Lymph node biopsy in mycosis fungoides

Area of Science:

• Dermatopathology
• Oncology
• Hematopathology

Background:

• Mycosis fungoides (MF) is a type of cutaneous T-cell lymphoma.
• Lymph node involvement is a critical prognostic factor in MF staging.
• Histopathological assessment of lymph node biopsies is essential for diagnosis and prognosis.

Purpose of the Study:

• To characterize the spectrum of lymph node changes in mycosis fungoides.
• To evaluate the correlation between lymph node histopathology and patient survival.
• To assess the utility of grading atypical lymphocytes in predicting outcomes.

Main Methods:

• Review of 90 lymph node biopsy specimens from 76 patients with mycosis fungoides.
• Histopathological analysis focusing on dermatopathic lymphadenopathy and MF lymphoma infiltration.
• Grading of pretreatment biopsies based on the number of atypical small lymphocytes (AL) in the paracortical region.
• Correlation of histopathological findings and grades with patient survival data.

Main Results:

• Dermatopathic lymphadenopathy was the most frequent finding in palpable lymph nodes.
• Characteristic features included paracortical expansion and specific histiocyte morphology.
• MF lymphoma exhibited diverse histological appearances, commonly with atypical, hyperconvoluted lymphoid cells.
• No significant survival differences were observed across different grades of lymph node involvement, from benign changes to overt lymphoma.
• Patients with extensive skin disease showed higher grades and poorer outcomes.

Conclusions:

• Lymph node biopsy findings in mycosis fungoides range from reactive changes to lymphoma infiltration.
• The degree of atypical lymphocyte infiltration in lymph nodes, as graded, did not significantly predict survival.
• Extensive skin disease is associated with more advanced lymph node changes and a worse prognosis.