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12

NCCN Guidelines for Patients

®

Mycosis Fungoides, Version 1.2016

1

Mycosis fungoides basics

Do I have mycosis fungoides?

Protein tests

At times, it may be useful to study the proteins

in the cells’ surface (membrane). This is called

immunophenotyping. It can support or confirm the

diagnosis that was made based on cell structure. An

IHC (

i

mmuno

h

isto

c

hemistry) panel is a test for surface

proteins. It involves applying a chemical marker to

cells then looking at them with a microscope.

The IHC panel often tests for ßF1, CD2, CD3,

CD4, CD5, CD7, CD8, CD20, CD25, CD30, CD56,

granzyme B, TIA1, and TCR-CγM1. Mycosis

fungoides cells typically have ßF1, CD2, CD3, CD4,

and CD5 but not CD7, granzyme B, and TIA1. Cells

rarely have CD8. CD30 is found on at least a few

cells in most cases of mycosis fungoides. However,

up to half of people with large-cell transformed

mycosis fungoides have many cells with CD30.

Blood tests

If results from the skin biopsy aren’t clear, your blood

may be tested for Sézary cells. Your blood may also

be tested if your doctor suspects Sézary syndrome.

Sézary cells have one, round nucleus that is shaped

like the outer surface of the brain. Healthy people

may have a very small number of cells that look like

Sézary cells. People with mycosis fungoides may

have more. In Sézary syndrome, there is a very high

number of Sézary cells in blood.

Sézary cells have a common pattern of surface

proteins. Testing for this pattern is needed for

diagnosis since some cells look like Sézary cells.

Flow cytometry is a newer method of assessing

for surface proteins and should be used to test

for Sézary cells. The method first involves adding

a marker—a light-sensitive dye—to cells. Then,

your blood will be passed through a flow cytometry

machine. The machine measures surface proteins

on thousands of cells. To test for Sézary cells, flow

cytometry often includes CD3, CD4, CD7, CD8, and

CD26 proteins.

Gene tests

A gene rearrangement is the fusion of one gene with

another gene to create a new gene. Often, mycosis

fungoides has rearrangements in the TCR (

T

-

c

ell

r

eceptor) genes. PCR (

p

olymerase

c

hain

r

eaction) is

a test that can assess for TCR rearrangements. PCR

may be done on your skin cells, blood cells, or both.

This test may be helpful when cell structure and IHC

results do not clearly confirm mycosis fungoides.

HTLV tests

HTLV (

h

uman

T

-cell

l

ymphotropic

v

irus) is important

for diagnosing a subtype of T-cell lymphoma. If you

have HTLV, the cancer may be adult T-cell leukemia

or lymphoma rather than mycosis fungoides. You

will need to be tested if your doctor thinks HTLV is

important for understanding your diagnosis.

Testing of HTLV is done on a blood sample. Serology

is a test that looks for antibodies that target HTLV. If

the results from serology are unclear, PCR can be

done. PCR is a process in which copies of a part of

DNA are made, which helps doctors find viruses.