Continuing our discussion of skin cancer.
We have mycosis fungoides.
First and foremost, please understand
it has nothing to do with fungi,
and I’ve mentioned that prior.
And so therefore, what is it?
It’s a T-cell lymphoma.
A T-cell lymphoma.
if we’re dealing with the skin, then
you should be thinking about T-cells.
If we’re thinking about the GI,
then you should be thinking
about your B-cells.
So here, we have a lymphoma that
is in your tissue of T-cell origin
I said tissue.
Because with mycosis fungoides,
you’re not going to find a description
clinically known as erythroderma.
What I mean by that is what
if this T-cell lymphoma
wants to leave the tissue and
then go onto circulation?
If it does, then you call this
condition Sézary syndrome.
So the only difference between
mycosis fungoides and Sézary
is the location of
your T-cell lymphoma.
If the T-cell lymphoma is located in your
tissue and you call this mycosis fungoides,
it is the most common form of
cutaneous T-cell lymphoma.
Usually diagnosed after
years and years because,
well, it’s rare and the fact that you
would be misdiagnosed or perhaps
your doctor doesn’t
even suspect it.
Or maybe even the patient just thinks that
it’s eczema or some type of dermatitis.
As far as etiology,
And morphology becomes important.
If you take a look at the skin
here upon gross examination,
you will notice that
it is erythematous.
However, you would not refer
to this as being erythroderma.
If it’s Sézary syndrome,
if the T-cell lymphoma actually left the
tissue and went into your circulation,
you call this Sézary cells and
therefore, the skin, 80% of your skin,
almost all of it, would
appear as being erythematous.
You call that erythroderma, which is not
the description in presentation
of mycosis fungoides.
with slight scale is your description.
Often involves double-protected
skin beneath undergarments.
And by that, we mean there
is nothing to do with
exposure to UV rays as
being a risk factor.
More advanced cases may then
present as your spreading
or we can call it
a leukemic phase.
What does that mean?
That means that now you
have your T cells,
your neoplastic cells that have left
the tissue, have entered circulation
and you call this Sézary phase
and this is what I was referring
to as being your erythroderma.
Here’s the skin and what you’ll
notice here is going to be your
erythematous type of plaque that you
can expect with mycosis fungoides.
Where would you then expect these
neoplastic cells to be located?
In your tissue.
Atypical lymphocytes are epidermotropic
or home to the epidermis.
Pautrier abscesses formed of
aggregate of atypical lymphocytes,
quite significant and specific
for mycosis fungoides.
And studies of gene rearrangement often
demonstrate a clonal type of population
with mycosis fungoides.
Pautrier microabscesses, it’s the
aggregates of these atypical lymphocytes
because you call this one of the most
common cutaneous T-cell lymphoma.
Well, advanced cases at this
point refer to specialist.
advanced cases at this
point, refer to specialist.
That is as far as I’m
going to go here
and probably all that you need to know at
this juncture in your medical education.