Mycosis Fungoides in Iraqi Patients—Clinical, Histopathological and Immunohistochemical Study

Hayder R. Al-Hamamy¹, Khalifa E. Sharquie^2*, Adil A. Noaimi², Waqas S. Abdulwahhab³

¹Scientific Council of Dermatology and Venereology, Iraqi Board for Medical Specializations, Baghdad Teaching Hospital, Medical City, Baghdad, Iraq.
²Scientific Council of Dermatology and Venereology, Iraqi and Arab Board for Medical Specializations, Department of Dermatology, College of Medicine, University of Baghdad, Baghdad, Iraq.
³Arab Board for Medical Specializations, Department of Dermatology and Venereology, Baghdad Teaching Hospital, Medical City, Baghdad, Iraq.

DOI: 10.4236/jcdsa.2015.52014                

Abstract

Background: Mycosis fungoides (MF) is not an uncommon T-cell lymphoma in Iraqi population which is increasing over years. There are many diagnostic techniques to confirm the diagnosis including histopathological and immunohistochemical tests. Objectives: To evaluate all cases of MF including clinical, histopathological and immunohistochemical tests with CD markers. Patients and Methods: This clinical, histopathological, immunohistochemical outpatient based study took place in the Department of Dermatology, Baghdad Teaching Hospital, Medical City, Baghdad, Iraq during the period from May 2012-September 2013. Twenty five patients with MF were included in the present work. History was obtained from each patient regarding all socio-demographic aspects related to the disease. Also, clinical evaluation was carried out for all patients. Incisional biopsies for ordinary histopathology and immunohistochemical tests were done. Then staging was carried out depending on TNMB classification for all patients. Results: All cases of MF were confirmed after clinical evaluation, histopathology and immunohistochemical examination. Male to female ratio was 1.5:1. The mean age of onset at presentation was 47.45 ± 16.9 years. Itching was found in 84% of cases. The patch stage was seen in 36% patients. The hypopigmentaed MF was presented in 12% cases. The lower extremities were seen in 80%. Lymph node involvement as a manifestation of the disease was seen in 44% cases. The histopathological features of MF went parallel with the clinical stage of disease. Immunohistochemical study aids in the diagnosis of patch and erythrodermic stages. The most patients presented with stage IB (36%). Conclusion: MF seems to be not uncommon problem in Iraqi population and is increasing over years. The disease was diagnosed early commonly with patch stage (stage I_B) while hypopigmented MF was not a common variant when compared with neighboring countries.

Keywords

Mycosis Fungoides, T-Cell Lymphoma, Immunohistochemical Examination, TNMB Classification

Conflicts of Interest

The authors declare no conflicts of interest.

