64 results on '"Mycosis Fungoide"'
Search Results
2. Multidisciplinary Approach to the Diagnosis and Therapy of Mycosis Fungoides
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Paola Vitiello, Caterina Sagnelli, Andrea Ronchi, Renato Franco, Stefano Caccavale, Maria Mottola, Francesco Pastore, Giuseppe Argenziano, Massimiliano Creta, Armando Calogero, Alfonso Fiorelli, Beniamino Casale, Antonello Sica, Vitiello, P., Sagnelli, C., Ronchi, A., Franco, R., Caccavale, S., Mottola, M., Pastore, F., Argenziano, G., Creta, M., Calogero, A., Fiorelli, A., Casale, B., Sica, A., Vitiello, Paola, Sagnelli, Caterina, Ronchi, Andrea, Franco, Renato, Caccavale, Stefano, Mottola, Maria, Pastore, Francesco, Argenziano, Giuseppe, Creta, Massimiliano, Calogero, Armando, Fiorelli, Alfonso, Casale, Beniamino, and Sica, Antonello
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mycosis fungoide ,multidisciplinary team approach ,primary cutaneous T-cell lymphoma ,Health Information Management ,Leadership and Management ,Health Policy ,early mycosis fungoide ,Health Informatics ,CTCL1 - Abstract
Mycosis fungoides is the most common primary cutaneous T-cell lymphoma, characterized by skin-homing CD4+ T cells derivation, indolent course, and low-grade of malignancy. Mycosis fungoides’s classic type typically onsets with cutaneous erythematous patches, plaque, and tumor. In WHO-EORTC classification, folliculotropic mycosis fungoides, pagetoid reticulosis, and granulomatous slack skin are recognized as distinct variants of mycosis fungoides, because of their clinical and histological features, behavior, and /or prognosis. Mycosis fungoides often shows diagnostic difficulties, due to its absence of specific features and lesional polymorphism. A patient’s treatment requires staging. In about 10% of cases, mycosis fungoides can progress to lymph nodes and internal organs. Prognosis is poor at advanced stage and management needs a multidisciplinary team approach. Advanced stage disease including tumors, erythroderma, and nodal, visceral, or blood involvement needs skin directed therapy associated with systemic drugs. Skin directed therapy includes steroids, nitrogen mustard, bexarotene gel, phototherapy UVB, and photochemiotherapy, i.e., total skin electron radiotherapy. Systemic therapies include retinoids, bexarotene, interferon, histone deacetylase inhibitors, photopheresis, targeted immunotherapy, and cytotoxic chemotherapy. Complexity of mycosis fungoides associated with long-term chronic evolution and multiple therapy based on disease stage need a multidisciplinary team approach to be treated.
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- 2023
3. Clinical Response in Heavily Pretreated Mycosis Fungoides with Pembrolizumab: A Case Report
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Alessandro Pileri, Beatrice Casadei, Lisa Argnani, Cinzia Pellegrini, Ginevra Lolli, Pier Luigi Zinzani, Lolli G., Casadei B., Argnani L., Pileri A., Pellegrini C., and Zinzani P.L.
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Mycosis fungoides ,medicine.medical_specialty ,Low toxicity ,business.industry ,Context (language use) ,Hematology ,General Medicine ,Pembrolizumab ,Mycosis fungoide ,medicine.disease ,Dermatology ,Relapsed ,Severity assessment ,Refractory disease ,Clinical response ,Medicine ,Stage (cooking) ,Adverse effect ,business ,Short duration - Abstract
Mycosis fungoides (MF) is a disease almost impossible to cure. In the context of heavily pretreated patients, the anti-programmed cell death protein 1 (anti-PD-1) pembrolizumab is a valid therapeutic option. The alteration of the PD-1-PD ligand 1 (PD-L1) axis is often present in MF, and this aspect explains the feasibility of this therapy. We report the case of a 60-year-old woman diagnosed with MF in 2003, Olsen stage IA (T1M0NXBO). Since the moment of the diagnosis, she received 10 lines of therapy, with a short duration of response after each one of them. In April 2020, our patient started pembrolizumab 2 mg/kg every 3 weeks, and she achieved a partial response after the 4th cycle, consistent with the modified severity assessment tool (mSWAT) 1, which she is still maintaining after 10 cycles. No grade ≥3 adverse events were recorded. We conclude that pembrolizumab can induce extremely rapid responses in MF, with very low toxicity.
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- 2021
4. Prognostic Significance of CD30 in Transformed Mycosis Fungoides
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Fabrizio Pane, Sara Pignatiello, Marco Picardi, Massimo Mascolo, Daniela Russo, Antonello Baldo, Silvia Varricchio, Antonio Travaglino, Travaglino, A., Russo, D., Varricchio, S., Pignatiello, S., Baldo, A., Picardi, M., Pane, F., and Mascolo, M.
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Oncology ,medicine.medical_specialty ,Skin Neoplasms ,Multivariate analysis ,CD30 ,Prognosi ,Ki-1 Antigen ,Transformation ,030207 dermatology & venereal diseases ,03 medical and health sciences ,Mycosis Fungoides ,0302 clinical medicine ,Internal medicine ,Biomarkers, Tumor ,Humans ,Medicine ,p-value ,Proportional Hazards Models ,Mycosis Fungoide ,Mycosis fungoides ,business.industry ,Hazard ratio ,Univariate ,General Medicine ,Prognosis ,medicine.disease ,Confidence interval ,Study heterogeneity ,Cutaneous lymphoma ,030220 oncology & carcinogenesis ,Proportional Hazards Model ,business ,Human - Abstract
Objectives Several studies suggested that CD30 expression is a favorable prognostic marker in transformed mycosis fungoides (tMF). However, evidence in this field is still unclear. This systematic review and meta-analysis aimed to evaluate the prognostic significance of CD30 in tMF. Methods Electronic databases were searched from their inception to June 2020 for all studies assessing the prognostic value of CD30 in tMF. Pooled hazard ratio (HR) for death was calculated; a P value less than .05 was considered significant. Inconsistency index (I2) was used to assess statistical heterogeneity among studies. Results Seven studies with 323 patients were included. CD30 expression in tMF was significantly associated with a decreased hazard of death both on univariate (HR, 0.459; 95% confidence interval [CI], 0.319-0.660; P < .001) and multivariate analysis (HR, 0.503; 95% CI, 0.345-0.734; P < .001), and the statistical heterogeneity among studies was null in all analyses (I2 = 0%). Conclusions tMF cases with CD30 expression in large cells have a hazard of death two times lower than CD30-negative cases.
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- 2021
5. Immune Check Point Inhibitors in Primary Cutaneous T-Cell Lymphomas: Biologic Rationale, Clinical Results and Future Perspectives
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Gabriele Roccuzzo, Silvia Giordano, Paolo Fava, Alessandro Pileri, Alba Guglielmo, Luca Tonella, Martina Sanlorenzo, Simone Ribero, Maria Teresa Fierro, Pietro Quaglino, Roccuzzo G., Giordano S., Fava P., Pileri A., Guglielmo A., Tonella L., Sanlorenzo M., Ribero S., Fierro M.T., and Quaglino P.
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Mycosis fungoides ,Oncology ,Cancer Research ,medicine.medical_specialty ,Cutaneous T-cell lymphoma ,medicine.medical_treatment ,T cell ,Review ,Pembrolizumab ,Immune system ,Internal medicine ,medicine ,Cutaneous T-cell lymphomas ,immune-checkpoint-inhibitors ,immunotherapy ,nivolumab ,pembrolizumab ,Sézary syndrome ,RC254-282 ,business.industry ,Neoplasms. Tumors. Oncology. Including cancer and carcinogens ,Immunotherapy ,immune-checkpoint-inhibitor ,Mycosis fungoide ,medicine.disease ,Clinical trial ,medicine.anatomical_structure ,Nivolumab ,business ,Check point - Abstract
Primary cutaneous T-cell lymphomas (PCTCL) are the most common types of cutaneous lymphomas, with Mycosis fungoides as the most frequent subtype. Besides early stages which usually have a good prognosis, advanced stages remain a great therapeutic challenge with low survival rates. To date, none of the currently available therapeutic options have significantly improved the outcomes of advanced cutaneous lymphomas. Recent studies have demonstrated that immune-checkpoint molecules, such as PD-1 and CTLA-4, play part in the proliferation pathways of neoplastic T-cells, as well as in other tumors. Hence, the potential role of immune-checkpoint-inhibitors in treating cutaneous lymphomas has been investigated in the last years. Herein, we outline the current knowledge regarding the role of immune-checkpoint molecules in PCTCL, their signaling pathways, microenvironment and therapeutic inhibition rationale. Moreover, we review the published data on immunotherapies in PCTCL and summarize the currently ongoing clinical trials in this field.
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- 2021
6. Lack of impact of type and extent of prior therapy on outcomes of mogamulizumab therapy in patients with cutaneous T cell lymphoma in the MAVORIC trial
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Julia Scarisbrick, Karen Dwyer, Martine Bagot, Pierluigi Porcu, Pier Luigi Zinzani, Youn H. Kim, Wei Sun, Steven M. Horwitz, Fiona Herr, Alison J. Moskowitz, Horwitz S., Zinzani P.L., Bagot M., Kim Y.H., Moskowitz A.J., Porcu P., Dwyer K., Sun W., Herr F.M., and Scarisbrick J.
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Oncology ,mycosis fungoide ,Cancer Research ,medicine.medical_specialty ,Skin Neoplasms ,Antibodies, Monoclonal, Humanized ,Systemic therapy ,Mycosis Fungoides ,Internal medicine ,Post-hoc analysis ,medicine ,Mogamulizumab ,prior systemic therapy ,Humans ,Sezary Syndrome ,In patient ,cutaneous T-cell lymphoma ,Vorinostat ,Mycosis fungoides ,business.industry ,Cutaneous T-cell lymphoma ,Hematology ,medicine.disease ,Lymphoma, T-Cell, Cutaneous ,Prior Therapy ,Sézary syndrome ,business ,medicine.drug - Abstract
Patients with mycosis fungoides (MF) and Sezary syndrome (SS) often require multiple lines of systemic therapy. In the phase 3 MAVORIC study (NCT01728805), mogamulizumab demonstrated superiority to vorinostat in median progression-free survival (PFS) and confirmed overall response rate (ORR) in patients with MF/SS. This post hoc analysis examined the effects of number and type of prior systemic therapies on mogamulizumab response. MAVORIC patients randomized to mogamulizumab (1.0 mg/kg intravenously weekly) or vorinostat (400 mg orally daily) were grouped by number of prior therapies and immunomodulatory activity of immediate prior systemic therapy while also considering time elapsed since treatment. ORR, PFS, and duration of response (DOR) did not vary with number of prior therapies. ORR and DOR remained consistent regardless of immediate prior therapy type. Additionally, immunomodulatory activity of the last prior therapy and time from prior treatment generally did not affect the ORR or PFS observed in response to mogamulizumab.
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- 2021
7. Response to brentuximab vedotin versus physician's choice by CD30 expression and large cell transformation status in patients with mycosis fungoides: An ALCANZA sub-analysis
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Meredith Little, Lisa Brown, José Antonio Sanches, Pietro Quaglino, J. Scarisbrick, Oliver Bechter, Kerry Taylor, David E. Fisher, Matthew Onsum, M. Corinna Palanca-Wessels, Veronica Bunn, Pascal Wolter, Steven M. Horwitz, Jan Walewski, Judith Trotman, Madeleine Duvic, Rudolf Stadler, Lauren C. Pinter-Brown, Herbert Eradat, Reinhard Dummer, Pier Luigi Zinzani, Marise McNeeley, Sean Whittaker, Alejandro A. Gru, Pablo L. Ortiz-Romero, Julie Lisano, H. Miles Prince, Michael Weichenthal, Youn H. Kim, William L. Trepicchio, Oleg E. Akilov, Kim Y.H., Prince H.M., Whittaker S., Horwitz S.M., Duvic M., Bechter O., Sanches J.A., Stadler R., Scarisbrick J., Quaglino P., Zinzani P.L., Wolter P., Eradat H., Pinter-Brown L.C., Ortiz-Romero P.L., Akilov O.E., Trotman J., Taylor K., Weichenthal M., Walewski J., Fisher D., McNeeley M., Gru A.A., Brown L., Palanca-Wessels M.C., Lisano J., Onsum M., Bunn V., Little M., Trepicchio W.L., and Dummer R.
