Mycosis fungoides – therapeutic difficulties

Lymphoma belongs to a heterogeneous group of malignant neoplasms of the lymphatic system developing from lymphocytes, precursor cells, or directly from a multipotent stem cell [1]. Cutaneous T-cell lymphoma (CTCL), including mycosis fungoides, first affects the skin [2].
Mycosis fungoides, first described by Albert in 1806, is a type of lymphoma developing from peripheral T cells, characterised by low malignancy, chronic nature and slow progress [3, 4].
The first skin lesions, in the form of non-specific patchy eruptions, occurred in a 50-year-old male patient in 2004. Initially, patches on the skin were located on the lower extremities, and later also on the abdomen. In 2008, the patient visited the Outpatient Clinic of Dermatology in Poznan due to the exacerbation of skin symptoms. Because of the extent of the skin lesions and an initial suspicion of cutaneous T-cell lymphoma, the patient was referred to the Wielkopolskie Centre of Oncology in Poznan, where a skin biopsy was taken for histopathological examination that confirmed the clinical diagnosis of mycosis fungoides. In addition, a specimen was taken from the left axillary lymph node, and the examination revealed that the image may correspond with lymphonodulitis dermatopathica. The immunohistochemical skin examination revealed CD3+, CD4+ and CD8+ cells and Ki 67 proliferation antigen. Trephine biopsy revealed bone marrow with a reduced cell count containing all cell lines. The patient was treated with total skin electron beam therapy (TSEB), and an improvement in the skin condition was achieved. In December 2008, the therapy was completed and the patient was in remission for almost 8 months. In March 2009, due to the exacerbation of skin lesions, the patient was admitted to the Hospital Department of Dermatology in Poznan, where he was qualified for phototherapy. Starting from April 2010 the patient was treated with UVA1, and received a total dose of irradiation of 1980 J/cm² in 30 sessions. Both before the treatment with UVA1, and after completion of the phototherapeutic cycle, the patient was subject to skin tests with a high-resolution ultrasound technique. In addition, histopathological examination of skin biopsy specimens with lesions was done twice (before treatment and after the cycle of irradiation) (Figures 1 and 2). Both methods confirmed that clinical remission was achieved in the patient. About 3 months after the completed UVA1 treatment, a single infiltrative...


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