References

[1]	Burg, G. and Kempf, W. (2005) Etiology and Pathogenesis of Cutaneous Lymphomas. In: Burg, G. and Kempf, W., Eds., Cutaneous Lymphomas, Taylor and Francis, London.
[2]	Willemze, R., Jaffe, E.S., Burg, G., Cerroni, L., Berti, E., Swerdlow, S.H., Ralfkiaer, E., Chimenti, S., Diaz-Perez, J.L., Duncan, L.M., Grange, F., Harris, N.L., Kempf, W., Kerl, H., Kurrer, M., Knobler, R., Pimpinelli, N., Sander, C., Santucci, M., Sterry, W., Vermeer, M.H., Wechsler, J., Whittaker, S. and Meijer, C.J. (2005) WHO-EORTC Classification for Cutaneous Lymphomas. Blood, 105, 3768-3785. http://dx.doi.org/10.1182/blood-2004-09-3502
[3]	Burg, G., Kempf, W., Cozzio, A., Dobbeling, U., Feit, J., Golling, P., Michaelis, S., Scharer, L., Nestle, F. and Dummer, R. (2006) Cutaneous Malignant Lymphomas: Update. JDDG: Journal der Deutschen Dermatologischen Gesellschaft, 4, 914-933. http://dx.doi.org/10.1111/j.1610-0387.2006.06069.x
[4]	Khamaysi, Z., Ben-Arieh, Y., Izhak, O.B., Epelbaum, R., Dann, E.J. and Bergman, R. (2008) The Applicability of the New WHO-EORTC Classification of Primary Cutaneous Lymphomas to a Single Referral Center. The American Journal of Dermatopathology, 30, 37-44. http://dx.doi.org/10.1097/DAD.0b013e31815f9841
[5]	Olsen, E.A., Whittaker, S., Kim, Y.H., Duvic, M., Prince, H.M., Lessin, S.R., Wood, G.S., Willemze, R., Demierre, M.-F., Pimpinelli, N., Bernengo, M.G., Ortiz-Romero, P.L., Bagot, M., Estrach, T., Guitart, J., Knobler, R., Sanches, J. A., Iwatsuki, K., Sugaya, M., Dummer, R., Pittelkow, M., Hoppe, R., Parker, S., Geskin, L., Pinter-Brown, L., Girardi, M., Burg, G., Ranki, A., Vermeer, M., Horwitz, S., Heald, P., Rosen, S., Cerroni, L., Dreno, B. and Vonderheid, E.C. (2011) Clinical End Points and Response Criteria in Mycosis Fungoides and Sezary Syndrome: A Consensus Statement of the International Society for Cutaneous Lymphomas, the United Stated Cutaneous Lymphoma Consortium, and the Cutaneous Lymphoma Task Force of the European Organisation for Research and Treatment of Cancer. Journal of Clinical Oncology, 29, 2598-2607. http://dx.doi.org/10.1200/JCO.2010.32.0630
[6]	Criscione, V.D. and Weinstock, M.A. (2007) Incidence of Cutaneous T-Cell Lymphoma in the United States, 1973-2002. Archives of Dermatology Journal, 143, 854-859. http://dx.doi.org/10.1001/archderm.143.7.854
[7]	Pimpinelli, N., Olsen, E.A., Santucci, M., et al. (2005) Defining Early Mycosis Fungoides. Journal of the American Academy of Dermatology, 53, 1053-1063. http://dx.doi.org/10.1016/j.jaad.2005.08.057
[8]	Santucci, M., Biggeri, A., Feller, A.C., Massi, D. and Burg, G. (2000) Efficacy of Histologic Criteria for Diagnosing Early Mycosis Fungoides: An EORTC Cutaneous Lymphoma Study Group Investigation. European Organization for Research and Treatment of Cancer. The American Journal of Surgical Pathology, 24, 40-50. http://dx.doi.org/10.1097/00000478-200001000-00005
[9]	Smoller, B.R., Bishop, K., Glusac, E., Kim, Y.H. and Hendrickson, M. (1995) Reassessment of Histologic Parameters in the Diagnosis of Mycosis Fungoides. The American Journal of Surgical Pathology, 19, 1423-1430. http://dx.doi.org/10.1097/00000478-199512000-00009
[10]	Zola, H., Swart, B., Nicholson, I. and Voss, E., Eds. (2007) Leukocyte and Stromal Cell Molecules: The CD Markers. John Wiley and Sons, Hoboken.
[11]	Ali, A.N. (1999) Mycosis Fungoides in Iraqi Patients a Clinical and Histopathological Study. A Thesis Submitted to Iraqi Board for Medical Specializations, Dermatology and Venereology.
