A Case Series of Diagnostic Challenges in Mycosis Fungoides in Resource-poor Settings: Blood Film Examination – A Useful Tool

Abstract

The prognosis/mortality rate in mycosis fungoides (MF)/cutaneous T-cell lymphomas (CTCL) is alarming in resource-poor countries due to delayed diagnosis in meeting recognised criteria. We highlight the diagnostic accuracy of examining peripheral blood films (PBFs). We reviewed clinically diagnosed MF/CTCL cases in the Dermatology Clinic of Lagos University Teaching Hospital between January and October 2022 and analysed clinical, haematological and histology findings. Eight patients (male:female = 5:3) between 35 and 68 years had blood films with characteristic Sezary cells of <5%. Flow cytometry (FC) in 1 (12.5%) was inconclusive, and immunohistochemistry (IHC) on skin/lymph nodes in 5 (62.5%) was highly suggestive or confirmatory. Three patients had no biopsy. Patients had methotrexate, phototherapy (±psoralen) and systemic steroids with varying improvements. Since immunophenotyping (FC or IHC) is lacking in resource-poor countries or low- and middle-income countries, Sezary cells in PBF of clinically diagnosed patients with MF/CTCL should prompt treatment.

Keywords

• blood film
• cutaneous t-cell lymphoma
• mycosis fungoides
• resource-poor countries
• sezary cells