Mycosis fungoides: Pathologic findings in staging laparotomies

Staging laparotomies were performed in 13 patients with mycosis fungoides for the purpose of determining the presence of visceral and deep lymph node involvement. T h e spleen was found to be involved in 4 of these patients, the abdominal lymph nodes in 3, and the liver in 1. Unlike the spleens in Hodgkin's disease, only one of the involved spleens showed grossly perceptible tumor nodules. I n the remaining three, the infiltration was diffuse and affected primarily the red pulp. T h e range of weights of the four involved spleens was between 250 and 480 g, and those of the uninvolved spleens, between 65 and 155 g. In the lymph nodes, complete obliteration of the architecture was observed in one instance and focal involvement in two. T h e diagnosis of the involvement of spleen and lymph nodes depends on the recognition of abnormal cells, the sizes of which range between those of histiocytes and lymphocytes. Some of them have deeply indented nuclei. When these cells occur in clusters or continuous sheets, they are relatively easily recognized as neoplastic infiltration by mycosis fungoides. I t is extremely difficult, however, to detect individual cells when the infiltration does not occur in the form of cohesive cell masses; negative histologic interpretation is therefore unreliable. Ultrastructural studies assist in the recognition of the characteristic cells and their Occurrence in clusters.