DENSITOMETRY OF PAUTRIER MICROABSCESS CELLS IN CUTANEOUS T-CELL LYMPHOMA

Background. Epidermotropic lymphoid T cell infiltrates are part of a c ontinuous spectrum of lesions ranging from ''benign'' parapsoriasis to frank cutaneous T cell lymphoma (CTCL, mycosis fungoides). Either the clinical or histologic differentiation between these entities prove o ften difficult and the prognosis may be difficult to assess. Patients and Methods. We studied 15 patients, men aged 50 to 81 years, mean +/- SD 68 +/- 12 years, with patch-plaque CTCL. Sections from punch biops ies from active lesions were stained with Feulgen reagent, coupled wit h a ''twin'' adjacent hematoxylin and eosin (H&E)-stained section and analyzed with a VIDAS Zeiss-Kontron Image Analyzer. At least 50 dermal infiltrating cells and 50 epidermotropic Pautrierian cells per specim en were counted and the biopsies were repeated periodically. Results. Nine patients with aneuploid Pautrierian cell DNA patterns did well af ter conventional phototherapy (dermal cell ploidy was irrelevant), whe reas six patients with euploid Pautrierian cell DNA patterns had to be treated aggressively (IFN + retinoids, cop). Clinical and histopathol ogic aspects of the first group were comparable to those of the second group. Conclusions. The classical cytophotometric aphorism seems to b e reversed in this sample: ''The more abnormal the ploidy of epidermot ropic Pautrierian cells, the better the prognosis.'' Euploid epidermot ropic cell prove more efficient in invading the skin and other areas a nd this efficiency may be reflected in more aggressive trends in the e volution of the lymphoma. Thus, DSM analysis of epidermotropic cells c ould prove very useful as an inexpensive tool for routine CTCL grading .