Mycosis fungoides diagnostic study of choice: Difference between revisions

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__NOTOC__
__NOTOC__
{{Mycosis fungoides}}
{{Mycosis fungoides}}
{{CMG}}; {{AE}}
{{CMG}}; {{AE}} {{S.G.}}
== Overview ==
== Overview ==
Mycosis fungoides is primarily [[Diagnosis|diagnosed]] based on the [[clinical]] presentation.


== Diagnostic Study of Choice ==
== Diagnostic Study of Choice ==


=== Study of choice ===
*Mycosi fungoides must be performed when:<ref name="pmid20568590">{{cite journal |vauthors=Galper SL, Smith BD, Wilson LD |title=Diagnosis and management of mycosis fungoides |journal=Oncology (Williston Park, N.Y.) |volume=24 |issue=6 |pages=491–501 |date=May 2010 |pmid=20568590 |doi= |url=}}</ref>
[Name of the investigation] is the gold standard test for the diagnosis of [disease name].
**Mycosis fungoides is primarily diagnosed based on the [[clinical]] presentation.
**The [[patient]] presents with [[symptomatic]] progressive [[skin]] [[Lesion|lesions]] such as: [[Patched|patches]], [[Plaque|plaques]], [[Tumor|tumors]], and [[erythroderma]], and a poorer [[prognosis]] in later stages.
**There is no single [[Diagnosis|diagnostic]] study of choice for the [[diagnosis]] of mycosis fungoides, and mycosis fungoides can be [[Diagnosis|diagnosed]] difficult by nonspecific [[skin]] presentation.
**[[Disease]] present with [[skin]] [[Lesion|lesions]] not treated by useual [[medication]].


OR
*[[Diagnosis]] [[Criterion|criteria]] from the International Society for [[Cutaneous]] [[Lymphoma]] is:<ref name="FossGirardi2017" /><ref name="PimpinelliOlsen2005">{{cite journal|last1=Pimpinelli|first1=Nicola|last2=Olsen|first2=Elise A.|last3=Santucci|first3=Marco|last4=Vonderheid|first4=Eric|last5=Haeffner|first5=Andreas C.|last6=Stevens|first6=Seth|last7=Burg|first7=Guenter|last8=Cerroni|first8=Lorenzo|last9=Dreno|first9=Brigitte|last10=Glusac|first10=Earl|last11=Guitart|first11=Joan|last12=Heald|first12=Peter W.|last13=Kempf|first13=Werner|last14=Knobler|first14=Robert|last15=Lessin|first15=Stuart|last16=Sander|first16=Christian|last17=Smoller|first17=Bruce S.|last18=Telang|first18=Gladys|last19=Whittaker|first19=Sean|last20=Iwatsuki|first20=Keiji|last21=Obitz|first21=Erik|last22=Takigawa|first22=Masahiro|last23=Turner|first23=Maria L.|last24=Wood|first24=Gary S.|title=Defining early mycosis fungoides|journal=Journal of the American Academy of Dermatology|volume=53|issue=6|year=2005|pages=1053–1063|issn=01909622|doi=10.1016/j.jaad.2005.08.057}}</ref>


The following result of [gold standard test] is confirmatory of [disease name]:
{| class="wikitable"
* [Result 1]
|+
* [Result 2]
! style="background: #4479BA; color:#FFF;" |Criteria
 
! style="background: #4479BA; color:#FFF;" |Major( 2pinots)
OR
! style="background: #4479BA; color:#FFF;" |Minor(1point)
 
|-
[Name of the investigation] must be performed when:
|'''Persistent and/or progressive patches and plaques plus'''
* The patient presents with [symptom/sign 1], [symptom/sign 2], and [symptom/sign 3].
|Any 2
* A [name of test] is positive for [sign 1], [sign 2], and [sign 3] in the patient.
|Any 1
 
|-
OR
| colspan="3" style="background: #B0C4DE; color:#FFF;" ! |Clinical
 
|-
[Name of the investigation] is the gold standard test for the diagnosis of [disease name].
|1. Non–sun-exposed location
 
|
OR
|
 
|-
The diagnostic study of choice for [disease name] is [name of the investigation].
|2.Size/shape variation
 
|
OR
|
 
|-
There is no single diagnostic study of choice for the diagnosis of [disease name].  
|3.Poikiloderma
 
|
OR
|
 
|-
There is no single diagnostic study of choice for the diagnosis of [disease name], but [disease name] can be diagnosed based on [name of the investigation 1] and [name of the investigation 2].
| colspan="3" style="background: #B0C4DE; color:#FFF;" ! |'''Histopathologic'''
 
|-
OR
|Superficial lymphoid infiltrate plus
 
|Both
[Disease name] is primarily diagnosed based on the clinical presentation.
|Either
 
|-
OR
|1. Epidermotropism
 
|
Investigations:
|
* Among the patients who present with clinical signs of [disease name], the [investigation name] is the most specific test for the diagnosis.
|-
* Among the patients who present with clinical signs of [disease name], the [investigation name] is the most sensitive test for diagnosis.
|2. [[Atypia]]
* Among the patients who present with clinical signs of [disease name], the [investigation name] is the most efficient test for diagnosis.
|
 