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0301 basic medicine ,Oncology ,Male ,Cancer Research ,Lymphoma ,Choice Behavior ,0302 clinical medicine ,Antineoplastic Agents, Immunological ,immune system diseases ,Retrospective Studie ,hemic and lymphatic diseases ,Objective response ,80 and over ,Brentuximab vedotin ,Cancer ,Aged, 80 and over ,Brentuximab Vedotin ,Mycosis Fungoide ,integumentary system ,medicine.diagnostic_test ,Antibody-drug conjugate ,CD30 ,Cutaneous T-cell lymphoma ,Efficacy ,Large-cell transformation ,Mycosis fungoides ,Progression-free survival ,Safety ,Hematology ,Middle Aged ,Prognosis ,Survival Rate ,Immunological ,International Agencie ,030220 oncology & carcinogenesis ,Public Health and Health Services ,Female ,medicine.drug ,Human ,Adult ,medicine.medical_specialty ,Prognosi ,Oncology and Carcinogenesis ,Ki-1 Antigen ,Antineoplastic Agents ,Follow-Up Studie ,Decision Support Techniques ,03 medical and health sciences ,Young Adult ,Rare Diseases ,Clinical Research ,Internal medicine ,Physicians ,Biopsy ,medicine ,Humans ,Oncology & Carcinogenesis ,Retrospective Studies ,Aged ,business.industry ,International Agencies ,medicine.disease ,Clinical trial ,030104 developmental biology ,Orphan Drug ,Physician ,business ,Follow-Up Studies - Abstract
INTRODUCTION: Mycosis fungoides (MF), the most common type of cutaneous T-cell lymphoma, can lead to disfiguring lesions, debilitating pruritus and frequent skin infections. This study assessed response to brentuximab vedotin in patients with MF in the phase III ALCANZA study. METHODS: Baseline CD30 levels and large-cell transformation (LCT) status were centrally reviewed in patients with previously-treated CD30-positive MF using ≥2 skin biopsies obtained at screening; eligible patients required ≥1 biopsy with ≥10% CD30 expression. Patients were categorised as CD30min
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- 2021
8. Efficacy and safety of mogamulizumab by patient baseline blood tumour burden: a post hoc analysis of the MAVORIC trial
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Amy Musiek, M. C. Medley, Richard A Cowan, Francine M. Foss, P. L. Zinzani, Reinhard Dummer, J. P Rosen, Jan P. Nicolay, Julia Scarisbrick, Lauren C. Pinter-Brown, Lubomir Sokol, Lars Iversen, Pietro Quaglino, Takahiro Ito, University of Zurich, Cowan, R A, Cowan R.A., Scarisbrick J.J., Zinzani P.L., Nicolay J.P., Sokol L., Pinter-Brown L., Quaglino P., Iversen L., Dummer R., Musiek A., Foss F., Ito T., Rosen J.-P., and Medley M.C.
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Skin Neoplasms ,business.operation ,Tumor burden ,610 Medicine & health ,Dermatology ,Antibodies, Monoclonal, Humanized ,Antibodies ,2708 Dermatology ,Mycosis Fungoides ,Humans ,Neoplasm Recurrence, Local ,Tumor Burden ,Monoclonal ,Medicine ,Humanized ,Mycosis Fungoide ,business.industry ,10177 Dermatology Clinic ,Mallinckrodt ,2725 Infectious Diseases ,Management ,Neoplasm Recurrence ,Infectious Diseases ,Local ,business ,Human - Abstract
RC is a consultant for Kyowa Kirin and served on an advisory board for Helsinn. JJS is a consultant for Kyowa Kirin, Takeda, Recordat, 4SC, Innate Pharma and Helsinn. She received a 1-year educational grant from Kyowa Kirin for work on quality of life in CTCL. She also has membership on an entity’s Board of Directors or advisory committees for Kyowa Kirin, Takeda, 4SC, Innate Pharma, Miragen and Helsinn. PLZ has received honoraria from MSD, Celltrion, Gilead, Janssen-Cilag, BMS and TG Therapeutics. He is also a consultant for MSD, EUSA Pharma, Sanofi and Verastem. He also has membership on an entity’s Board of Directors or advisory committees for MSD, Eusa Pharma, Celltrion, Gilead, Janssen-Cilag, BMS, Servier, Sandoz, Immune Design, Celgene, Portola, Roche, Kyowa Kirin, TG Therapeutics, and Verastem. He has also been on a Speakers Bureau for MSD, EUSA Pharma, Celltrion, Gilead, Janssen-Cilag, BMS, Servier, Immune Design, Celgene, Portola, Roche, Kyowa Kirin and Verastem. JPN has received honoraria from Pharmaceutical Industries, TEVA, Novartis AG, Biogen GmbH, Almirall Hermal AG, Actelion Pharmaceuticals, UCB Pharma, LaRoche Posay, Takeda Pharmaceuticals and Kyowa Kirin. He is also a consultant for Novartis AG, Biogen GmbH, Almirall Hermal AG, Actelion Pharmaceuticals, Innate Pharma, Kyowa Kirin and Takeda Pharmaceuticals. He has also received grants and personal fees from Pharmaceutical Industries outside of the submitted work. LS is a consultant for Dren Bio and served on an advisory board for Kyowa Kirin, Kymera Therapeutics and EUSA Pharma. LP-B has been an advisory board for Epizyme, Morphosys, Helsinn, Verastem and Actelion. She is also a consultant for Acrotech. PQ has received honoraria from Actelion, Innate Pharma, Takeda, Kyowa Kirin, Helsinn and Therakos. He also been on an advisory board for Actelion, Innate Pharma, Takeda, Kyowa Kirin, Helsinn and Therakos. LI has served as a consultant and/or paid speaker for and/or participated in clinical trials sponsored by AbbVie, Almirall, Amgen, AstraZeneca, BMS, Boehringer Ingelheim, Celgene, Centocor, Eli Lilly, Janssen-Cilag, Kyowa Kirin, LEO Pharma, MSD, Novartis, Pfizer, Sun Pharma and UCB. RD is a consultant for Merck Sharp & Dohme, Novartis, Bristol-Myers Squibb, Roche, Amgen, Takeda, Pierre Fabre, Sun Pharma, Sanofi, Catalym and Second Genome. AM is an investigator for Menlo, Soligenix, Pfizer, Elorac and miRagen. She has also received honoraria from Kyowa Kirin. She also has a membership on an entity’s Board of Directors or advisory committees for Helsinn. FF has received honoraria from Seagen, Mallinckrodt and Kyowa Kirin. She is also a consultant for Miragen. She had also served on a Data Safety Monitoring Board for Celgene. She was also the President of the US Cutaneous Lymphoma Consortium. TI is an employee of Kyowa Kirin, Inc. J-PR is an employee of Kyowa Kirin, Inc. MCM is an employee of Kyowa Kirin, Inc.
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- 2021
9. Role of chromatin assembly factor-1/p60 and poly [ADP-ribose] polymerase 1 in mycosis fungoides
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Elena Sabattini, Claudio Agostinelli, Fabrizio Pane, Daniela Russo, Alessandro Pileri, Clara Bertuzzi, Marco Picardi, Stefania Staibano, Massimo Mascolo, Antonio Travaglino, Antonello Baldo, Silvia Varricchio, Mascolo, Massimo, Travaglino, Antonio, Varricchio, Silvia, Russo, Daniela, Sabattini, Elena, Agostinelli, Claudio, Bertuzzi, Clara, Baldo, Antonello, Pileri, Alessandro, Picardi, Marco, Pane, Fabrizio, Staibano, Stefania, Mascolo M., Travaglino A., Varricchio S., Russo D., Sabattini E., Agostinelli C., Bertuzzi C., Baldo A., Pileri A., Picardi M., Pane F., and Staibano S.
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0301 basic medicine ,Oncology ,Male ,Skin Neoplasms ,Time Factors ,medicine.medical_treatment ,Poly (ADP-Ribose) Polymerase-1 ,Cutaneous lymphoma ,Targeted therapy ,Poly [ADP-ribose] polymerase 1 ,0302 clinical medicine ,Risk Factors ,Stage (cooking) ,Chromatin assembly factor-1 ,Aged, 80 and over ,General Medicine ,Middle Aged ,Mycosis fungoide ,Prognosis ,Immunohistochemistry ,Exact test ,Treatment Outcome ,Italy ,030220 oncology & carcinogenesis ,Female ,Original Article ,Adult ,Mycosis fungoides ,medicine.medical_specialty ,Risk Assessment ,Pathology and Forensic Medicine ,03 medical and health sciences ,Predictive Value of Tests ,Internal medicine ,medicine ,Biomarkers, Tumor ,Humans ,Clinical significance ,Molecular Biology ,Survival analysis ,Aged ,Neoplasm Staging ,Retrospective Studies ,business.industry ,Cell Biology ,medicine.disease ,030104 developmental biology ,business - Abstract
Mycosis fungoides (MF) represents the most common type of cutaneous lymphoma. In the majority of patients, the disease has a slow evolution and a protracted course; however, a subset of patients shows poor oncologic outcomes. Unfortunately, there are no reliable prognostic markers for MF, and the currently available treatments are only effective in a minority of patients. This study aimed to evaluate the expression and clinical significance of PARP-1 and CAF-1/p60 in MF. Sixty-four MF representatives of the different stages of disease were assessed by immunohistochemistry for PARP-1 and CAF-1/p60. The association of PARP-1 and CAF-1/p60 with the MF stage and outcome was assessed by using Fisher’s exact test and Kaplan-Meier survival analysis with the Log-rank test; a p value II (p = 0.034) but not with the risk of death (p = 0.237). CAF-1/p60 was overexpressed in 26.8% of MF and was significantly associated with decreased overall survival (p p = 1). A significant association was found between PARP-1 overexpression and CAF-1/p60 overexpression (p = 0.0025). Simultaneous overexpression of PARP-1 and CAF-1/p60 was significantly associated with decreased overall survival (p χ2 = 14.916 vs 21.729, respectively). In MF, PARP-1 is overexpressed in advanced stages, while CAF-1/p60 is overexpressed in the cases with shorter overall survival, appearing as a significant prognostic marker. A role for PARP-1 inhibitors and anti-CAF-1/p60 targeted therapy may be reasonably hypothesized in MF.
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- 2021
10. Health-related quality of life effect of mogamulizumab by patient blood involvement
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Pablo L. Ortiz-Romero, Pier Luigi Zinzani, Margarida Lima, Auris Huen, Zinzani P.L., Ortiz-Romero P., Lima M., and Huen A.O.
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Health related quality of life ,mycosis fungoide ,Cancer Research ,medicine.medical_specialty ,Mycosis fungoides ,business.industry ,mogamulizumab ,MAVORIC ,medicine.disease ,Quality of life (healthcare) ,CTCL ,Oncology ,quality of life ,Sézary syndrome ,Mogamulizumab ,Medicine ,business ,Intensive care medicine ,medicine.drug - Abstract
NA
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- 2021
11. Dermoscopic and trichoscopic features of primary cutaneous lymphomas – systematic review
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Berenika Olszewska, Małgorzata Sokołowska-Wojdyło, Iris Zalaudek, Michał Sobjanek, Roman Nowicki, Martyna Sławińska, Slawinska, M., Sokolowska-Wojdylo, M., Olszewska, B., Nowicki, R. J., Sobjanek, M., and Zalaudek, I.
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Male ,medicine.medical_specialty ,Lymphoma, B-Cell ,Skin Neoplasms ,Lymphoma ,review ,Dermoscopy ,Dermatology ,dermatoscopy ,030207 dermatology & venereal diseases ,03 medical and health sciences ,0302 clinical medicine ,Mycosis Fungoides ,primary skin lymphoma ,medicine ,Humans ,Lymphoma, T-Cell, Cutaneou ,Primary cutaneous follicle centre lymphoma ,Mycosis fungoides ,Dermatoscopy ,Mycosis Fungoide ,Comedo ,medicine.diagnostic_test ,business.industry ,trichoscopy ,B-Cell ,Folliculotropic Mycosis Fungoides ,medicine.disease ,dermoscopy ,Lymphoma, T-Cell, Cutaneous ,T-Cell ,Trichoscopy ,Infectious Diseases ,Cutaneous ,030220 oncology & carcinogenesis ,medicine.symptom ,business ,Systematic search ,Human - Abstract
Dermoscopy and trichoscopy are non-invasive methods used as auxiliary tools in diagnostics of different dermatoses. To date, no systematic review concerning the utility of dermoscopy and trichoscopy in the diagnostics of primary cutaneous lymphomas has been published. The aim of this study was to summarize the current state of knowledge on this topic based on systematic search of PubMed database and related references published before 8th of August 2020. Besides dermoscopic features, type of dermoscope, polarization mode, magnification, number of cases and histopathological correlation were analysed. A total of 34 records were included into the final analysis, evaluating 141 patients diagnosed with primary cutaneous T-cell lymphomas and 70 patients with primary cutaneous B-cell lymphomas. Most of the analysed records evaluated dermoscopic features (n = 206); trichoscopy was analysed in only 5 cases. Structures most commonly observed in classical mycosis fungoides (n = 108) were fine short linear vessels/linear vessels, spermatozoa-like vessels and orange-yellow patchy areas. In folliculotropic mycosis fungoides (n = 12), most frequently observed were comedonal lesions/comedo openings/central keratotic plugs and white halo around hair follicles/perifollicular accentuation. Primary cutaneous marginal zone B-cell lymphoma (n = 42) and primary cutaneous follicle centre lymphoma (n = 20) most commonly presented with salmon-coloured background and fine short/linear irregular/serpentine vessels. For other PCL, with less than 10 cases reported in the analysed records, details have been provided in the article. Most observations analysed in this systematic review rely on findings from case reports/case series (with the level of evidence V) and lack a control group. A few studies provided information concerning technical aspects of dermoscopic/trichoscopic examination. The role of dermoscopy/trichoscopy in diagnostics of cutaneous lymphomas requires further studies, especially in entities where dermoscopic features have been described in only single or a few cases. However, it seems that this practical, accessory tool in future may provide additional clues during clinical assessment.
