Hypopigmented Interface T-Cell Dyscrasia and Hypopigmented Mycosis Fungoides: A Comparative Study

Hypopigmented interface T-cell dyscrasia (HITCD) is a distinct form of lymphoid dyscrasia that may progress to hypopigmented mycosis fungoides (HMF). We compared both diseases as regards their CD4/CD8 phenotype and expression of granzyme B and tumor necrosis factor-alpha (TNF-α) and how these are af...

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Bibliographic Details
Published in:	The American journal of dermatopathology Vol. 40; no. 10; pp. 727 - 735
Main Authors:	Youssef, Randa, Mahgoub, Doaa, Zeid, Ola A, Abdel-Halim, Dalia M, El-Hawary, Marwa, Hussein, Marwa F, Morcos, Mary A, Aboelfadl, Dalia M, Abdelkader, Heba A, Abdel-Galeil, Yosra, Abdel-Halim, Mona R E
Format:	Journal Article
Language:	English
Published:	United States 01-10-2018
Subjects:	Adolescent Adult Biopsy CD4-Positive T-Lymphocytes - chemistry CD4-Positive T-Lymphocytes - pathology CD4-Positive T-Lymphocytes - radiation effects CD8-Positive T-Lymphocytes - chemistry CD8-Positive T-Lymphocytes - pathology CD8-Positive T-Lymphocytes - radiation effects Child Cross-Sectional Studies Female Granzymes - analysis Humans Hypopigmentation - metabolism Hypopigmentation - pathology Hypopigmentation - radiotherapy Immunohistochemistry Immunoproliferative Disorders - metabolism Immunoproliferative Disorders - pathology Immunoproliferative Disorders - radiotherapy Male Middle Aged Mycosis Fungoides - chemistry Mycosis Fungoides - pathology Mycosis Fungoides - radiotherapy Phenotype Skin - chemistry Skin - pathology Skin - radiation effects Skin Neoplasms - chemistry Skin Neoplasms - pathology Skin Neoplasms - radiotherapy Skin Pigmentation - radiation effects Treatment Outcome Tumor Necrosis Factor-alpha - analysis Ultraviolet Therapy Young Adult
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Summary:	Hypopigmented interface T-cell dyscrasia (HITCD) is a distinct form of lymphoid dyscrasia that may progress to hypopigmented mycosis fungoides (HMF). We compared both diseases as regards their CD4/CD8 phenotype and expression of granzyme B and tumor necrosis factor-alpha (TNF-α) and how these are affected by narrow-band UVB (nb-UVB). The study included 11 patients with HITCD and 9 patients with HMF. They received nb-UVB thrice weekly until complete repigmentation or a maximum of 48 sessions. Pretreatment and posttreatment biopsies were stained using anti CD4, CD8, TNF-α, and granzyme B monoclonal antibodies. Epidermal lymphocytes were CD8 predominant in 54.5% and 66.7% of HITCD and HMF cases, respectively, whereas dermal lymphocytes were CD4 predominant in 63.6% and 66.7%, respectively. Significantly, more dermal infiltrate was encountered in HMF (P = 0.041). In both diseases, granzyme B was only expressed in the dermis, whereas TNF-α was expressed both in the epidermis and dermis. No difference existed as regards the number of sessions needed to achieve repigmentation or cumulative nb-UVB dose reached at end of study. (P > 0.05). Narrow-band UVB significantly reduced only the epidermal lymphocytes in both diseases (P ≤ 0.05) with their complete disappearance in 8 (72.7%) HITCD and 6 (66.7%) HMF cases. In both diseases, nb-UVB did not affect granzyme B or TNF-α expression (P > 0.05). In conclusion, both diseases share the same phenotype, with HITCD being a milder form of T-cell dysfunction. In both diseases, epidermal lymphocytes are mainly CD8-exhausted cells lacking cytotoxicity, whereas dermal cells are mostly reactive cells exerting antitumor cytotoxicity. Tumor necrosis factor-alpha mediates hypopigmentation in both diseases and prevents disease progression. Repigmentation after nb-UVB in both diseases occurs before and independently from disappearance of the dermal infiltrate.
Bibliography:	ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 23
ISSN:	0193-1091 1533-0311
DOI:	10.1097/DAD.0000000000001187