|
==== The comparison of various diagnostic studies for [disease name] ====
|-
{|
| colspan="3" style="background: #B0C4DE; color:#FFF;" ! |'''Molecular/biological'''
|- style="background: #4479BA; color: #FFFFFF; text-align: center;"
|-
! style="background: #4479BA; color: #FFFFFF; text-align: center;" | Test
|Clonal [[TCR]] [[gene]] [[rearrangement]]
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Sensitivity
|
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Specificity
|Present
|-
| colspan="3" style="background: #B0C4DE; color:#FFF;" ! |'''Immunopathologic'''
|-
|1. [[CD2]], [[CD3]], [[CD5]] in <59% of [[T cell|T cells]]
|
|Any 1
|-
|-
! style="background: #696969; color: #FFFFFF; text-align: center;" |Test 1
|2. [[CD7]] in <10% of [[T cell|T cells]]
| style="background: #DCDCDC; padding: 5px; text-align: center;" |...%
|
| style="background: #DCDCDC; padding: 5px; text-align: center;" |...%
|
|-
|-
! style="background: #696969; color: #FFFFFF; text-align: center;" |Test 2
| colspan="3" |3. [[Epidermis (skin)|Epidermal]] discordance from [[expression]] of [[CD2]], [[CD3 (immunology)|CD3]], [[CD5]], and [[CD7]] on [[dermal]] [[T cell|T cells]]
| style="background: #DCDCDC; padding: 5px; text-align: center;" |...%
| style="background: #DCDCDC; padding: 5px; text-align: center;" |...%
|}
|}
<small> [Name of test with higher sensitivity and specificity] is the preferred investigation based on the sensitivity and specificity</small>
===== Diagnostic results =====
The following finding(s) on performing [investigation name] is(are) confirmatory for [disease name]:
* [Finding 1]
* [Finding 2]
===== Sequence of Diagnostic Studies =====
The [name of investigation] must be performed when:
* The patient presented with symptoms/signs 1, 2, and 3 as the first step of diagnosis.
* A positive [test] is detected in the patient, to confirm the diagnosis.
OR
The various investigations must be performed in the following order:
* [Initial investigation]
* [2nd investigation]
=== Name of Diagnostic Criteria ===
'''It is recommended that you include the criteria in a table. Make sure you always cite the source of the content and whether the table has been adapted from another source.'''
[Disease name] is primarily diagnosed based on clinical presentation. There are no established criteria for the diagnosis of [disease name].
OR
There is no single diagnostic study of choice for [disease name], though [disease name] may be diagnosed based on [name of criteria] established by [...].
OR
The diagnosis of [disease name] is made when at least [number] of the following [number] diagnostic criteria are met: [criterion 1], [criterion 2], [criterion 3], and [criterion 4].
OR
The diagnosis of [disease name] is based on the [criteria name] criteria, which includes [criterion 1], [criterion 2], and [criterion 3].
OR
[Disease name] may be diagnosed at any time if one or more of the following criteria are met:
* Criteria 1
* Criteria 2
* Criteria 3
OR
'''IF there are clear, established diagnostic criteria'''
The diagnosis of [disease name] is made when at least [number] of the following [number] diagnostic criteria are met: [criterion 1], [criterion 2], [criterion 3], and [criterion 4].
OR
The diagnosis of [disease name] is based on the [criteria name] criteria, which include [criterion 1], [criterion 2], and [criterion 3].
OR
The diagnosis of [disease name] is based on the [definition name] definition, which includes [criterion 1], [criterion 2], and [criterion 3].
OR
'''IF there are no established diagnostic criteria'''
There are no established criteria for the diagnosis of [disease name].


==References==
==References==
{{Reflist|2}}
{{Reflist|2}}
{{WH}}
{{WS}}

Latest revision as of 16:41, 12 February 2019

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Sogand Goudarzi, MD [2]

Overview

Mycosis fungoides is primarily diagnosed based on the clinical presentation.

Diagnostic Study of Choice

Criteria Major( 2pinots) Minor(1point)
Persistent and/or progressive patches and plaques plus Any 2 Any 1
Clinical
1. Non–sun-exposed location
2.Size/shape variation
3.Poikiloderma
Histopathologic
Superficial lymphoid infiltrate plus Both Either
1. Epidermotropism
2. Atypia
Molecular/biological
Clonal TCR gene rearrangement Present
Immunopathologic
1. CD2, CD3, CD5 in <59% of T cells Any 1
2. CD7 in <10% of T cells
3. Epidermal discordance from expression of CD2, CD3, CD5, and CD7 on dermal T cells

References

  1. ↑ Galper SL, Smith BD, Wilson LD (May 2010). "Diagnosis and management of mycosis fungoides". Oncology (Williston Park, N.Y.). 24 (6): 491–501. PMID 20568590.
  2. ↑
  3. ↑ Pimpinelli, Nicola; Olsen, Elise A.; Santucci, Marco; Vonderheid, Eric; Haeffner, Andreas C.; Stevens, Seth; Burg, Guenter; Cerroni, Lorenzo; Dreno, Brigitte; Glusac, Earl; Guitart, Joan; Heald, Peter W.; Kempf, Werner; Knobler, Robert; Lessin, Stuart; Sander, Christian; Smoller, Bruce S.; Telang, Gladys; Whittaker, Sean; Iwatsuki, Keiji; Obitz, Erik; Takigawa, Masahiro; Turner, Maria L.; Wood, Gary S. (2005). "Defining early mycosis fungoides". Journal of the American Academy of Dermatology. 53 (6): 1053–1063. doi:10.1016/j.jaad.2005.08.057. ISSN 0190-9622.
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