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- 2021
12. The microenvironment’s role in mycosis fungoides and sézary syndrome: From progression to therapeutic implications
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Nicola Pimpinelli, Emilio Berti, Alba Guglielmo, Alessandro Pileri, Pietro Quaglino, Daniele Fanoni, Silvia Alberti Violetti, Paolo Fava, Claudio Agostinelli, Vieri Grandi, Pileri A., Guglielmo A., Grandi V., Violetti S.A., Fanoni D., Fava P., Agostinelli C., Berti E., Quaglino P., and Pimpinelli N.
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Skin Neoplasms ,Lymphoma ,QH301-705.5 ,Review ,Cutaneous T-cell lymphomas (CTCLs) ,Pathogenesis ,Immune system ,Mycosis Fungoides ,Cutaneous ,Lymphomas ,Sezary syndrome ,medicine ,Tumor Microenvironment ,Animals ,Humans ,Skin Neoplasm ,Biology (General) ,Mycosis fungoides ,Mycosis Fungoide ,business.industry ,Animal ,General Medicine ,medicine.disease ,Cutaneou ,Immunology ,Disease Progression ,business ,Human - Abstract
Background: Mycosis fungoides (MF) and Sezary Syndrome (SS) are the most common cutaneous T-cell lymphomas. It has been hypothesized that the interaction between the immune system, cutaneous cells, and neoplastic elements may play a role in MF/SS pathogenesis and progression. Methods: This paper aims to revise in a narrative way our current knowledge of the microenvironment’s role in MF/SS. Results and Conclusions: Literature data support a possible implication of microenvironment cells in MF/SS pathogenesis and progression, opening up new therapeutic avenues.
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- 2021
13. Italian expert-based recommendations on the use of photo(chemo)therapy in the management of mycosis fungoides: Results of an e-Delphi consensus
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Karl P. Lawrence, Piergiacomo Calzavara-Pinton, Emanuele Cozzani, Paolo D. Pigatto, Roberta Piccinno, Emanuele Trovato, Antonello Baldo, Martina Burlando, Maria Concetta Fargnoli, Valeria Brazzelli, Giuseppe Monfrecola, Nicola Pimpinelli, Serena Rupoli, Elisa Molinelli, Vieri Grandi, Carlo Cota, Michele Pellegrino, Paola Savoia, Alberico Motolese, Marco Simonacci, Paolo Iacovelli, Silvia Alberti-Violetti, Emilio Berti, Daniele Gambini, Mauro Alaibac, Aurora Parodi, Marina Venturini, Alessia Pacifico, Pietro Quaglino, Caterina Longo, Giorgio Mozzicafreddo, Pier Luigi Bruni, Paolo Amerio, Alessandro Pileri, Annamaria Offidani, Grandi V., Baldo A., Berti E., Quaglino P., Rupoli S., Alaibac M., Alberti-Violetti S., Amerio P., Brazzelli V., Bruni P.L., Calzavara-Pinton P., Parodi A., Cozzani E., Burlando M., Fargnoli M.C., Gambini D., Iacovelli P., Pacifico A., Longo C., Monfrecola G., Motolese A., Mozzicafreddo G., Cota C., Pigatto P., Pileri A., Savoia P., Simonacci M., Venturini M., Offidani A., Molinelli E., Pellegrino M., Trovato E., Piccinno R., Lawrence K., and Pimpinelli N.
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mycosis fungoide ,medicine.medical_specialty ,Consensus ,Skin Neoplasms ,Delphi Technique ,Immunology ,Delphi method ,Dermatology ,delphi study ,evidence-based medicine ,guideline ,mycosis fungoides ,phototherapy ,030207 dermatology & venereal diseases ,03 medical and health sciences ,0302 clinical medicine ,Mycosis Fungoides ,Cronbach's alpha ,medicine ,Immunology and Allergy ,Humans ,Radiology, Nuclear Medicine and imaging ,Medical physics ,PUVA Therapy ,computer.programming_language ,Mycosis fungoides ,business.industry ,Advanced stage ,General Medicine ,Evidence-based medicine ,Guideline ,medicine.disease ,030220 oncology & carcinogenesis ,Chemo therapy ,business ,computer ,Delphi - Abstract
Background Phototherapy is a mainstay for the treatment of MF. However, there is scarce evidence for its use, mostly due to the lack of a unified schedule. Aims The primary aim of this study was to establish the first structured, expert-based consensus regarding the indications and technical schedules of NB-UVB and PUVA for MF. The secondary aim was to determine the consensus level for each specific item. Materials & methods E-delphi study. Item-specific expert consensus was defined as the number of "Totally Agree" results to ≥80% of the panelists. Cronbach alpha index ≥0.7 was used as a measure of homogeneity in the responses among questions related to the same topic. Results Overall, there was a high homogeneity among responders (0.78). On specific topics, the highest grade was observed for technical items (0.8) followed by indications for early (0.73) and advanced stages (0.7). Conclusions Items related to the most canonical indications of phototherapy and to treatment schedules showed the highest agreements rates. There is consensus about the use of standardized treatment schedules for the induction and consolidation phases for NB-UVB and PUVA in MF.
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- 2021
14. Critical concepts and management recommendations for cutaneous T-cell lymphoma: A consensus-based position paper from the Italian Group of Cutaneous Lymphoma
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Nicola Pimpinelli, Pier Luigi Zinzani, Gaia Goteri, Maria Cantonetti, Francesco Onida, Silvia Alberti Violetti, Marco Paulli, Serena Rupoli, Pietro Quaglino, Giovanni Barosi, Zinzani P.L., Quaglino P., Violetti S.A., Cantonetti M., Goteri G., Onida F., Paulli M., Rupoli S., Barosi G., and Pimpinelli N.
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mycosis fungoide ,recommendation ,Adult ,Cancer Research ,medicine.medical_specialty ,Consensus ,diagnosis ,Consensu ,Scientific literature ,Cutaneous lymphoma ,03 medical and health sciences ,0302 clinical medicine ,Histological diagnosis ,cutaneous T-cell lymphomas ,mycosis fungoides ,recommendations ,Sèzary syndrome ,treatment ,medicine ,Biomarkers, Tumor ,Humans ,Medical physics ,cutaneous T-cell lymphoma ,Mycosis fungoides ,business.industry ,Cutaneous T-cell lymphoma ,Hematology ,General Medicine ,medicine.disease ,Lymphoma, T-Cell, Cutaneous ,Clinical Practice ,diagnosi ,Group discussion ,Oncology ,Italy ,030220 oncology & carcinogenesis ,Position paper ,Female ,business ,030215 immunology ,Human - Abstract
In this paper, we present a review of critical concepts, and produce recommendations on management issues in cutaneous T-cell lymphomas (CTCLs) of adults. A panel of nine experts was selected for their expertise in research and clinical practice of CTCLs. During an initial meeting, the areas of major concern in the management of CTCLs were selected by generating and rank-ordering clinical key questions using the criterion of clinical relevance, through group discussion. Recommendations were achieved by multiple-step formalized procedures to reach a consensus after a comprehensive analysis of the scientific literature. The panel produced recommendations on how to facilitate the clinical suspicion of CTCL; indication of cutaneous biopsy; optimal histological diagnosis, immunohistochemistry and genetic markers; and staging pathway and up-to-date therapeutics (with particular focus on new treatments). The critical concept of integration of the different medical expertise in the management of the patients with CTCL was thoroughly examined. These recommendations are intended for use not only by expert centers but above all by "not experienced" dermatologists and hematologists as well as general practitioners.
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- 2020
15. Dermoscopy of Syringotropic and Folliculotropic Mycosis Fungoides
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Danijela Ćurković, Ivana Ilić, Ružica Jurakić Tončić, Jaka Radoš, Stefano Caccavale, Mirna Bradamante, Jurakic Toncic, R., Rados, J., Curkovic, D., Ilic, I., Caccavale, S., and Bradamante, M.
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Mycosis fungoides ,medicine.medical_specialty ,primary cutaneous lymphoma ,Letter ,business.industry ,mycosis fungoides ,Primary cutaneous lymphoma ,Folliculotropic mycosis fungoide ,Dermatology ,Syringotropic mycosis fungoides ,medicine.disease ,Folliculotropic Mycosis Fungoides ,Mycosis fungoide ,syringotropic mycosis fungoides ,Oncology ,RL1-803 ,Genetics ,medicine ,folliculotropic mycosis fungoides ,dermoscopy ,business ,Molecular Biology - Published
- 2020
16. Características clinicoepidemiológicas de pacientes con micosis fungoide.
- Author
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Tablada Robinet, María Elena, López Pupo, Natacha, Rodriguez Torres, Gisela, Jacas Portuondo, Ana Lucia, and Baltazar Green, Adelina
- Abstract
A descriptive, retrospective and cross-sectional study of the 15 patients with mycosis fungoides, admitted in the Dermatology Service of "Dr. Juan Bruno Zayas Alfonso" Teaching General Hospital in Santiago de Cuba was carried out from January, 2004 to December, 2012, with the objective of determining the clinical and epidemiological manifestations of the disease, for which the variables age, sex, skin color, predominant skin lesions, clinical course duration and clinical stage at the moment of the diagnosis were analyzed. After evaluating the results of the series, it was concluded that difficulties existed to diagnose the clinical entity because there were not the necessary means, which would decrease the period of the clinical course between the emergence of the symptoms and the confirmation of the presence of this dermopathy. [ABSTRACT FROM AUTHOR]
- Published
- 2014
17. A rare case of nephrotic syndrome revealing mycosis fungoide managed successfully with chemotherapy
- Author
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Mouna Kairouani, Sakina Sekkate, Nabil Ismaili, Halima Abahssain, and Hassan Errihani
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nephrotic syndrome ,mycosis fungoide ,chemotherapy ,multidisciplinary ,Medicine - Abstract
The occurrence of the nephrotic syndrome during mycosis fungoide is very unusual. We report a rare case of mycosis fungoide revealed by hydrops related to nephrotic syndrom in a 37-year old male patient. He has been admitted to intensive care unit because of a breathing distress and a hydrophobs. Whole body computed tomography scan revealed bilateral axillary, cervical lymph nodes, tumoral infiltration of the subcutaneous tissue in the cervicothoracic and abdominal regions, multiples bilateral pulmonary metastasis, bilateral pleural effusion, and abdominal effusion; the kidneys were normal. The patient was staged IVb (T3N3M1). He was treated with CHOP (cyclophosphamide, Doxorubicin, Vincristin and prednisone). Evolution after eight cycles of chemotherapy was spectacular. The development of nephrotic syndrom secondary to mycosis fungoide is rare. It requires a multidisciplinary approach with nephrologists and oncologists.
