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July 2001

From Inflammation to Neoplasia: Mycosis Fungoides Evolves From Reactive Inflammatory Conditions(Lymphoid Infiltrates) Transforming Into Neoplastic Plaques and Tumors

Arch Dermatol. 2001;137(7):949-952. doi:10-1001/pubs.Arch Dermatol.-ISSN-0003-987x-137-7-ded00018

THE ARTICLE by Rubegni et al1 describesthe cytokine production profile of peripheral blood mononuclear cells (PBMCs)in patients with large-plaque parapsoriasis. Interleukin 4 (IL-4) and interferongamma (IFN-γ) were measured in PBMCs following phytohemagglutinin antigen(PHA) stimulation in patients with large-plaque parapsoriasis (LPP), patientswith stage Ib (more than 10% of the body surface involved) mycosis fungoides(MF), and healthy controls. One difficulty with this approach is the biasin differentiating LPP and early patch-stage MF. As acknowledged by the authors,1 discrimination between the 2 diseases emerges as increasinglydifficult. It is not clear why 4 patients (40% in their series of patientswith LPP, Nos. 4, 5, 8, and 9) whose cells exhibited T-cell receptor gamma(TCR-γ) rearrangement were included in the LPP group instead of withthe early MF group. Furthermore, the question raised is how many of the patientsdiagnosed as having early MF had PBMCs that did not show TCR-γ rearrangement.A second controversial point concerns the controls, who should not be healthyvolunteers or patients with nonneoplastic Th2-type reactions like atopic eczema.The results indicate that the cytokine pattern of LPP measured in the differentcategories corresponds more closely to that of normal controls than to thatof subjects with MF.