Follicular mucinosis in patients with hematologic malignancies other than mycosis fungoides: A clinicopathologic study

Publication date: Available online 1 February 2019

Source: Journal of the American Academy of Dermatology

Author(s): Shamir Geller, Christian J. Gomez, Patricia L. Myskowski, Melissa Pulitzer

Abstract

Background

Follicular mucinosis (FM), defined by mucin accumulation within follicular epithelium, may occur in mycosis fungoides (MF). FM without MF is occasionally reported in systemic hematologic malignancies, and may be diagnostically challenging.

Objective

To describe clinicopathological characteristics of FM in patients with hematologic malignancies other than MF.

Methods

Clinical data and histopathology were analyzed in patients with FM and hematologic malignancies diagnosed between 1994 and 2017.

Results

Eighteen patients with FM and systemic hematologic malignancies without cutaneous T-cell lymphoma (CTCL) were identified, nine of them were post hematopoietic stem cell transplantation (HSCT). No non-CTCL associated FM cases (n=46, 37 biopsies) developed CTCL during mean follow-up of 4.3 years. Of CTCL associated with FM (n=44, 31 biopsies) MF was the most common subtype (n=38), although other CTCLs were identified. FM in patients with non-CTCL hematologic malignancies differed clinically from MF-associated FM, presenting most frequently with erythematous papules (P < .0001), without plaques (P <.0001), without alopecia (P = .001), and without histopathologically identified epidermal exocytosis (P = .013).

Limitations

A retrospective study in a single cancer center.

Conclusions

FM can present in systemic hematologic malignancies, including post-HSCT. Papular lesional morphology and histopathology may help to distinguish these cases from MF.

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