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JOURNAL OF MEDICAL AND SURGICAL RESEARCH - Special Issue "Pathology", March, 2023

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Granulomatous mycosis fungoides: report of three cases and review of the literature.

Author: L. Benbella, I. Elouarith, S. Sassi, O. Essadeq, Z. Loubaris, F. Zouaidia,  A. Jahid,  Z. Bernoussi, K. Znati

Category: JMSR Pathology


Introduction: Granulomatous mycosis fungoides (GMF) is a rare form of cutaneous T-cell lymphoma that is a major diagnostic challenge. The objective of this work is to relate the clinical and pathological aspects of this condition and to discuss its differential diagnoses. Case reports: The cases included 3 patients with GMF, admitted to the dermatology department of Ibn Sina Hospital in Rabat. The first one is a 35 year-old female patient, diabetic, admitted for the management of a slowly growing erythematosquamous plaque formed on the abdomen, which rapidly ulcerated. The second one is a 46 year-old female, with no medical history, presented with erythematous plaque of the neck, evolving for 3 weeks. The 3rd case corresponds to a 63-year-old male patient, treated since 2013 for Mycosis fungoides. Resultts: The histological study showed the same findings in the 3 patients, including the exocytosis of atypical lymphocytes in the epidermis and the presence of authentic epithelioid granulomas in the underlying dermis. The immunohistochemical study showed a negative staining of the anti-CD5 antibody (1st case), the anti-CD7 antibody (2nd case) and the anti-CD2 antibody (3rd case). The anti-CD30 antibody was negative in all 3 cases. Comment: Granulomatous MF, originally described in 1970, is a rare histological form, constituting 6.3% of MF described in the literature.The clinical findings are nonspecific and the diagnosis is purely anatomo-pathological. Histologically, the signs of classical MF are present, namely atypical lymphocytes in the dermis with epidermotropism. The granulomas are sarcoid-like, mixed with langhans giant cells. Conclusion: To conclude, MFG is a rare histological form of cutaneous T-cell lymphoma that can histologically mimic infectious or inflammatory dermatosis and cause a delay in diagnosis. Anatomo-clinical correlation, good morphological analysis and immunohistochemical study help guide the diagnosis.

Keywords: Mycosis fungoides, T-cell lymphoma, granulomas.

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