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- 2012
- Full Text
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18. Development of conjunctival intraepithelial neoplasia following phototherapy for mycosis fungoides
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Ido Didi Fabian, Jonathan Weidenfeld, and Ofira Zloto
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Ophthalmology ,Mycosis fungoides ,medicine.medical_specialty ,business.industry ,Conjunctival intraepithelial neoplasia ,Image ,Medicine ,Phototherapy ,Conjunctival Intraepithelial Neoplasia ,business ,medicine.disease ,Mycosis fungoide ,Dermatology - Published
- 2019
19. Photodynamic therapy: An option in mycosis fungoides
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Claudio Agostinelli, Sabina Vaccari, Salvatore Domenico Infusino, Paola Sgubbi, Alessandro Pileri, Annalisa Patrizi, Pileri, Alessandro, Sgubbi, Paola, Agostinelli, Claudio, Infusino, Salvatore Domenico, Vaccari, Sabina, and Patrizi, Annalisa
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Adult ,Male ,medicine.medical_specialty ,medicine.medical_treatment ,Biophysics ,Plantar ,Photodynamic therapy ,Dermatology ,Lesion ,030207 dermatology & venereal diseases ,03 medical and health sciences ,Methyl aminolaevulinate ,Mycosis Fungoides ,0302 clinical medicine ,Unilesional ,medicine ,Humans ,Effective treatment ,Pharmacology (medical) ,In patient ,Red light ,Mycosis fungoides ,Photosensitizing Agents ,business.industry ,Remission Induction ,Aminolevulinic Acid ,Middle Aged ,Mycosis fungoide ,medicine.disease ,Biophysic ,Photochemotherapy ,Oncology ,030220 oncology & carcinogenesis ,Pubic Area ,Female ,medicine.symptom ,business - Abstract
Background Photodynamic therapy (PDT) is a well-known and effective treatment for non-melanoma skin-cancer. Numerous studies have also shown its effectiveness in mycosis fungoides. The aim of the study was to analyse MF patients treated with PDT at the Dermatology Unit of Bologna University. Methods We retrospectively analysed MF patients treated with PDT over the last ten years. Each PDT protocol consisted of the appliance for 3 h under an occlusive film dressing on each lesion of a one-mm-thick layer of 16% methyl aminolaevulinate (MAL) 160 mg/g cream (Metvix ® , Galderma, Paris, France). The cream was then removed and the skin was exposed to 630 nm red light from a diode lamp (Aktilite ® , Galderma Benelux, Rotterdam, the Netherlands), with a total radiation dose of 37 J/cm2 for 9 mins. A protocol of one session every month was scheduled. The treated lesions were clinically examined, before each treatment. Results Four cases, three male and one female, had been treated with PDT. Two patch lesions on the plantar area, one leg and the pubic area were treated. The number of PDT sessions ranged from 4 to 9. Two complete remissions and two partial remissions were observed. A low-to-mild burning sensation was reported during the treatment, and persisted over the next day; no further side effects were observed. Conclusions Our series shows that PDT can be considered an effective second-line treatment in patients characterised by a disease located in difficult-to-treat anatomical areas such as the feet and the pubic area.
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- 2017
20. Hématologie et Peau
- Abstract
Nous rapportons le résumé de la PEAUse « Hématologie et peau » organisée en février 2018 par le service de dermatologie des Cliniques universitaires Saint-Luc et consacrée aux lymphomes cutanés. Le professeur E. Van Den Neste nous a présenté les lymphomes cutanés les plus fréquents, leurs traitements suivis de quelques cas cliniques issus du service d’hématologie. Le Professeur A. Camboni nous a parlé plus précisément des aspects histologiques.
- Published
- 2019
21. Hématologie et Peau
- Abstract
Nous rapportons le résumé de la PEAUse « Hématologie et peau » organisée en février 2018 par le service de dermatologie des Cliniques universitaires Saint-Luc et consacrée aux lymphomes cutanés. Le professeur E. Van Den Neste nous a présenté les lymphomes cutanés les plus fréquents, leurs traitements suivis de quelques cas cliniques issus du service d’hématologie. Le Professeur A. Camboni nous a parlé plus précisément des aspects histologiques., [Hematology & dermatology] We here briefly summarize the “PEAUse dermatologique” meeting organized in February 2018 by the Department of Dermatology of the Saint-Luc University Clinics and dedicated to cutaneous lymphomas. Professor E. Van Den Neste presented the most frequent cutaneous lymphomas, their treatments, as well as several clinical cases from the Department of Hematology. Professor A. Camboni focused on the histological aspects.
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- 2019
22. Hématologie et Peau
- Author
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Debois, Déborah, Marot, Liliane, Van Den Neste, Eric, Camboni, Alessandra, Tromme, Isabelle, UCL - SSS/DDUV - Institut de Duve, UCL - SSS/DDUV/BCHM - Biochimie-Recherche métabolique, UCL - SSS/IREC/PNEU - Pôle de Pneumologie, ORL et Dermatologie, UCL - SSS/IREC/GYNE - Pôle de Gynécologie, UCL - SSS/IRSS - Institut de recherche santé et société, UCL - (SLuc) Service de dermatologie, UCL - (SLuc) Service d'hématologie, and UCL - (SLuc) Service d'anatomie pathologique
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mycosis fungoïde ,Lymphomes cutanés ,syndrome de Sézary ,syndromes lymphoprolifératifs CD30+ - Abstract
Nous rapportons le résumé de la PEAUse « Hématologie et peau » organisée en février 2018 par le service de dermatologie des Cliniques universitaires Saint-Luc et consacrée aux lymphomes cutanés. Le professeur E. Van Den Neste nous a présenté les lymphomes cutanés les plus fréquents, leurs traitements suivis de quelques cas cliniques issus du service d’hématologie. Le Professeur A. Camboni nous a parlé plus précisément des aspects histologiques. [Hematology & dermatology] We here briefly summarize the “PEAUse dermatologique” meeting organized in February 2018 by the Department of Dermatology of the Saint-Luc University Clinics and dedicated to cutaneous lymphomas. Professor E. Van Den Neste presented the most frequent cutaneous lymphomas, their treatments, as well as several clinical cases from the Department of Hematology. Professor A. Camboni focused on the histological aspects.
- Published
- 2019
23. Verrucous mycosis fungoides
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Alessandro Pileri, Claudio Agostinelli, Michelangelo La Placa, Aurora Alessandrini, and La Placa M, Alessandrini A, Agostinelli C, Pileri A.
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medicine.medical_specialty ,Mycosis fungoides ,atypical presentation ,differential diagnosis ,business.industry ,Cutaneous T-cell lymphoma ,Dermatology ,medicine.disease ,Mycosis fungoide ,Immunopathology ,Verrucous mycosis ,Medicine ,immunopathology ,cutaneous T-cell lymphoma ,Differential diagnosis ,business - Abstract
Not present
- Published
- 2019
24. Panoptic clinical review of the current and future treatment of relapsed/refractory T-cell lymphomas: Cutaneous T-cell lymphomas
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Pier Luigi Zinzani, Vijayveer Bonthapally, Dirk Huebner, Richard Lutes, Andy Chi, Stefano Pileri, Zinzani, PIER LUIGI, Bonthapally, Vijayveer, Huebner, Dirk, Lutes, Richard, Chi, Andy, and Pileri, Stefano
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Mycosis fungoides ,0301 basic medicine ,Skin Neoplasms ,Cutaneous T-cell lymphoma ,Romidepsin ,03 medical and health sciences ,0302 clinical medicine ,hemic and lymphatic diseases ,Antineoplastic Combined Chemotherapy Protocols ,Humans ,Skin Neoplasm ,Lymphoma, T-Cell, Cutaneou ,Salvage Therapy ,Vorinostat ,Antineoplastic Combined Chemotherapy Protocol ,Hematology ,Mycosis fungoide ,Lymphoma, T-Cell, Cutaneous ,030104 developmental biology ,Oncology ,Bexarotene ,Drug Resistance, Neoplasm ,Sézary syndrome ,030220 oncology & carcinogenesis ,Brentuximab vedotin ,Neoplasm Recurrence, Local ,Geriatrics and Gerontology ,Human - Abstract
Primary cutaneous T-cell lymphomas (CTCLs), such as mycosis fungoides and Sézary syndrome, are a rare group of non-Hodgkin lymphomas, usually treated using a multimodal approach. Unfortunately, many patients go on to develop relapsed/refractory disease. Systemic treatment for relapsed/refractory CTCL has historically relied on chemotherapies and interferons, and while active, responses are often short-lived. Three drugs are now approved in the US to treat relapsed/refractory CTCL including the oral retinoid, bexarotene, and histone deacetylase inhibitors, romidepsin and vorinostat. Although response rates are typically
- Published
- 2016
25. Early dermoscopic sign of folliculotropism in patients with mycosis fungoides
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Jaka Rados, Stefano Caccavale, Daniela Ledić Drvar, Giuseppe Argenziano, Mirna Bradamante, Ruzica Jurakic Toncic, Sandra Jerkovic-Gulin, Toncic, Ruzica Jurakic, Drvar, Daniela Ledic, Bradamante, Mirna, Rados, Jaka, Jerkovic-Gulin, Sandra, Caccavale, Stefano, and Argenziano, Giuseppe
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mycosis fungoide ,medicine.medical_specialty ,primary cutaneous lymphoma ,dermoscopy ,folliculotropic mycosis fungoides ,folliculotropism ,mycosis fungoides ,Dermatology ,030207 dermatology & venereal diseases ,03 medical and health sciences ,0302 clinical medicine ,Genetics ,medicine ,In patient ,Molecular Biology ,Mycosis fungoides ,business.industry ,Primary cutaneous lymphoma ,Articles ,Folliculotropic Mycosis Fungoides ,medicine.disease ,Oncology ,030220 oncology & carcinogenesis ,RL1-803 ,business ,folliculotropic mycosis fungoide ,Sign (mathematics) - Abstract
Accentuation of the follicle is an easily recognized dermoscopic sign that can be found in patients who do not exhibit clinical signs of folliculotropic MF. It represents a very early sign that allows us to choose a proper biopsy site, predict histology even at an early stage of MF, select more complex treatment and, finally, to predict the group of MF patients who will have a poor response to the standard treatment
- Published
- 2018
26. Expression of FK506-binding protein 51 (FKBP51) in Mycosis fungoides
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G. De Rosa, Francesco Merolla, Massimiliano Scalvenzi, Massimo Mascolo, M F Romano, Simona Romano, Gennaro Ilardi, Silvia Varricchio, Giuseppe Argenziano, Daniela Russo, Antonello Baldo, Stefania Staibano, Giuseppe Ciancia, Michele Russo, Francesca Pagliuca, Mascolo, M., Romano, M. F., Ilardi, G., Romano, S., Baldo, A., Scalvenzi, M., Argenziano, G., Merolla, F., Russo, D., Varricchio, S., Pagliuca, F., Russo, M., Ciancia, G., De Rosa, G., Staibano, S., Mascolo, M, Romano, M. F, Ilardi, G, Romano, S, Baldo, A, Scalvenzi, M, Argenziano, Giuseppe, Merolla, F, Russo, D, Varricchio, S, Pagliuca, F, Russo, M, Ciancia, G, and De Rosa, G
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0301 basic medicine ,Male ,TRAF2 ,Pathology ,Necrosis ,Dermatitis ,Disease ,0302 clinical medicine ,Skin ,Aged, 80 and over ,Mycosis Fungoide ,FKBP51 ,Mycosis fungoides ,clinical behaviour ,target therapy ,Middle Aged ,Prognosis ,Immunohistochemistry ,Infectious Diseases ,Real-time polymerase chain reaction ,FKBP ,030220 oncology & carcinogenesis ,Female ,medicine.symptom ,Human ,Adult ,medicine.medical_specialty ,Prognosi ,Dermatology ,Thymus Gland ,Dermatiti ,Tacrolimus Binding Proteins ,03 medical and health sciences ,medicine ,Humans ,RNA, Messenger ,Gene ,Aged ,business.industry ,Tacrolimus Binding Protein ,Biomarker ,medicine.disease ,TNF Receptor-Associated Factor 2 ,030104 developmental biology ,Cancer research ,business ,Biomarkers - Abstract
SummaryBackground Mycosis fungoides (MF) is the major subtype of cutaneous T-cell lymphomas (CTCL). It usually has a prolonged indolent clinical course with a minority of cases acquiring a more aggressive biological profile and resistance to conventional therapies, partially attributed to the persistent activation of Nuclear Factor-kappa B (NF-κB) pathway. In the last decade, several papers suggested an important role for the FK506-binding protein 51 (FKBP51), an immunophilin initially cloned in lymphocytes, in the control of NF-κB pathway in different types of human malignancies. Objectives We aimed to investigate the possible value of FKBP51 expression as a new reliable marker of outcome in MF patients. Methods We assessed by immunohistochemistry (IHC) FKBP51 expression in 44 patients with MF, representative of different stages of the disease. Immunohistochemical results were subsequently confirmed at mRNA level with quantitative PCR (qPCR) in a subset of enrolled patients. In addition, IHC and qPCR served to study the expression of some NF-κB target genes, including the tumour necrosis factor receptor-associated factor 2 (TRAF2). Results Our results show that FKBP51 was expressed in all evaluated cases, with the highest level of expression characterizing MFs with the worst prognosis. Moreover, a significant correlation subsisted between FKBP51 and TRAF2 IHC expression scores. Conclusions we hypothesize a role for FKBP51 as a prognostic marker for MF and suggest an involvement of this immunophilin in deregulated NF-κB pathway of this CTCL. This article is protected by copyright. All rights reserved.
