Histological Parameters

Infiltration

The thickness of the clinically thickest lesion (measured from the granular layer to the lower limit of the infiltrate, as in malignant melanoma) (8) has been reported to be significantly correlated with prognosis in CTCL, which is not surprising since the histologically measurable infiltrate correlates with the clinical stage of the disease: patchy eczematous lesions histologically show a patchy infiltrate in the papillary dermis; in the plaque stage, there is a dense subepidermal infiltrate, filling the papillary dermis, whereas in the tumor stage there is a dense, diffuse infiltrate reaching into or filling the reticular dermis and even the subcutaneous fat. The presence of granulomatous features in CTCL does not have prognostic implications, as cases with aggressive, but also with a prolonged, course have been described (9,10).

Nuclear Atypia

The nuclear contour index (NCI) taken alone has very poor diagnostic value (11). The combination of the NCI and the nuclear surface area has a highly significant prognostic value. The best electron microscopic discrimination between benign and mycosis fungoides groups occurred when the proportion of cells with an NCI of 7 or more and the proportion of cells with a nuclear profile area greater than 30 mm2 were used together (12). In one study, nuclear volume (more or less than 104 nm3) appeared to be a good prognostic indicator in plaque and tumor stage of mycosis fungoides (13).

Transformation

Histological and cytological transformation is thought to be associated with worsening of the prognosis (14-16). Transformation may be found even before progression of the disease (17). The prognosis of lymphoma complicated by hemophagocytosis is reported to be very poor (18-20).

DNA Cytometry

The prognostic significance of DNA cytometry in cutaneous malignant lymphomas (21) is of limited value today, as better markers for cytological characterization are available.

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