DOI: https://doi.org/10.22263/2312-4156.2020.2.51
Katina M.A., Lesnichaya O.V.
Large plaque parapsoriasis: clinicohistological parallels
Vitebsk State Order of Peoples’ Friendship Medical University, Vitebsk, Republic of Belarus
Vestnik VGMU. 2020;19(2):51-62.
Abstract.
Large plaque parapsorisis (LPP) is of great importance in the practice of dermatologists due to the difficulties of managing such patients. Problems are caused by nonspecific clinical, histological and immunohistochemical data in LPP and early patch stage of mycosis fungoides (MF).
Objectives. To assess the clinical and histological features of LPP and MF cases: to identify clinical and pathomorphological signs that require more intensive monitoring of patients with the diagnosis of LPP for early detection of MF, to develop an algorithm for examining patients with LPP for the improvement of the effectiveness of early-stage diagnosis of MF.
Material and methods. 15 inpatients with large plaque parapsoriasis and retrospectively 3 patients with advanced stages of MF, initially diagnosed as LPP were studied.
Results. Alarming clinical signs in relation to MF were detected in 14 (94%) patients, of which the most frequent were the following: localization of rashes in non-sunexposed areas (80%), different shape and size of rashes (73%), the appearance of new patches during the last 3-6 months (94%), the appearance of patches again after the discontinuation of topical steroid creams (74%), chaotic location of the rash (67%). There were no specific pathohistological findings of MF among the examined patients. However, the following signs identified in 5 (33%) patients can serve as alarming ones in relation to MF: focal (cell cluster arrangement) exocytosis of lymphocytes like microabscesses Pautrie with weakly expressed spongiosis, infiltration around the sebaceous glands, the presence of eosinophils and plasma cells, vacuole interface dermatitis, papillary dermis fibrosis. In this group of patients, the dynamic follow-up by a dermatologist is required with compulsory repeated biopsies after 6 months.
Conclusions. Based on the obtained data, including a retrospective analysis of clinical cases with late stages of MF, we propose an algorithm for the management of patients with large plaque parapsoriasis by dermatologists and dermatopathologists.
Key words: large plaque parapsoriasis, mycosis fungoides, pathohistology, clinical signs, immunohistochemistry, retrospective analysis.
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Information about authors:
Katina M.A. – Candidate of Medical Sciences, associate professor of the Chair of Dermatovenerology, Vitebsk State Order of Peoples’ Friendship Medical University;
Lesnichaya O.V. – Candidate of Medical Sciences, associate professor of the Chair of Pathologic Anatomy with the course of Forensic Medicine, Vitebsk State Order of Peoples’ Friendship Medical University.
Correspondence address: Republic of Belarus, 210009, Vitebsk, 27 Frunze ave., Vitebsk State Order of Peoples’ Friendship Medical University, Chair of Dermatovenerology. E-mail: Этот адрес электронной почты защищён от спам-ботов. У вас должен быть включен JavaScript для просмотра. – Mariya A. Katina.
