A Retrospective Study of the Probability of the Evolution of Parapsoriasis en Plaques into Mycosis Fungoides
doi: 10.1080/00015550510030087
Abstract:
Parapsoriasis en plaque has been suggested to be an early manifestation of mycosis fungoides (cutaneous T-cell lymphoma). We explored the disease course of patients with small plaque or large plaque parapsoriasis in a 26-year retrospective cohort analysis of 105 parapsoriasis patients, who were clinically and histopathologically followed up in Helsinki and Tampere University Hospitals. Eventual later cancers of these patients were verified from the Finnish Cancer Registry. In the small plaque parapsoriasis group, 7 patients (10%) and in the large plaque parapsoriasis group 12 patients (35%), developed histologically confirmed mycosis fungoides during a median of 10 and 6 years, respectively. No significant differences were found regarding the risk of developing mycosis fungoides or the tendency to remission in patients treated with or without phototherapy. Our results show that not only large plaque parapsoriasis, but also small plaque parapsoriasis, as currently defined in textbooks, can progress to mycosis fungoides. The benefits of phototherapy are equivocal in parapsoriasis treatment as far as progression to cancer is concerned.
Key words:
cytokines, parapsoriasis, phototherapy, cutaneous T-cell lymphoma, PUVA
References:
- Willemze, R. and Kerl, H. and Sterry, W. and Berti, E. and Cerroni, L. and Chimanti, S. (1999) EORTC classification for primary cutaneous lymphomas. A Proposal from the Cutaneous Lymphoma Study Group of the European Organization for Research and Treatment of Cancer. Blood, 90, pp. 354 - 371.
- Lambert, W. C. (1985) Premycotic eruptions. Dermatol Clin, 3, pp. 629 - 645.
- Burg, G. (2000) From inflammation to neoplasia. Arch Dermatol, 137, pp. 949 - 951.
- Qin, J. Z. and Zhang, C. L. and Kamarashev, J. and Dummer, R. and Burg, G. and Dobbeling, U. (2001) Interleukin-7 and interleukin-15 regulate the expression of the bcl-2 and c-myb genes in cutaneous T-cell lymphoma cells. Blood, 98, pp. 2778 - 2783.
- Trainor, K. J. and Brisco, M. J. and Wan, J. H. and Neoh, S. and Grist, S. and Morley, A. A. (1991) Gene rearrangements in B- and T- lymphoproliferative disease detected by the polymerase chain reaction. Blood, 78, pp. 192 - 196.
- Bottaro, M. and Berti, E. and Biondi, A. and Migone, N. and Crosti, L. (1994) Heteroduplex analysis of T-cell receptor gamma gene rearrangements for the diagnosis and monitoring of cutaneous T-cell lymphomas. Blood, 83, pp. 3271 - 3278.
- Kikuchi, A. and Naka, W. and Harada, T. (1993) Parapsoriasis en plaque. J Am Acad Dermatol, 29, pp. 419 - 422.
- Braun-Falco, O. and Plewig, G. and Wolff, H. H. and Burgdorf, W. H. C.(Springer 2000) Dermatology, 2nd edn.. In .
- Kim, Y. H. and Hoppe, R. T. (1999) Mycosis fungoides and Sezary syndrome. Semin Oncol, 26, pp. 276 - 289.
- Stachowitz, S. and Mempel, M. and Schmöckel, C. and von Spanyi, R. and Abeck, D. (2000) Variable course of patients with plaque psoriasis: lack of transformation into tumorous mycosis fungoides. Blood, 95, pp. 3635 - 3636.
- Duvic, M. and Cather, J. C. (2000) Emerging new therapies for cutaneous T-cell lymphoma. Dermatol Clin, 18, pp. 147 - 156.
- Muche, J. M. and Gellrich, S. and Sterry, W. (2002) Treatment of cutaneous T-cell lymphoms. Semin Cutan Med Surg, 19, pp. 142 - 148.
- Wood, G. S. and Hu, C. H.(1999) Parapsoriasis.. In Dermatology in general medicine. . New York : McGraw-Hill.
- Weedon, D.(2002) Skin pathology, 2nd edn.. In . Churchill Livingstone.
- Koh, H. K. and Charif, M. and Weinstock, M. A. (1995) Epidemiology and clinical manifestations of cutaneous T-cell lymphoma. Hematol Oncol Clin North Am, 9, pp. 943.
- Siegel, R. S. and Pandolfino, T. and Guitart, J. and Rosen, S. and Kuzel, T. M. (2002) Primary cutaneous T-cell lymphoma: review and current concepts. J Clin Oncol, 18, pp. 2908 - 2925.
- Väkevä, L. and Pukkala, E. and Ranki, A. (2000) Increased risk of secondary cancer in patients with primary cutaneous T-cell lymphoma. J Invest Dermatol, 15, pp. 62 - 65.
- Cerroni, L. and Fink-Puches, R. and Bäck, B. and Kerl, H. (2002) Follicular mucinosis – a critical reappraisal of clinicopathologic features and association with mycosis fungoides and Sezary syndrome. Arch Dermatol, 138, pp. 182 - 189.
- Muche, M. and Lukowsky, A. and Asadullah, K. and Gellrich, S. and Sterry, W. (1997) Demonstration of frequent occurrence of clonal T cells in the peripheral blood of patients with primary cutaneous T-cell lymphoma. Blood, 90, pp. 1636 - 1642.
- Fraser-Andrews, E. A. and Woolford, A. J. and Russell-Jones, R. and See, P. T. and Whittaker, S. J. (2000) Detection of a peripheral blood T-cell clone is an independent prognostic parameter in mycosis fungoides. J Invest Dermatol, 114, pp. 117 - 121.
- Muche, M. and Lukowsky, A. and Heim, J. and Friedrich, M. and Audring, H. and Sterry, W. (1999) Demonstration of frequent occurrence of clonal T cells in the peripheral blood but not in the skin of patients with small plaque parapsoriasis. Blood, 94, pp. 1409 - 1417.
- Muche, M. and Karenko, L. and Gellrich, S. and Karhu, R. and Kytölä, S. and Kähkönen, M. and (2004) Cellular coincidence of clonal T-cell receptor rearrangements and complex clonal chromosomal aberrations – a hallmark of malignancy in cutaneous T-cell lymphoma. J Invest Dermatol, 122, pp. 574 - 578.
- Simon, M. and Flaig, M. J. and Kind, P. and Sander, C. and Kaudewitz, P. (2000) Large plaque parapsoriasis: clinical and genotypic correlations. J Cutan Pathol, 27, pp. 57.
- Klemke, C. D. and Dippel, E. and Dembinski, A. and Ponitz, N. and Assaf, C. and Hummel, M. and (2002) Clonal T cell receptor gamma-chain gene rearrangement by PCR-based GeneScan analysis in the skin and blood of patients with parapsoriasis and early-stage mycosis fungoides. J Cutan Pathol, 197, pp. 348 - 354.
- Karenko, L. and Sarna, S. and Kähkönen, M. and Ranki, A. (2003) Molecular cytogenetic methods in the follow-up of patients with cutaneous T-cell lymphoma. Br J Dermatol, 148, pp. 55 - 63.