Cutaneous T-Cell Lymphoma Differential Diagnoses

  • Author: Robert A Schwartz, MD, MPH; Chief Editor: Dirk M Elston, MD   more...
 
Updated: Mar 22, 2012
 
 

Differential Diagnoses

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Contributor Information and Disclosures
Author

Robert A Schwartz, MD, MPH  Professor and Head, Dermatology, Professor of Pathology, Pediatrics, Medicine, and Preventive Medicine and Community Health, University of Medicine and Dentistry of New Jersey-New Jersey Medical School

Robert A Schwartz, MD, MPH is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, American College of Physicians, and Sigma Xi

Disclosure: Nothing to disclose.

Coauthor(s)

W Clark Lambert, MD, PhD  Professor and Head, Dermatopathology, Departments of Pathology and Dermatology, UMDNJ-New Jersey Medical School

W Clark Lambert, MD, PhD is a member of the following medical societies: American Academy of Dermatology, American College of Physicians, American Dermatological Association, American Society of Dermatopathology, International Academy of Pathology, Medical Society of New Jersey, Sigma Xi, and Society for Investigative Dermatology

Disclosure: Nothing to disclose.

Specialty Editor Board

Günter Burg, MD  Professor and Chairman Emeritus, Department of Dermatology, University of Zürich School of Medicine; Delegate of The Foundation for Modern Teaching and Learning in Medicine Faculty of Medicine, University of Zürich, Switzerland

Günter Burg, MD is a member of the following medical societies: American Academy of Dermatology, American Dermatological Association, International Society for Dermatologic Surgery, North American Clinical Dermatologic Society, and Pacific Dermatologic Association

Disclosure: Nothing to disclose.

David F Butler, MD  Professor of Dermatology, Texas A&M University College of Medicine; Chair, Department of Dermatology, Director, Dermatology Residency Training Program, Scott and White Clinic, Northside Clinic

David F Butler, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, American Medical Association, American Society for Dermatologic Surgery, American Society for MOHS Surgery, Association of Military Dermatologists, and Phi Beta Kappa

Disclosure: Nothing to disclose.

Jeffrey Meffert, MD  Assistant Clinical Professor of Dermatology, University of Texas School of Medicine at San Antonio

Jeffrey Meffert, MD is a member of the following medical societies: American Academy of Dermatology, American Medical Association, Association of Military Dermatologists, and Texas Dermatological Society

Disclosure: Nothing to disclose.

Catherine M Quirk, MD  Clinical Assistant Professor, Department of Dermatology, University of Pennsylvania

Catherine M Quirk, MD is a member of the following medical societies: Alpha Omega Alpha and American Academy of Dermatology

Disclosure: Nothing to disclose.

Chief Editor

Dirk M Elston, MD  Director, Ackerman Academy of Dermatopathology, New York

Dirk M Elston, MD is a member of the following medical societies: American Academy of Dermatology

Disclosure: Nothing to disclose.

References

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Tumor-stage cutaneous T-cell lymphoma.
Patch-stage cutaneous T-cell lymphoma. Courtesy of Jeffrey Meffert, MD.
Plaque-stage parapsoriasis.
Patch-stage mycosis fungoides progressing to plaque stage with cutaneous cigarette-paper appearance evident.
Erythematous partially confluent plaques in advancing mycosis fungoides.
Close-up view of advancing plaque-stage mycosis fungoides with partially confluent erythematous plaques.
Early patch-stage cutaneous T-cell lymphoma.
Hypopigmented cutaneous T-cell lymphoma. Courtesy of Jeffrey Meffert, MD.
Hypopigmented cutaneous T-cell lymphoma. Courtesy of Jeffrey Meffert, MD.
Nodular mycosis fungoides.
Middle-aged woman with mycosis fungoides showing ulceration and marked depigmentation of advanced disease.
Middle-aged woman with mycosis fungoides showing ulceration and marked depigmentation of advanced disease.
Middle-aged woman with mycosis fungoides showing ulceration and marked depigmentation of advanced disease.
Middle-aged woman with mycosis fungoides showing ulceration and marked depigmentation of advanced disease.
Mycosis fungoides with large atypical T lymphocytes in both epidermis and dermis.
Mycosis fungoides with epidermal nest of large atypical T cells displaying bizarre, convoluted nuclei surrounded by a clear space (Pautrier microabscess).
Table 1. Staging of CTCL
StageSkin LesionsLymphadenopathyErythrodermaHistological Lymphoma
Patches



< 10%



Plaques



³10%



TumorsLymph NodesViscera
IA+------
IB+ or -+-----
IIA+ or -+ or -+ or -+---
IIB+ or -+ or -++ or ----
III+ or -+ or -+ or -+ or -+--
IVA+ or -+ or -+ or -+ or -+ or -+-
IVB+ or -+ or -+ or -+ or -+ or -+ or -+
Table 2. TNMB Staging of CTCL
Stage ClassStageDefinition
T



(Tumor)



T1Patches/plaques involving < 10% of body surface
T2Patches/plaques involving ³10% of body surface
T3Tumor(s) present on skin
T4Erythroderma
N



(Nodes)



N0No enlarged lymph node present
N1Enlarged lymph nodes, histologically uninvolved
N2No enlarged lymph node; one or more nodes histologically involved*
N3Enlarged lymph nodes, histologically involved
M



(Metastasis to viscera)



M0No visceral lesion present
M1Visceral involvement
B



(Blood involvement)



B0Circulating atypical lymphocytes (Sézary cells) £5% of lymphocytes
B1Circulating atypical lymphocytes ³5% of lymphocytes (Sézary syndrome)
*Uncommon finding, usually not considered/investigated.
Table 3. Comparison of Staging Systems for CTCL
Clinical StageTNM (B) Stage
IAT1 N0 M0
IIBT2 N0 M0
IIAT1 N1 M0T2 N1 M0
IIBT3 N0 M0T3 N1 M0
IIIT4 N0 M0T4 N1 M0
IVAT1 N2 M0T2 N2 M0T3 N2 M0T4 N2 M0
T1 N3 M0T2 N3 M0T3 N3 M0T4 N3 M0
IVBT1 N0 M1T2 N0 M1T3 N0 M1T4 N0 M1
T1 N1 M1T2 N1 M1T3 N1 M1T4 N1 M1
T1 N2 M1T2 N2 M1T3 N2 M1T4 N2 M1
T1 N3 M1T2 N3 M1T3 N3 M1T4 N3 M1
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