A comparison of the histological features of the annular lesions of this group with those of the three patients with only cutaneous sarcoidal changes showed only insignificant quantitative differences. We conclude that annular granulomatous lesions in patients with exogenous ochronosis is a form of sarcoidosis.     

Skin cancers at Tertiary Referral Skin Hospital in Singapore

BACKGROUND: Skin cancer is the seventh most common cancer in Singapore. This study was performed to determine the pattern of skin cancers seen in a tertiary referral skin hospital. METHODS: Histologically confirmed skin cancers, seen between 1980 and 1991, were analyzed according to age, sex, race, site, and presence/absence of preexisting skin conditions. RESULTS: Of a total of 520 patients, the commonest skin cancer was basal cell carcinoma (BCC) (36.5%), followed by squamous cell carcinoma (SCC) (24.4%), Bowen's disease (16.7%), and mycosis fungoides (9.0%). Malignant melanomas (2.7%) were rare. The sharp increase (26.2%) in BCC in the recent 3 years was largely contributed by a fivefold increase of non-resident Caucasian patients with BCC. All types of skin cancers were more common in Chinese (78.1%) and less frequent in the more pigmented races (9.4%). The men to women ratio was 1.72:1. The peak age distribution was in the 51-70-year group, with the exception of mycosis fungoides (31-50 years). The commonest site involved in BCC was the head and neck (67.0%) and in Bowen's disease the trunk (33.3%). Squamous cell carcinoma was found on the head and neck and the lower extremities with equal frequency (29.3%) and 46.2% of all SCC on the lower extremities occurred in leprosy patients with chronic trophic ulcers. Of patients with Bowen's disease involving the nonsunexposed parts (trunk and upper extremities), 42.6% had probable arsenic exposure evident either from the history or clinical examination. Malignant melanomas were commonly located on the foot (71.4%). CONCLUSIONS: The commonest skin cancers seen were BCC, SCC, Bowen's disease, and mycosis fungoides. There were differences in the site distribution of SCC, Bowen's disease, and malignant melanomas in our study when compared to studies in Caucasians.     

Lymphoma of the skin. A comparative clinico-pathologic study of 50 cases including mycosis fungoides and primary and secondary cutaneous lymphoma

A clinico-pathologic study of lymphomas of the skin included 14 cases of mycosis fungoides, 14 of primary lymphoma and 22 of secondary lymphoma. Mycosis fungoides has clinical and histopathologic features which allow for separation from the other groups. In this study, patients with mycosis fungoides had a longer duration of history and presented with papules, plaques, erythroderma or generalized dermatitis but not with tumor nodules ab initio. A confident histologic diagnosis required the presence of the mycosis cell, which was usually present in association with a mixed inflammatory cell infiltrate. Another important histologic feature was the presence of invasion of the epidermis by the mycosis cells singly and/or in nests (Pautrier microabscesses). Primary and secondary lymphomas of the skin presented clinically as multiple tumor nodules and histologically as a monomorphic infiltrate of neoplastic cells confined to the dermis and subcutis. A feature which has not been adequately documented in a large series was the presence of an associated prominent epithelioid cell reaction in several cases from all three groups.     

Genetics of male infertility

This study was undertaken to analyze the influence of total skin dose and dose-fractionation schedules on the response rate, survival and skin toxicity of patients with mycosis fungoides [MF] treated with total skin electron irradiation [TSEI]. From 1979 to 1992, 40 patients with MF were treated with TSEI using a modified Christie Hospital technique. Mean follow-up time was 48 months [median 20 months]. 37/40 patients completed TSEI; three died due to non-treatment-related conditions during therapy. 34/37 [92%] treated patients achieved complete remission [CR] and 16/40 [40%] are alive with no evidence of disease. Over the years, changes in dose-fractionation schedules were made and correlated with the pattern of CR and skin toxicity. The 5-year actuarial survival [Stanford staging] was 84% in Stages IA-IB [all Stage IA patients are alive] and 59% in Stage II. The probability of survival of Stage III-IV patients was 30% at 30 months. Late skin toxicity was mild to moderate in 60% and severe in 25% of patients. A reduction of the total dose and dose-per-fraction resulted in an acceptable CR rate and a significantly lower toxicity. TSEI is effective in early stage MF. Skin control and late skin toxicity seem to be dose-fractionation-schedule related. For the early stages, the optimal treatment schedule seems to be 24-30 Gy to the whole skin surface in 2.4-3.0 Gy fractions, given twice weekly over a period of four to six weeks. Total doses of 24-30 Gy at 2.4-3.0 Gy per fraction yielded comparable skin control rates with lower skin toxicity.