الفهرس 
Aim of the WorkOnly 14 pages are availabe for public view
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Abstract
Mycosis fungoides (MF) is the most common type of primary cutaneous lymphoma (PCL), a malignant disease initially affecting the skin. MF is characterized by a clonal expansion of atypical CD4+ skin-homing T lymphocytes.
Mycosis fungoides has an indolent and prolonged clinical course over years progressing from patches to more infiltrated plaques and eventually to tumors and erythroderma. The survival rate for MF critically depends on the stages of the disease.
The diagnosis of MF is mainly based on an integrated algorithm of clinical and histological criteria. However, the diagnosis of early stage MF (eMF, patch and early plaque MF) is challenging even for experienced dermatologists, because of the morphologic and histological similarities of MF to benign inflammatory dermatosis (BID).
The current study aimed at evaluation of the role of TOX as a diagnostic marker in mycosis fungoides skin compared to other benign inflammatory dermatosis
The study was carried out on 20 patients presented with mycosis fungoides and 12 patients presented with inflammatory dermatosis. The inflammatory group was divided into; 3 cases of chronic non-specific dermatitis, 3 cases of spongiotic dermatitis, 3 cases of lichen planus and 3 cases of psoriasis. These cases were collected from Dermatology, Andrology and STDs Department, Faculty of Medicine, Menoufia University in the period between August 2017 and January 2019.
All participants were subjected to history taking, general and dermatological examination for determination of stage of disease in MF group.(Patch, plaque, tumor, erythrodermic)
- 0.3 mm punch biopsy was taken from the representative lesion. The biopsies were sent to Pathology Department, Faculty of Medicine, Menoufia University for routine tissue processing and paraffin blocks preparation.
1- H&E histopathological evaluation:
Haematoxylin and eosin stained sections were examined by light microscope to confirm diagnosis of selected cases and evaluate pathological changes.
- Patch stage MF, showed epidermotropism and upper dermal perivascular atypical lymphocytic infiltrate
- Plaque stage MF, showed psoraisiform epidermal hyperplasia with epidermotropism and upper dermal dense atypical lymphocytic infiltrate with intra epidermal collection of atypical lymphocytes (pautrier microabcessess)
- Tumor stage MF, showed diffuse and dense dermal infiltrate of atypical lymphocytes
2- Immunohistochemical staining with TOX.
• Positive TOX expression was detected as homogenous brown stain in the nucleus of lymphocytic infiltrate.
• Counting the number of cells with brown nuclear staining comparable to the total number of infiltrating lymphocytes was performed then the percentage was determined.
(-) (< 30%)
- + (30-50%)
- ++ (>50%)
• TOX was significantly higher in mycosis fungoides compared to inflammatory mimics.
• There was a significant difference between mycosis fungoides and inflammatory groups as regards TOX expression which was in favor of malignant group (P = 0.001)
• There was a significant relation between TOX expression and clinical phase of studied cases demonstrating that higher TOX expression in tumor phase cases.
• Comparing cases that showed +TOX expression versus those showed ++ revealed that advanced clinical phase and stage of MF were in favor of ++ TOX (>50%) compared to + (30-50%) (P = 0.013) (P =0.005).
• There was no significant association between TOX immunohistochemical expression in mycosis fungoides patients as regard age and sex