Localized pagetoid reticulosis Woringer Kolopp typeunilesional solitary mycosis fungoides

Localized pagetoid reticulosis is a variant of mycosis fungoides presenting with solitary psoriasiform scaly erythematous patches or plaques, usually located on the extremities (Fig. 2.50). The clinical picture can be deceptive, simulating that of benign conditions such as warts or eczematous dermatitis (Fig. 2.51) [80]. The histological picture shows a markedly hyperplastic epidermis with striking epidermotro-pism of T lymphocytes (Figs 2.52 & 2.53). Intraepidermal lymphocytes are characterized usually by medium-sized pleomorphic nuclei. Both T-helper and T-cytotoxic pheno-types have been described.

The term pagetoid reticulosis should be restricted to solitary lesions only (Woringer-Kolopp type) [1,2]. Patients presenting with the 'generalized' form of pagetoid reticulosis

(Ketron-Goodman type) probably have either classic mycosis fungoides or, more frequently, one of the recently described primary cutaneous cytotoxic NK/T-cell lymphomas (aggressive epidermotropic CD8+ T-cell lymphoma, y/8 cutaneous T-cell lymphoma, NK/T-cell lymphoma—nasal type) (see Chapter 6).

The prognosis of patients with solitary pagetoid reticulosis is excellent, and involvement of internal organs has never been observed. In a few patients, development of 'classic' mycosis fungoides has been documented. The treatment of choice is surgical excision or local radiotherapy.

Besides localized pagetoid reticulosis, a solitary variant of mycosis fungoides with clinicopathological features similar to 'common' mycosis fungoides has been described (Fig. 2.54) [81-83]. It is as yet unclear whether the prognosis for these patients is better, but in some instances development of generalized lesions of mycosis fungoides has been observed over time.

Fig. 2.54 Solitary lesion of mycosis fungoides located on the breast.

Fig. 2.55 Poikilodermatous mycosis fungoides characterized by the presence of a reticulated atrophic plaque on the thigh.

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