Lymph node biopsy in mycosis fungoides

Ninety lymph node biopsy specimens from 76 patients with mycosis fungoides (MF) were reviewed. Dermatopathic lymphadenopathy was the most common change found in biopsies of palpable lymph nodes obtained from patients with MF. The paracortical expansion and histiocytes with elongated, folded, and delicate nuclei were characteristic. Lymph node involvement by MF lymphoma had a broad spectrum of histologic appearance. Most commonly, MF lymphoma was composed of atypical, often hyperconvoluted, lymphoid cells showing a wide variation in size. The pretreatment biopsies from 38 patients were graded according to the number of atypical small lymphocytes (AL) in the paracortical region and the results were correlated with survival. No significant differences in survival were found among the various grades, which ranged from dermatopathic lymphadenopathy without AL to frank involvement by MF lymphoma. Patients with more extensive skin disease tended to have a higher grade and to do poorly.