- Published
- 2018
27. Global patterns of care in advanced stage mycosis fungoides/Sezary syndrome: a multicenter retrospective follow-up study from the Cutaneous Lymphoma International Consortium
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Alessandro Pileri, K. Rogers, G. Ognibene, C. Postigo-Llorente, Larisa J. Geskin, M. Kheterpal, S. Alberti Violetti, Daniela Zugna, Paolo Fava, Youn H. Kim, V. Nikolaou, A. Stevens, Evangelia Papadavid, Joan Guitart, Nicola Pimpinelli, P L Ortiz-Romero, Emilio Berti, Ch. Antoniou, Iris Amitay-Laish, F. Child, René Stranzenbach, Tomomitsu Miyagaki, Denis Miyashiro, R. Knobler, Pier Luigi Zinzani, Maarten H. Vermeer, Teresa Estrach, Francesco Onida, Stephen Morris, S. Chaganti, Martina Sanlorenzo, Ellen Kim, Cristina Muniesa, José Antonio Sanches, Pietro Quaglino, Makoto Sugaya, M. Duvic, J. Scarisbrick, N. Spaccarelli, Vieri Grandi, Steve Horwitz, Simona Osella-Abate, Alain H. Rook, Martine Bagot, Chiara Astrua, Octavio Servitje, Emmilia Hodak, Rakhshandra Talpur, Sean Whittaker, Milena Maule, Christopher McCormack, S. Fabbro, A. Combalia, Rein Willemze, Rudolf Stadler, Estela Martinez-Escala, Pierluigi Porcu, S. Porkert, M.T. Fierro, Caroline Ram-Wolff, Simone Ribero, Henry Miles Prince, Richard T. Hoppe, Constanze Jonak, Quaglino, P, Maule, M, Prince, H. M, Porcu, P, Horwitz, S, Duvic, M, Talpur, R, Vermeer, M, Bagot, M, Guitart, J, Papadavid, E, Sanches, J. A, Hodak, E, Sugaya, M, Berti, E, Ortiz-Romero, P, Pimpinelli, N, Servitje, O, Pileri, A, Zinzani, P. L, Estrach, T, Knobler, R, Stadler, R, Fierro, M. T, Alberti Violetti, S, Amitay-Laish, I, Antoniou, C, Astrua, C, Chaganti, S, Child, F, Combalia, A, Fabbro, S, Fava, P, Grandi, V, Jonak, C, Martinez-Escala, E, Kheterpal, M, Kim, E. J, Mccormack, C, Miyagaki, T, Miyashiro, D, Morris, S, Muniesa, C, Nikolaou, V, Ognibene, G, Onida, F, Osella-Abate, S, Porkert, S, Postigo-Llorente, C, Ram-Wolff, C, Ribero, S, Rogers, K, Sanlorenzo, M, Stranzenbach, R, Spaccarelli, N, Stevens, A, Zugna, D, Rook, A. H, Geskin, L. J, Willemze, R, Whittaker, S, Hoppe, R, Scarisbrick, J, and Kim, Y.
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Oncology ,Male ,medicine.medical_treatment ,Medical Oncology ,Cutaneous lymphoma ,030207 dermatology & venereal diseases ,0302 clinical medicine ,Photopheresis ,CTCL ,Japan ,Child ,Bexarotene ,Aged, 80 and over ,treatment ,Follow up studies ,Hematology ,Middle Aged ,Chemotherapy regimen ,Europe ,Mycosis fungoides ,Prognosis ,Survival ,Treatment ,030220 oncology & carcinogenesis ,Female ,prognosi ,Brazil ,medicine.drug ,mycosis fungoide ,Mycosis fungoides/Sezary syndrome ,Adult ,medicine.medical_specialty ,Adolescent ,survival ,03 medical and health sciences ,Young Adult ,Internal medicine ,medicine ,Humans ,Sezary Syndrome ,Aged ,Neoplasm Staging ,Retrospective Studies ,Patterns of care ,Chlorambucil ,business.industry ,mycosis fungoides ,Advanced stage ,Australia ,Retrospective cohort study ,medicine.disease ,Dermatology ,Gemcitabine ,United States ,Relative risk ,prognosis ,business - Abstract
Background Advanced-stage mycosis fungoides (MF)/Sezary syndrome (SS) patients are weighted by an unfavorable prognosis and share an unmet clinical need of effective treatments. International guidelines are available detailing treatment options for the different stages but without recommending treatments in any particular order due to lack of comparative trials. The aims of this second CLIC study were to retrospectively analyze the pattern of care worldwide for advanced-stage MF/SS patients, the distribution of treatments according to geographical areas (USA versus non-USA), and whether the heterogeneity of approaches has potential impact on survival. Patients and methods This study included 853 patients from 21 specialist centers (14 European, 4 USA, 1 each Australian, Brazilian, and Japanese). Results Heterogeneity of treatment approaches was found, with up to 24 different modalities or combinations used as first-line and 36% of patients receiving four or more treatments. Stage IIB disease was most frequently treated by total-skin-electron-beam radiotherapy, bexarotene and gemcitabine; erythrodermic and SS patients by extracorporeal photochemotherapy, and stage IVA2 by polychemotherapy. Significant differences were found between USA and non-USA centers, with bexarotene, photopheresis and histone deacetylase inhibitors most frequently prescribed for first-line treatment in USA while phototherapy, interferon, chlorambucil and gemcitabine in non-USA centers. These differences did not significantly impact on survival. However, when considering death and therapy change as competing risk events and the impact of first treatment line on both events, both monochemotherapy (SHR = 2.07) and polychemotherapy (SHR = 1.69) showed elevated relative risks. Conclusion This large multicenter retrospective study shows that there exist a large treatment heterogeneity in advanced MF/SS and differences between USA and non-USA centers but these were not related to survival, while our data reveal that chemotherapy as first treatment is associated with a higher risk of death and/or change of therapy and thus other therapeutic options should be preferable as first treatment approach.
- Published
- 2017
28. The role of histological presentation in erythroderma
- Author
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I. N Chuprov, Ruslan A. Nasyrov, A. A. Sidikov, Joerg Wenzel, Elena A. Timoshchuk, Matteo Megna, Uliya Egorova, D. V. Zaslavsky, Megna, Matteo, Sidikov, Akmal A., Zaslavsky, Denis V., Chuprov, Igor N., Timoshchuk, Elena A., Egorova, Uliya, Wenzel, Joerg, and Nasyrov, Ruslan A.
- Subjects
Adult ,Male ,medicine.medical_specialty ,Skin Neoplasms ,Eczema ,Erythroderma ,Dermatology ,Disease ,Diagnosis, Differential ,030207 dermatology & venereal diseases ,03 medical and health sciences ,0302 clinical medicine ,Mycosis Fungoides ,Retrospective Studie ,Psoriasis ,Medicine ,Humans ,Skin Neoplasm ,Retrospective Studies ,Aged ,Aged, 80 and over ,Psoriasi ,Mycosis fungoides ,Mycosis Fungoide ,business.industry ,Retrospective cohort study ,Middle Aged ,medicine.disease ,Drug eruption ,Drug Eruption ,030220 oncology & carcinogenesis ,Etiology ,Histopathology ,Female ,Drug Eruptions ,business ,Dermatitis, Exfoliative ,Human - Abstract
BACKGROUND: Erythroderma is a serious medical condition characterized by inflamed red skin involving over 90% of the body. It can be the common presentation of different diseases, therefore clinical diagnosis can be problematic. Controversial data are reported regarding the diagnostic value of histological examination in erythroderma subjects. METHODS: A retrospective study was performed, investigating histological skin specimens of patients with a clinical diagnosis of erythroderma admitted to the Department of Dermatology of State Pediatric Medical University, Saint Petersburg, from 2001 to 2014. Histopathology examination was performed in each case by a pathologist with a special interest in the skin disease who was blind to any clinical information as well as to final diagnosis. RESULTS: Blinded histopathology examination alone was able to give the correct diagnosis in 61% (n = 50/82) of cases when compared to final diagnosis. A diagnosis of psoriasis was made in 23.2% (n = 19/82) of subjects, spongiotic dermatitis/eczema in 20.7% (n = 17/82), mycosis fungoides in 8.5% (n = 7/82), and drug eruption in 8.5%; histological diagnosis was inconclusive or not matching the final diagnosis when available in the remaining 39.1% of cases (n = 32/82). CONCLUSION: Erythroderma remains a condition difficult to study and treat. We showed that a correct judgment about its cause can be based on objective histopathological criteria in up to 60% of cases. More studies are needed to try to find out further histological and/or immunohistochemical markers that could help the clinician with the erythroderma etiology diagnostic process.
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- 2017
29. Langerhans, plasmacytoid dendritic and myeloid-derived suppressor cell levels in mycosis fungoides vary according to the stage of the disease
- Author
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Marco Santucci, Maurizio Sessa, Claudio Agostinelli, Chiara Astrua, Stefano Pileri, Simona Righi, Pietro Quaglino, Carlo Tomasini, Alessandro Pileri, Vieri Grandi, Annalisa Patrizi, Paolo Fava, Nicola Pimpinelli, Pileri, Alessandro, Agostinelli, Claudio, Sessa, Maurizio, Quaglino, Pietro, Santucci, Marco, Tomasini, Carlo, Grandi, Vieri, Fava, Paolo, Astrua, Chiara, Righi, Simona, Patrizi, Annalisa, Pileri, Stefano A, and Pimpinelli, Nicola
- Subjects
Adult ,Male ,0301 basic medicine ,Mycosis fungoides ,Skin Neoplasms ,Langerin ,Pathology and Forensic Medicine ,law.invention ,03 medical and health sciences ,0302 clinical medicine ,law ,medicine ,Myeloid-derived suppressor cell ,Humans ,Stage (cooking) ,Molecular Biology ,Aged ,biology ,Myeloid-Derived Suppressor Cells ,Dendritic Cells ,Cell Biology ,General Medicine ,Dendritic cell ,Middle Aged ,Mycosis fungoide ,medicine.disease ,Immunohistochemistry ,Exact test ,030104 developmental biology ,Langerhans Cells ,030220 oncology & carcinogenesis ,Immunology ,Disease Progression ,Myeloid-derived Suppressor Cell ,biology.protein ,Suppressor ,Female - Abstract
Mycosis fungoides (MF) is characterized by a switch from indolent behaviour in the early stages to a worse clinical outcome in the advanced ones. Recently, various studies have investigated the role the microenvironment might play in such a switch. We have analysed the distribution of Langerhans cells, plasmacytoid dendritic cells and myeloid-derived suppressor cells in 46 MF cases in various stages, aiming to assess whether changes occur from early to advanced stage. We have investigated the number of langerin, CD303 and arginase-1 positive cells and their distribution at high power. Data were analysed using t test for continuous variables, χ 2 tests or Fisher’s exact test for categorical variables, as well as analysis of covariance. In comparing stages IA/B to IIB, we observed a significant decrease in Langerhans cells (p value 0.03) and a significant increase in CD303 and arginase-1 positive cells (p value
