Assessment of The Diagnostic Value of TOX Versus CD3 Immunohistochemical Markers in Detection of Early Mycosis Fungoides Cases

Background: Primary cutaneous lymphoma (PCL) with clonal proliferation of atypical CD4+ skin-homing T lymphocyte cells is called Mycosis Fungoides (MF). TOX staining is observed in subtypes of PCL, as MF & Sézary Syndrome (SS) in comparison to controls. Early MF is difficult to diagnose, & its distinction from inflammatory diseases may be impossible.Objective: This study aimed to evaluate the expression of the TOX versus CD3 as a diagnostic marker for early MF.Patients and methods: retrospective-cross sectional study includes 30 MF and 30 benign cutaneous inflammatory diseases (BCID) cases. All were evaluated using H & E and immunohistochemical staining for TOX & CD3. Results: There was statistically significant increase of TOX & CD3 expression in MF than BCID & ability of TOX to detect all true positive cases (100.0%) compared to (76.7%) for CD3, (P < 0.001).Conclusion: TOX had the highest sensitivity (100.0%) & accuracy (88.3%). TOX is useful marker in the diagnosis of early MF & differentiating it from BCID

Mycosis Fungoides Diagnosis Using TOX Versus Old Panel Immunohistochemical Markers

Background: For primary cutaneous lymphoma, mycosis fungoides (MF) is the most prevalent form with skin-homing T cells plus clonal proliferation of CD4. In many CTCLs, thymocyte selection associated with the HMG-box (TOX) is an uncontrolled gene, together with MF in comparison with controls. Early mycosis fungoides is difficult to diagnose, and, its distinction from inflammatory diseases is sometimes impossible. Objective: In this study, we compared the TOX vs C7 and CD4 expression as an early mycosis fungoides diagnostic markers & to assess their ability to differentiate Mycosis fungoides from benign cutaneous inflammatory diseases (BCID). Materials and methods: 60 patients who had been previously diagnosed as MF (30 cases) and BCID (30 cases). All were evaluated histopathologically using H & E and immunohistochemically staining for TOX, CD7 & CD 4. Results: There was statistically significant difference between MF and BCID with increased TOX, CD7 & CD4 expression among MF than among BCID and ability of TOX to detect all true positive cases (100.0%) compared to 83.3% for CD4 and 13.3% for CD7. TOX had the highest sensitivity (100.0%) and accuracy (88.3%) followed by CD4 with sensitivity of 88.3% and accuracy of 66.7%, (P < 0.001). Conclusion: TOX had the highest sensitivity (100.0%) & accuracy (88.3%) followed by CD4 with sensitivity of 88.3% and accuracy of 66.7%. Our results suggest that TOX is a useful marker in diagnosis of MF & differentiating it from BCID

Magnetic Resonance Imaging Features of Rhino-Orbito-Cerebral Mucormycosis in Post-COVID-19 Patients: Radio-Pathological Correlation

There has been a notable increase in rhino-orbito-cerebral mucormycosis (ROCM) post-coronavirus disease 2019 (COVID-19), which is an invasive fungal infection with a fatal outcome. Magnetic resonance imaging (MRI) is a valuable tool for early diagnosis of ROCM and assists in the proper management of these cases. This study aimed to describe the characteristic MRI findings of ROCM in post-COVID-19 patients to help in the early diagnosis and management of these patients. This retrospective descriptive study was conducted at a single hospital and included 52 patients with COVID-19 and a histopathologically proven ROCM infection who were referred for an MRI of the paranasal sinuses (PNS) due to sino-orbital manifestations. Two radiologists reviewed all the MR images in consensus. The diagnosis was confirmed by histopathological examination. The maxillary sinus was the most commonly affected PNS (96.2%). In most patients (57.7%), multiple sinuses were involved with the black turbinate sign on postcontrast images. Extrasinus was evident in 43 patients with orbital involvement. The pterygopalatine fossa was involved in four patients. Three patients had cavernous sinus extension, two had pachymeningeal enhancement, and one had epidural collection. The alveolar margin was affected in two patients, and five patients had an extension to the cheek. The awareness of radiologists by the characteristic MRI features of ROCM in post-COVID-19 patients helps in early detection, early proper management, and prevention of morbid complications