[12]	Bradford, P.T., Devesa, S.S., Anderson, W.F. and Toro, J.R. (2009) Cutaneous Lymphoma Incidence Patterns in the United States: A Population-Based Study of 3884 Cases. Blood, 113, 5064-5073. http://dx.doi.org/10.1182/blood-2008-10-184168
[13]	Jenni, D., Karpova, M.B., Seifert, B., et al. (2011) Primary Cutaneous Lymphoma: Two-Decade Comparison in a Population of 263 Cases from a Swiss Tertiary Referral Centre. British the Journal of Dermatology, 164, 1071-1077.
[14]	Jang, M.S., Kang, D.Y., Park, J.B., Kim, S.T. and Suh, K.S. (2012) Cutaneous T-Cell Lymphoma in Asians. International Scholarly Research Notices Dermatology Journal, 2012, Article ID: 575120, 8 p.
[15]	Laroche, L., Trautinger, F., Whittaker, S., Ranki, A., Burg, G., Heald, P., Pittelkow, M., Bernengo, M.-G., Sterry, W., Zackheim, H., Duvic, M., Estrach, T., Lamberg, S., Wood, G., Dummer, R., Olsen, E., Vonderheid, E., Pimpinelli, N., Willemze, R., Kim, Y. and Knobler, R. (2007) Revisions to the Staging and Classification of Mycosis Fungoides and Sézary Syndrome: A Proposal of the International Society for Cutaneous Lymphomas (ISCL) and the Cutaneous Lymphoma Task Force of the European Organization of Research and Treatment of Cancer (EORTC). Blood Journal, 110, 1713-1722.
[16]	Youn, H.K., Steve, C., Anna, V. and Richard, T.H. (1999) Clinical Characteristics and Long-Term Outcome of Patients with Generalized Patch and/or Plaque (T2) Mycosis Fungoides. Archives of Dermatology, 135, 26-32.
[17]	Scott, R., Melissa, C., Ryan, B., Kenneth, M., Glen, M., Ronald, M., Marta, J., John, J., Sheryl, T. and Sherrie, L. (2006) Usefulness (or Lack Thereof) of Immunophenotyping in Atypical Cutaneous T-Cell Infiltrates. American Journal of Clinical Pathology, 125, 727-736. http://dx.doi.org/10.1309/3JK2H6Y988NUAY37
[18]	Sharquie, K.E., Mehenna, S.H., Naji, A.A. and Al-Azzawi, H. (2004) Inflammatory Changes in Vitiligo: Stage I and II Depigmentation. The American Journal of Dermatopathology, 26, 108-112. http://dx.doi.org/10.1097/00000372-200404000-00004
[19]	El-Shabrawi-Caelen, L., Cerroni, L., Medeiros, L.J. and McCalmont, T.H. (2002) Hypopigmented Mycosis Fungoides: Frequent Expression of a CD8+ T-Cell Phenotype. American Journal of Surgical Pathology, 26, 450-457. http://dx.doi.org/10.1097/00000478-200204000-00006
[20]	Singh, Z.N., Tretiakova, M.S., Shea, C.R. and Petronic-Rosic, V.M. (2006) Decreased CD117 Expression in Hypopigmented Mycosis Fungoides Correlates with Hypomelanosis: Lessons Learned from Vitiligo. Modern Pathology, 19, 1255-1260. http://dx.doi.org/10.1038/modpathol.3800644
[21]	AlGhamdi, K.M., Arafah, M.M., Al-Mubarak, L.A., Khachemoune, A. and Al-Saif, F.M. (2012) Profile of Mycosis Fungoides in 43 Saudi Patients. Annals of Saudi Medicine, 32, 283-287.
[22]	Nanda, A., AlSaleh, Q.A., Al-Ajmi, H., Al-Sabah, H., Elkashlan, M., Al-Shemmari, S. and Demierre, M.-F. (2010) Mycosis Fungoides in Arab Children and Adolescents: A Report of 36 Patients from Kuwait. Pediatric Dermatology, 27, 607-613. http://dx.doi.org/10.1111/j.1525-1470.2010.01129.x
[23]	Kempf, W., Ostheeren-Michaelis, S., Paulli, M., Lucioni, M., Wechsler, J., Audring, H., Assaf, C., Rüdiger, T., Willemze, R., Meijer, C.J., Berti, E., Cerroni, L., Santucci, M., Hallermann, C., Berneburg, M., Chimenti, S., Robson, A., Marschalko, M., Kazakov, D.V., Petrella, T., Fraitag, S., Carlotti, A., Courville, P., Laeng, H., Knobler, R., Golling, P., Dummer, R. and Burg, G. (2008) Granulomatous Mycosis Fungoides and Granulomatous Slack Skin. Archives of Dermatology, 144, 1609-1617.