- Published
- 2017
30. A rare case of nephrotic syndrome revealing mycosis fungoide managed successfully with chemotherapy.
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Kairouani, Mouna, Sekkate, Sakina, Ismaili, Nabil, Abahssain, Halima, and Errihani, Hassan
- Abstract
The occurrence of the nephrotic syndrome during mycosis fungoide is very unusual. We report a rare case of mycosis fungoide revealed by hydrops related to nephrotic syndrom in a 37-year old male patient. He has been admitted to intensive care unit because of a breathing distress and a hydrophobs. Whole body computed tomography scan revealed bilateral axillary, cervical lymph nodes, tumoral infiltration of the subcutaneous tissue in the cervicothoracic and abdominal regions, multiples bilateral pulmonary metastasis, bilateral pleural effusion, and abdominal effusion; the kidneys were normal. The patient was staged IVb (T3N3M1). He was treated with CHOP (cyclophosphamide, Doxorubicin, Vincristin and prednisone). Evolution after eight cycles of chemotherapy was spectacular. The development of nephrotic syndrom secondary to mycosis fungoide is rare. It requires a multidisciplinary approach with nephrologists and oncologists. [ABSTRACT FROM AUTHOR]
- Published
- 2012
31. Mycosis fungoides: Association of KIR ligands and HLA-DQB1∗05 with bad prognosis of the disease
- Author
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Giovanni Borroni, M. Martinetti, Nicolò Rivetti, C. Badulli, A. De Silvestri, Andrea Carugno, Raffaello Cananzi, Valeria Brazzelli, Brazzelli, V, Rivetti, N, Badulli, C, Carugno, A, Cananzi, R, De Silvestri, A, Martinetti, M, and Borroni, G
- Subjects
Adult ,Male ,0301 basic medicine ,medicine.medical_specialty ,Skin Neoplasms ,Dermatology ,Disease ,Human leukocyte antigen ,Ligands ,Gastroenterology ,Epitope ,03 medical and health sciences ,KIR ligands ,Mycosis Fungoides ,Gene Frequency ,Receptors, KIR ,Internal medicine ,medicine ,HLA-DQ beta-Chains ,Humans ,Typing ,Allele ,Alleles ,Aged ,Mycosis fungoides ,HLA-DQB1 ,business.industry ,DNA, Neoplasm ,Middle Aged ,Prognosis ,medicine.disease ,Mycosis fungoide ,Lymphoma ,030104 developmental biology ,Infectious Diseases ,Immunology ,Disease Progression ,Female ,business - Abstract
Background Mycosis fungoides (MF) is the most common cutaneous T-cell lymphoma. We previously reported that the prognosis of MF patients is not only related on clinical variables but it is also associated with peculiar HLA alleles. Until today, the association of HLA ligands for KIR with the prognosis of the disease has not yet been analysed. Objective We investigated the frequency of HLA ligands for killer cell Immunoglobulin-like receptors (KIRs) in MF patients, evaluating if the presence of particular HLA alleles that are ligands for KIR may have prognostic value. Methods The study includes 46 Caucasian MF patients that, between 1993 and 1997, underwent HLA genomic typing. All patients were diagnosed and followed up from 1977 to 2012 (mean follow-up of 11 years). Results MF patients have been divided into two groups (long survivors and dead patients). We noticed that the HLA-Bw6/Bw6 specificity increased among the group of seven dead patients compared to the group of 39 long survivors (71.4% vs. 41.0%, P = ns, OR = 3.59), while in the long survivors group the HLA- Bw4/Bw4 specificity increased when compared to dead patients (23.0% vs. 0%, P = ns). Moreover, we observed that six of the seven dead patients had HLA-DQB1*05; the phenotypic frequency of this HLA allele, in dead and long survivors patients, was 85.7% and 23.0% respectively (P = 0.004; OR = 20). Conclusion Our observations suggest that the presence of the HLA-DQB1*05 alleles characterizes the patients with the poorest prognosis in MF. In addition, absence of the KIR-ligand epitope HLA-B Bw4 showed a trend of being more prominent in MF patients with the poorest prognosis.
- Published
- 2016
32. Clinicopathological and molecular study of primary cutaneous CD4+ small/medium-sized pleomorphic T-cell lymphoma
- Author
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Silvia, Alberti-Violetti, Carlos A, Torres-Cabala, Rakhshandra, Talpur, Laura, Corti, Daniele, Fanoni, Luigia, Venegoni, Emilio, Berti, Madeleine, Duvic, Alberti Violetti, S, Torres Cabala, C, Talpur, R, Corti, L, Fanoni, D, Venegoni, L, Berti, E, and Duvic, M
- Subjects
Adult ,Aged, 80 and over ,CD4-Positive T-Lymphocytes ,Male ,mycosis fungoide ,Comparative Genomic Hybridization ,Skin Neoplasms ,Adolescent ,Radiotherapy ,mycosis fungoides ,Dermatologic Surgical Procedures ,CD4+ small medium pleomorphic lymphoma ,Antineoplastic Agents ,Middle Aged ,Polymerase Chain Reaction ,Lymphoma, T-Cell, Cutaneous ,PD1 ,Young Adult ,array comparative genomic hybridization ,Humans ,Female ,cutaneous T-cell lymphoma ,Neoplasm Recurrence, Local ,Aged ,Retrospective Studies - Abstract
Background: Primary cutaneous CD4+ small-/medium-sized pleomorphic T-cell lymphoma (CD4+ PCSM-TCL) is a rare lymphoproliferative disorder with a favorable prognosis. Distinguishing it from other cutaneous lymphomas is often a challenge. Methods: We retrospectively collected CD4+PCSM-TCL cases from two centers (MD Anderson Cancer Center, USA and University of Milan, Italy) and evaluated their clinicopathological features. Array-comparative genomic hybridization (aCGH) analysis was performed on 11 cases. Results: A total of 62 patients were identified. Single lesions were the most common clinical presentations (79%). Five patients (8%) showed multiple MF-like plaques. All patients' disease had an indolent course. The infiltrate was nodular and diffuse, multinodular or superficial but in all cases, it was characterized by small/medium pleomorphic CD4+/CD279(PD1+) lymphocytes grouped in clusters and ‘pseudorosettes’ around B-cells. aCGH analysis showed no significant genomic abnormalities. Single lesions were mainly treated with surgical excision (91%) and/or radiotherapy (95%) with low rate of relapse (12%). For multiple lesions, topical steroids, nitrogen mustard and phototherapy were mainly used but the rate of relapse was high (69%). Conclusions: CD4+PCSM-TCL is characterized by heterogeneous clinical presentations. The arrangement of atypical cells in clusters or pseudorosettes is a useful criterion for diagnosis. The absence of significant genomic alterations is in agreement with its indolent behavior.
- Published
- 2016
33. Time course, clinical pathways, and long-term hazards risk trends of disease progression in patients with classic mycosis fungoides
- Author
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Piergiacomo Calzavara-Pinton, Serena Rupoli, Angelo Carbone, Angela Maria Mamusa, Ugo Bottoni, Nicola Pimpinelli, Paolo Fava, Pietro Quaglino, Mauro Alaibac, Emilio Berti, Stefano Titli, Maria Grazia Bernengo, Michele Fimiani, Pier Luigi Zinzani, Giuseppe Alfonso Lombardo, Quaglino, P, Pimpinelli, N, Berti, E, Calzavara Pinton, P, Alfonso Lombardo, G, Rupoli, S, Alaibac, M, Bottoni, U, Carbone, A, Fava, P, Fimiani, M, Mamusa, A, Titli, S, Zinzani, P, Bernengo, M, Quaglino P, Pimpinelli N, Berti E, Calzavara-Pinton P, Alfonso Lombardo G, Rupoli S, Alaibac M, Bottoni U, Carbone A, Fava P, Fimiani M, Mamusa AM, Titli S, Zinzani, P L, Bernengo MG, and On behalf of the Gruppo Italiano Linfomi Cutanei (GILC).
- Subjects
Adult ,Male ,Oncology ,Cancer Research ,Pathology ,medicine.medical_specialty ,Skin Neoplasms ,Adolescent ,Erythroderma ,Disease ,Cutaneous lymphoma ,Follow-Up Studie ,Retrospective Studie ,Internal medicine ,classification, cutaneous T-cell lymphoma, erythroderma, multivariate analysis, mycosis fungoides, prognosis, tumor-lymph node-metastasis-blood (TNMB), tumor-stage ,Humans ,Medicine ,Skin Neoplasm ,cutaneous T-cell lymphoma ,Child ,tumor-lymph node-metastasis-blood (TNMB) ,Aged ,Neoplasm Staging ,Retrospective Studies ,Aged, 80 and over ,Mycosis Fungoide ,Mycosis fungoides ,mycosis fungoides ,business.industry ,erythroderma ,Cutaneous T-cell lymphoma ,Cancer ,Retrospective cohort study ,Middle Aged ,medicine.disease ,Lymphoma ,multivariate analysis ,classification ,Disease Progression ,Female ,prognosis ,business ,prognosi ,Human ,Follow-Up Studies ,tumor-stage - Abstract
BACKGROUND: Mycosis fungoides (MF) is an indolent primary cutaneous T-cell lymphoma. To the authors' knowledge, no data currently are available regarding the evolution over time of the risk of developing specific pathways of disease progression. METHODS: This retrospective study analyzed 1422 patients with MF who were diagnosed and followed from 1975 through 2010 in 27 Italian Study Group for Cutaneous Lymphoma centers. The primary objectives were to ascertain the time course, pathways, and hazards risk trends of cutaneous/extracutaneous disease progression; to evaluate whether different tumor-lymph node-metastasis-blood (TNMB) stages have different pathways of disease progression; and to analyze differences between tumor-stage and erythrodermic MF with regard to clinical onset, disease evolution, and prognosis. The secondary objective was to provide a further validation for the revised International Society for Cutaneous Lymphomas and the Cutaneous Lymphoma Task Force of the European Organization of Research and Treatment of Cancer (ISCL/EORTC) classification. RESULTS: The median follow-up was 14.5 years; stage progression occurred in 29.7% of patients and blood involvement was the most frequent extracutaneous site of disease progression. Patients with stage IA to stage IB disease demonstrated a steady low annual incidence of disease progression to tumor-stage (1%-2%); patients with stage IIA disease had a higher risk within the first years (up to 9.4%). Erythroderma evolved with a significantly higher frequency from patches/plaques (13.9%/28.2%) than tumors (P = .028 and P = .013, respectively). Hazards rates of extracutaneous involvement were low (< 1%). The T-score was found to be associated with extracutaneous involvement site, tumor-stage disease with lymph node/visceral lesions, and erythroderma with blood involvement. TNMB classification and stage progression resulted as independent prognostic variables being detected on multivariate analysis; the type of extracutaneous involvement was found to affect survival . CONCLUSIONS: The data from the current study support the need for a stage-tailored follow-up, suggest that the classification of tumor-stage disease at a stage below erythroderma could be modified, and offer a further validation for the revised TNMB classification. Cancer 2012. © 2012 American Cancer Society.
- Published
- 2012
34. Mycosis fungoides: Association of KIR ligands and HLA-DQB1∗05 with bad prognosis of the disease
- Abstract
Background Mycosis fungoides (MF) is the most common cutaneous T-cell lymphoma. We previously reported that the prognosis of MF patients is not only related on clinical variables but it is also associated with peculiar HLA alleles. Until today, the association of HLA ligands for KIR with the prognosis of the disease has not yet been analysed. Objective We investigated the frequency of HLA ligands for killer cell Immunoglobulin-like receptors (KIRs) in MF patients, evaluating if the presence of particular HLA alleles that are ligands for KIR may have prognostic value. Methods The study includes 46 Caucasian MF patients that, between 1993 and 1997, underwent HLA genomic typing. All patients were diagnosed and followed up from 1977 to 2012 (mean follow-up of 11 years). Results MF patients have been divided into two groups (long survivors and dead patients). We noticed that the HLA-Bw6/Bw6 specificity increased among the group of seven dead patients compared to the group of 39 long survivors (71.4% vs. 41.0%, P = ns, OR = 3.59), while in the long survivors group the HLA- Bw4/Bw4 specificity increased when compared to dead patients (23.0% vs. 0%, P = ns). Moreover, we observed that six of the seven dead patients had HLA-DQB1∗05; the phenotypic frequency of this HLA allele, in dead and long survivors patients, was 85.7% and 23.0% respectively (P = 0.004; OR = 20). Conclusion Our observations suggest that the presence of the HLA-DQB1∗05 alleles characterizes the patients with the poorest prognosis in MF. In addition, absence of the KIR-ligand epitope HLA-B Bw4 showed a trend of being more prominent in MF patients with the poorest prognosis.
- Published
- 2016
35. Clinicopathological and molecular study of primary cutaneous CD4+ small/medium-sized pleomorphic T-cell lymphoma
- Abstract
Background: Primary cutaneous CD4+ small-/medium-sized pleomorphic T-cell lymphoma (CD4+ PCSM-TCL) is a rare lymphoproliferative disorder with a favorable prognosis. Distinguishing it from other cutaneous lymphomas is often a challenge. Methods: We retrospectively collected CD4+PCSM-TCL cases from two centers (MD Anderson Cancer Center, USA and University of Milan, Italy) and evaluated their clinicopathological features. Array-comparative genomic hybridization (aCGH) analysis was performed on 11 cases. Results: A total of 62 patients were identified. Single lesions were the most common clinical presentations (79%). Five patients (8%) showed multiple MF-like plaques. All patients' disease had an indolent course. The infiltrate was nodular and diffuse, multinodular or superficial but in all cases, it was characterized by small/medium pleomorphic CD4+/CD279(PD1+) lymphocytes grouped in clusters and ‘pseudorosettes’ around B-cells. aCGH analysis showed no significant genomic abnormalities. Single lesions were mainly treated with surgical excision (91%) and/or radiotherapy (95%) with low rate of relapse (12%). For multiple lesions, topical steroids, nitrogen mustard and phototherapy were mainly used but the rate of relapse was high (69%). Conclusions: CD4+PCSM-TCL is characterized by heterogeneous clinical presentations. The arrangement of atypical cells in clusters or pseudorosettes is a useful criterion for diagnosis. The absence of significant genomic alterations is in agreement with its indolent behavior.
