Rare variant of mycosis fungoides

Cutaneous lymphomas represent a heterogeneous group of T-, NK- and B-cell neoplasms, with mycosis fungoides (MF) being the most common subtype.1 Clinically, the disease is typified bygradual progression from patches (flat, scaly, various shades of red, variably pruritic) and plaques (indurated, often annular with central clearing), mostly on photoprotected sites, to tumors. Unusual clinical and histopathologic variants often coexist with typical patches or plaques. These clinical variants include follicular, syringotropic, vesicular, granulomatous, poikilodermic, hypo- and hyperpigmented, palmoplantar, hyperkeratotic, papillomatous, ichthyosiform, pigmented purpura-like,pustular and with mucosal involvement. Microscopically, patch-stage MF exhibits a sparse papillary dermal lymphocytic infiltrate with epidermotropism and atypical lymphocytes, either in collections or singly within the epidermis and these are probably the most specific finding in early MF. Plaques of MF, in contrast, are usually diagnostic, exhibiting all of the findings of patches, and more, including1 deeper and denser dermal infiltrates,2 cytologically atypical intraepidermal lymphocytes, 3 easily found Pautrier’s microabscesses, and more prominent psoriasiform hyperplasia and papillary dermal fibrosis.4 Immunohistochemical studies are essential to confirm the diagnosis.2 In the following patient an unusual variant of MF was diagnosed after years of non-remitting disease.