- Published
- 2016
36. Aggressive epidermotropic cutaneous CD8+ lymphoma: A cutaneous lymphoma with distinct clinical and pathological features. Report of an EORTC Cutaneous Lymphoma Task Force Workshop
- Author
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Alistair Robson, Christine Castillo, Maria Geerts, Sean Whittaker, Chalid Assaf, Nicola Pimpinelli, Rein Willemze, Tony Petrella, Joclim Roewert, Mattias Steinhoff, Marco Santucci, Frederic Franck, Emilio Berti, Robin Russell-Jones, Lorenzo Cerroni, Janine Wechsler, Robert Knobler, Pierre Dechelotte, Nicola Chimenti, Cesare Massone, Chris J.L.M. Meijer, John R. Goodlad, Werner Kempf, Sylke Gellrich, Eduardo Calonje, Wolfram Sterry, Martine Bagot, Pablo Ortiz, Günter Burg, Robson, A, Assaf, C, Bagot, M, Burg, G, Calonje, J, Castillo, C, Cerroni, L, Chimenti, N, Dechelotte, P, Franck, F, Geerts, M, Gellrich, S, Goodlad, J, Kempf, W, Knobler, R, Massone, C, Meijer, C, Ortiz, P, Petrella, T, Pimpelli, N, Roewert, J, Russell-Jones, R, Santucci, M, Steinhoff, M, Sterry, W, Wechsler, J, Whittaker, S, Willemze, R, Berti, E, Pathology, and CCA - Innovative therapy
- Subjects
Adult ,Male ,mycosis fungoide ,Pathology ,medicine.medical_specialty ,Histology ,Lymphoma ,diagnosis ,Prognosi ,CD8-Positive T-Lymphocytes ,Cutaneous lymphoma ,Pathology and Forensic Medicine ,Immunophenotyping ,hemic and lymphatic diseases ,Medicine ,Neoplasm ,Humans ,Lymphomatoid papulosis ,Pathological ,Aged ,Aged, 80 and over ,Mycosis fungoides ,business.industry ,mycosis fungoides ,CD8 antigen, lymphoma, diagnosis, mycosis fungoides, prognosis ,General Medicine ,CD8 antigen ,Middle Aged ,medicine.disease ,Lymphoma, T-Cell, Cutaneous ,diagnosi ,Pagetoid ,Female ,prognosis ,business ,CD8 - Abstract
AIMS: Aggressive epidermotropic cutaneous CD8+ lymphoma is currently afforded provisional status in the WHO classification of lymphomas. An EORTC Workshop was convened to describe in detail the features of this putative neoplasm and evaluate its nosological status with respect to other cutaneous CD8+ lymphomas.METHODS & RESULTS: Sixty-one CD8+ cases were analysed at the workshop; clinical details, often with photographs, histological sections, immunohistochemical results, treatment and patient outcome were discussed & recorded. Eighteen cases had distinct features and conformed to the diagnosis of aggressive epidermotropic cutaneous CD8+ lymphoma. The patients typically present with widespread plaques and tumours, often ulcerated and haemorrhagic, and have striking pagetoid epidermotropism histologically. A CD8+ CD45RA+ CD45RO- CD2- CD5- CD56- phenotype, with 1 or more cytotoxic markers was found in 7/18 with a very similar phenotype in the remainder.. The tumours seldom involve lymph nodes but mucosae and central nervous system involvement are not uncommon. The prognosis is poor, with a median survival of 12 months. Examples of CD8+ mycosis fungoides, lymphomatoid papulosis and Woringer-Kolopp presented the typical features well documented in the CD4+ forms of those diseases.CONCLUSIONS: Aggressive Epidermotropic Cutaneous CD8+ Lymphoma is a distinct lymphoma that warrants inclusion as a distinct entity in future revisions of lymphoma classifications. This article is protected by copyright. All rights reserved.
- Published
- 2015
37. Aggressive epidermotropic cutaneous CD8+ lymphoma: A cutaneous lymphoma with distinct clinical and pathological features. Report of an EORTC Cutaneous Lymphoma Task Force Workshop
- Abstract
Aims: Aggressive epidermotropic cutaneous CD8+ lymphoma is currently afforded provisional status in the WHO classification of lymphomas. An EORTC Workshop was convened to describe in detail the features of this putative neoplasm and evaluate its nosological status with respect to other cutaneous CD8+ lymphomas. Methods and results: Sixty-one CD8+ cases were analysed at the workshop; clinical details, often with photographs, histological sections, immunohistochemical results, treatment and patient outcome were discussed and recorded. Eighteen cases had distinct features and conformed to the diagnosis of aggressive epidermotropic cutaneous CD8+ lymphoma. The patients typically present with widespread plaques and tumours, often ulcerated and haemorrhagic, and histologically have striking pagetoid epidermotrophism. A CD8+/CD45RA+/CD45RO-/CD2-/CD5-/CD56- phenotype, with one or more cytotoxic markers, was found in seven of 18 patients, with a very similar phenotype in the remainder. The tumours seldom involve lymph nodes, but mucosal and central nervous system involvement are not uncommon. The prognosis is poor, with a median survival of 12 months. Examples of CD8+ mycosis fungoides, lymphomatoid papulosis and Woringer-Kolopp disease presented the typical features well documented in the CD4+ forms of those diseases. Conclusions: Aggressive epidermotropic cutaneous CD8+ lymphoma is a distinct lymphoma that warrants inclusion as a distinct entity in future revisions of lymphoma classifications.
- Published
- 2015
38. Development of conjunctival intraepithelial neoplasia following phototherapy for mycosis fungoides.
- Author
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Zloto O, Weidenfeld J, and Fabian ID
- Published
- 2019
- Full Text
- View/download PDF
39. Dermoscopy of early stage mycosis fungoides
- Author
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A, Lallas, Z, Apalla, I, Lefaki, T, Tzellos, A, Karatolias, E, Sotiriou, E, Lazaridou, D, Ioannides, I, Zalaudek, G, Argenziano, Lallas, A, Apalla, Z, Lefaki, I, Tzellos, T, Karatolias, A, Sotiriou, E, Lazaridou, E, Ioannides, D, Zalaudek, I, Argenziano, Giuseppe, and Argenziano, G
- Subjects
Mycosis Fungoide ,Mycosis Fungoides ,Humans ,Retrospective Studies ,Sensitivity and Specificity ,Dermoscopy ,Retrospective Studie ,Human - Abstract
Early stage mycosis fungoides (MF) is difficult to be clinically differentiated from chronic dermatitis (CD) in a high proportion of patients. Dermoscopy is a rapid, cheep, non-invasive and widely used method for the evaluation of skin tumours and, recently, of inflammatory skin diseases, as well.To describe the dermoscopic pattern of early stage MF and compare it with the dermoscopic features observed in CD.This was a retrospective study. Dermoscopic images of lesions that were clinically equivocal between MF and CD were evaluated for the presence of predefined morphologic criteria. Diagnosis had been histopathologically and immunohistochemically confirmed in all cases. Sensitivity, specificity, positive predictive value, and negative predictive value were calculated for predefined dermoscopic criteria in relation to the diagnosis of mycosis fungoides.A total of 67 dermoscopic images were selected for dermoscopic evaluation. Mycosis fungoides lesions exhibited a characteristic dermoscopic pattern consisting of fine short linear vessels (sensitivity 93.7%, specificity 97.1%) and orange-yellowish patchy areas (sensitivity 90.6%, specificity 99.7%). A characteristic vascular structure resembling spermatozoa was also found to be highly specific for the diagnosis of mycosis fungoides. CD was typified by a different dermoscopic pattern, usually consisting of dotted vessels.These observations provide a first indication that early stage MF exhibits a characteristic dermoscopic pattern which is different from CD. Prospective studies with long term follow-up are needed to determine the value of these dermoscopic criteria in the differentiation between the two entities in the daily routine.
- Published
- 2013
40. Mycosis fungoides following pityriasis lichenoides: an exceptional event or a potential evolution
- Author
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Iria Neri, Alessandro Pileri, Annalisa Patrizi, Selena Ciabatti, Beatrice Raone, Federica Bellini, Alessandro Pileri, Iria Neri, Beatrice Raone, Selena Ciabatti, Federica Bellini, and Annalisa Patrizi
- Subjects
Male ,medicine.medical_specialty ,Mycosis fungoides ,business.industry ,Event (relativity) ,Pityriasis lichenoides ,Hematology ,Mycosis fungoide ,medicine.disease ,Dermatology ,Hematologic Diseases ,Skin Diseases ,potential evolution ,pityriasis lichenoide ,pediatric ,Oncology ,Pediatrics, Perinatology and Child Health ,Medicine ,Humans ,Female ,business - Abstract
Mycosis fungoides following pityriasis lichenoides: An exceptional event or a potential evolution
- Published
- 2011
41. Free-floating collagen fibers in interstitial mycosis fungoides
- Author
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Giuseppe Argenziano, Giuliana Crisman, Catherine M. Stefanato, Iris Zalaudek, Gerardo Ferrara, Ferrara, Gerardo, Crisman, Giuliana, Zalaudek, Iri, Argenziano, Giuseppe, Stefanato, Catherine M, Ferrara, G, Crisman, G, Zalaudek, I, and Stefanato, Cm
- Subjects
Pathology ,medicine.medical_specialty ,Skin Neoplasms ,T-Lymphocytes ,Dermatology ,Pathology and Forensic Medicine ,Diagnosis, Differential ,Granuloma Annulare ,Mycosis Fungoides ,Diagnosis ,medicine ,Humans ,Skin Neoplasm ,Granuloma annulare ,Mycosis fungoides ,Mycosis Fungoide ,business.industry ,General Medicine ,Middle Aged ,medicine.disease ,Drug Eruptions ,Female ,Collagen ,T-Lymphocyte ,Drug Eruption ,Differential ,Immunohistochemistry ,Interstitial granulomatous drug reaction ,Differential diagnosis ,business ,Morphea ,Human - Abstract
We present a case of interstitial mycosis fungoides showing pseudodovascular clefts with "free-floating'' collagen fibers surrounded by neoplastic T lymphocytes. Such a finding further expands the histopathologic spectrum of mycosis fungoides and could be taken into account in its differential diagnosis from granuloma annulare, inflammatory morphea, and interstitial granulomatous drug reaction.
- Published
- 2010
42. Time course, clinical pathways, and long-term hazards risk trends of disease progression in patients with classic mycosis fungoides: a multicenter, retrospective follow-up study from the Italian Group of Cutaneous Lymphomas
- Abstract
BACKGROUND: Mycosis fungoides (MF) is an indolent primary cutaneous T-cell lymphoma. To the authors' knowledge, no data currently are available regarding the evolution over time of the risk of developing specific pathways of disease progression. METHODS: This retrospective study analyzed 1422 patients with MF who were diagnosed and followed from 1975 through 2010 in 27 Italian Study Group for Cutaneous Lymphoma centers. The primary objectives were to ascertain the time course, pathways, and hazards risk trends of cutaneous/extracutaneous disease progression; to evaluate whether different tumor-lymph node-metastasis-blood (TNMB) stages have different pathways of disease progression; and to analyze differences between tumor-stage and erythrodermic MF with regard to clinical onset, disease evolution, and prognosis. The secondary objective was to provide a further validation for the revised International Society for Cutaneous Lymphomas and the Cutaneous Lymphoma Task Force of the European Organization of Research and Treatment of Cancer (ISCL/EORTC) classification. RESULTS: The median follow-up was 14.5 years; stage progression occurred in 29.7% of patients and blood involvement was the most frequent extracutaneous site of disease progression. Patients with stage IA to stage IB disease demonstrated a steady low annual incidence of disease progression to tumor-stage (1%-2%); patients with stage IIA disease had a higher risk within the first years (up to 9.4%). Erythroderma evolved with a significantly higher frequency from patches/plaques (13.9%/28.2%) than tumors (P =.028 and P =.013, respectively). Hazards rates of extracutaneous involvement were low (< 1%). The T-score was found to be associated with extracutaneous involvement site, tumor-stage disease with lymph node/visceral lesions, and erythroderma with blood involvement. TNMB classification and stage progression resulted as independent prognostic variables being detected on multivariate analysis; the type of e
- Published
- 2012
43. Mycosis fungoides: disease evolution of the 'lion queen' revisited
- Abstract
Mycosis fungoides (MF), which represents the most common subtype of primary cutaneous T-cell lymphoma (CTCL), is an epidermotropic lymphoma included as an indolent form in the recent WHO/EORTC classification. From a clinical point of view, the classic disease progression usually is slow and takes over years or even decades, and characterized by the evolution from patches to more infiltrated plaques and eventually to tumours or erythroderma. However, the analysis of the MF disease course has been greatly impaired by the rarity of the disease, thus data about the time course of disease progression and pattern of relapse during time are not well known. In this review, a summary of published data on MF large patients cohorts will be presented, together with the results obtained by a retrospective analysis of clinical features and follow-up data of 1,422 MF patients diagnosed and followed-up from 1975 to 2010 in 27 Italian Centres (Italian Study Group for Cutaneous Lymphoma). From a clinical perspective, the amount of data support the relevance of a stage-tailored, differentiated follow-up strategy, in as much as the TNMB staging appears not only to be associated with different progression rates, but also shows as a new finding a relationship with different patterns of disease progression. From a biological point of view, there is the need to understand the molecular basis of the different clinical pathways of disease progression, to be able to potentially identify at an earlier phase of disease evolution, the patients who are more likely to develop erythroderma or tumour-stage progression. In conclusion, if MF is indeed a true "lion queen", as dermatologists we need to be expert and wise tamers to keep it under control.
- Published
- 2012
44. Mycosis fungoides
- Author
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Pier Luigi Zinzani, Andrés J.M. Ferreri, Lorenzo Cerroni, Pier Luigi Zinzani, Andrés J.M. Ferreri, and Lorenzo Cerroni
- Subjects
Mycosis Fungoides ,Skin Neoplasms ,Oncology ,Risk Factors ,Humans ,T-cell lymphoma ,Hematology ,Mycosis fungoide ,Prognosis ,Sezary syndrome ,Neoplasm Staging - Abstract
Mycosis fungoides (MF) constitutes the most frequent cutaneous T-cell lymphoma. Sezary syndrome is considered by some authors to be an erythrodermic leukemic variant of MF, but is classified separately in the new WHO-EORT classification of cutaneous lymphomas. MF usually occurs in old adults with a 2:1 male to female ratio. Its prognosis is variable and strongly conditioned by the extent and type of skin involvement and presence of extracutaneous disease. Patients with stage IA-disease have an excellent prognosis with an overall long-term life expectancy that is similar to an age-, sex-, and race-matched control population. Almost all patients with stage IA MF will die from causes other than MF, with a median survival >33 years. Only 9% of these patients will progress to more extended disease. Patients with stage IB or IIA have a median survival greater than 11 years. These patients with T2 disease have a likelihood of disease progression of 24% and nearly 20% die of MF. Subgroups with stage IB or IIA have similar prognosis. Patients with cutaneous tumors or generalized erythroderma have a median survival of 3 and 4.5 years, respectively. The majority of these patients will die of MF. Extracutaneous dissemination is observed in less than 10% of patients with patch or plaque disease and in 30-40% of patients with tumors or generalized erythrodermatous involvement. Extracutaneous involvement is directly correlated to the extent of cutaneous disease. The most commonly involved organs are lung, spleen, liver, and gastrointestinal tract. Patients with extracutaneous disease at presentation involving either lymph nodes or viscera have a median survival of 33 years. Only 9% of these patients will progress to more extended disease. Patients with stage IB or IIA have a median survival greater than 11 years. These patients with T2 disease have a likelihood of disease progression of 24% and nearly 20% die of MF. Subgroups with stage IB or IIA have similar prognosis. Patients with cutaneous tumors or generalized erythroderma have a median survival of 3 and 4.5 years, respectively. The majority of these patients will die of MF. Extracutaneous dissemination is observed in less than 10% of patients with patch or plaque disease and in 30-40% of patients with tumors or generalized erythrodermatous involvement. Extracutaneous involvement is directly correlated to the extent of cutaneous disease. The most commonly involved organs are lung, spleen, liver, and gastrointestinal tract. Patients with extracutaneous disease at presentation involving either lymph nodes or viscera have a median survival of
- Published
- 2006
45. The crazy-paving pattern in granulomatous mycosis fungoides: high-resolution computed tomography-pathological correlation
- Author
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And Maurizio Zompatori, David M. Hansell, Gianluca Casoni, Nicola Sverzellati, Venerino Poletti, Marco Chilosi, Sverzellati, Nicola, Poletti, Venerino, Chilosi, Marco, Casoni, GianLuca, Hansell, David, and Zompatori, Maurizio
- Subjects
mycosis fungoide ,High-resolution computed tomography ,medicine.medical_specialty ,Pathology ,Skin Neoplasms ,Biopsy ,Computed tomography ,Diagnosis, Differential ,Mycosis Fungoides ,Rare Diseases ,Medicine ,Humans ,Radiology, Nuclear Medicine and imaging ,Pathological correlation ,Lung ,Mycosis fungoides ,Granuloma ,medicine.diagnostic_test ,business.industry ,Patient affected ,computed tomography ,Granulomatous mycosis fungoides ,Middle Aged ,medicine.disease ,eye diseases ,Radiographic Image Enhancement ,medicine.anatomical_structure ,Female ,Tomography ,Radiology ,business ,Tomography, X-Ray Computed - Abstract
The purpose of this report is to describe a further distinctive cause of crazy-paving pattern on thin-section computed tomography in a patient affected by pulmonary granulomatous mycosis fungoides. It was possible to reconcile the crazy-paving appearance on thin-section computed tomography scan with the histopathologic pattern termed acute fibrinous organizing pneumonia pattern.
- Published
- 2006
46. Mycosis fungoides: is it a Borrelia burgdorferi-associated disease?
- Author
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Serena Bonin, Giusto Trevisan, Giorgio Stanta, M. S. Tothova, Tothova, M. S., Bonin, Serena, Trevisan, Giusto, and Stanta, Giorgio
- Subjects
Adult ,DNA, Bacterial ,Male ,Mycosis fungoides ,Cancer Research ,Pathology ,medicine.medical_specialty ,Cutaneous T-cell lymphoma ,Biopsy ,Population ,Spirochaetaceae ,Lyme disease ,Borrelia ,Humans ,Medicine ,Borrelia burgdorferi ,Aetiology ,education ,Molecular Diagnostics ,Aged ,Skin ,Aged, 80 and over ,education.field_of_study ,biology ,business.industry ,Middle Aged ,Mycosis fungoide ,biology.organism_classification ,medicine.disease ,Peripheral T-cell lymphoma ,Polymerase chain reaction ,Italy ,Oncology ,Case-Control Studies ,Immunology ,Female ,business - Abstract
Mycosis fungoides (MF) is the most frequently found cutaneous T-cell lymphoma with an unknown aetiology. Several aetiopathogenetic mechanisms have been postulated, including persistent viral or bacterial infections. We looked for evidence of Borrelia burgdorferi (Bb), the aetiologic agent of Lyme disease (LD), in a case study of MF patients from Northeastern Italy, an area with endemic LD. Polymerase chain reaction for the flagellin gene of Bb was used to study formalin-fixed paraffin-embedded lesional skin biopsies from 83 patients with MF and 83 sex- and age-matched healthy controls with homolocalised cutaneous nevi. Borrelia burgdorferi-specific sequence was detected in 15 out of 83 skin samples of patients with MF (18.1%), but in none out of 83 matched healthy controls (P
- Published
- 2006
47. Mycosis fungoides is not associated with HCV virus infection
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MIERTUSOVA S, BONIN, Serena, TREVISAN, GIUSTO, STANTA, GIORGIO, Miertusova, S, Bonin, Serena, Trevisan, Giusto, and Stanta, Giorgio
- Subjects
Mycosis fungoides ,HCV ,RT-PCR ,formalin fixed and paraffin embedded tissues ,Mycosis fungoide - Abstract
Lettera all'Editore- no abstract available
- Published
- 2004
48. Treatment of advanced mycosis fungoides by allogeneic stem-cell transplantation with a nonmyeloablative regimen
- Author
-
A Ibatici, Emilio Berti, A. Della Volpe, Davide Soligo, Luigia Venegoni, Mario Corbellino, P Morandi, G. Lambertenghi Deliliers, Elvio Alessi, L Robbiolo, Claudio Annaloro, E Longhi, Soligo, D, Ibatici, A, Berti, E, Morandi, P, Longhi, E, Venegoni, L, Corbellino, M, Annaloro, C, Robbiolo, L, Della Volpe, A, Alessi, E, and Lambertenghi Deliliers, G
- Subjects
mycosis fungoide ,Oncology ,Adult ,Male ,medicine.medical_specialty ,Antifungal Agents ,Disease ,Polymerase Chain Reaction ,Mycosis Fungoides ,allogeneic stem cell transplantation ,Internal medicine ,MED/35 - MALATTIE CUTANEE E VENEREE ,medicine ,Humans ,Transplantation, Homologous ,Transplantation ,Mycosis fungoides ,Transplantation Chimera ,business.industry ,Gene Rearrangement, gamma-Chain T-Cell Antigen Receptor ,nonmyeloablative regimen ,Receptors, Antigen, T-Cell, gamma-delta ,Hematology ,Middle Aged ,medicine.disease ,Peripheral T-cell lymphoma ,Hematopoietic Stem Cell Mobilization ,Lymphoma ,Surgery ,Lymphoma, T-Cell, Cutaneous ,Regimen ,Female ,High incidence ,Stem cell ,business ,Immunosuppressive Agents ,Stem Cell Transplantation - Abstract
Given the poor prognosis of patients with advanced cutaneous T-cell lymphoma and the high transplant-related mortality associated with conventional allogeneic bone marrow transplantation, we performed nonmyeloablative transplantation of allogeneic stem cells (ASCT) from HLA-identical siblings in three patients with this disease. All patients achieved full donor engraftment, clearance of clonal T cells leading to durable complete remissions but experienced high incidence of infections, which proved fatal in one case. These results suggest that nonmyeloablative ASCT is a novel and potentially curative therapy for patients with advanced T-cell lymphomas who have a histocompatible sibling.
- Published
- 2003
49. Treatment of advanced mycosis fungoides by allogeneic stem-cell transplantation with a nonmyeloablative regimen
- Abstract
Given the poor prognosis of patients with advanced cutaneous T-cell lymphoma and the high transplant-related mortality associated with conventional allogeneic bone marrow transplantation, we performed nonmyeloablative transplantation of allogeneic stem cells (ASCT) from HLA-identical siblings in three patients with this disease. All patients achieved full donor engraftment, clearance of clonal T cells leading to durable complete remissions but experienced high incidence of infections, which proved fatal in one case. These results suggest that nonmyeloablative ASCT is a novel and potentially curative therapy for patients with advanced T-cell lymphomas who have a histocompatible sibling
- Published
- 2003
50. Mycosis fungoides: A unusual clinical presentation
- Author
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Bandini P., Costa A. M., La Placa M., Varotti C., Bandini P., Costa A.M., La Placa M., and Varotti C.
- Subjects
Cutaneous biopsy ,Differential diagnosi ,Palmoplantar lesions ,Mycosis fungoide - Abstract
The Authors describe a case of a 69-year-old woman who presented by two years erythematous, markedly hyperkeratotic and pruritic plaques with sharp borders on the palms and soles. Were also presents in these plaques deep vesicopustolar lesions. The patient was evaluated by other dermatologists that diagnosticated allergic contact dermatitis: patch tests confirmed theirs diagnosis (positivity for nickel and other substances). Fungal culture was negative. The lesions were treated with daily topical applications of a corticosteroid treaitment having a partial resolution. In consequence of the interruption of the therapy, the dermatosis flared up again. The clinical features gave evidence for psoriasis. A biopsy specimen taken from the right palm showed marked parakeratosis, acanthosis and diffuse infiltrate in the papillary dermis. The dermal bandlike infiltrate was composed of lymphocites and cells with hyperchromatic irregurarly shaped nuclei (mycosis cells). Immunohistochemistry confirmed diagnosis of mycosis fungoides. Further examinations excluded visceral involvement. The patient was treated with daily topical applications of mechlorethamine (nitrogen mustard). Before establishing the diagnosis of mycosis fungoides palmoplantaris (MFPP) has been diagnosed as dermatophyte infection, contact dermatitis and palmoplantar psoriasis. In summary, MFPP is an expression of MF that sometime initially presents and mimics many common palmoplantar dermatoses. A biopsy is recommended in the evaluation of unresponsive, chronic palmoplantar lesions.
- Published
- 2000
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