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تعداد آیتم قابل مشاهده باقیمانده : 3 مورد
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Recommended evaluation/initial staging of the patient with mycosis fungoides/Sézary syndrome

Recommended evaluation/initial staging of the patient with mycosis fungoides/Sézary syndrome
Evaluation and staging
Complete physical examination, including:
Determination of type(s) of skin lesions
Estimate percentage of BSA involved by patches, plaques, and tumor lesions and note any ulceration or folliculocentricity of lesions. The patient's palm (including all fingers) is approximately 1 percent of BSA.*
Identification of any palpable lymph node, especially those ≥1.5 cm in largest diameter or firm, irregular, clustered, or fixed
Identification of any organomegaly
Skin biopsy
Essential: At least two skin biopsies should be obtained of different anatomic areas and morphology for H&E evaluation. If only one biopsy can be obtained, then the lesion that has the most scaling and induration should be chosen.
If needed: Immunophenotyping to include at least the following markers: CD2, CD3, CD4, CD5, CD7, and CD8, beta-F1 (to confirm alpha-beta TCR), and a B cell marker, such as CD20; CD30 may also be indicated in cases where lymphomatoid papulosis, anaplastic lymphoma, or large-cell transformation is considered.
If needed: Evaluation for clonality of TCR gene rearrangement.
Blood tests
CBC with manual differential (assess for Sézary cells), comprehensive chemistries, LDH
Analysis for abnormal lymphocytes by either Sézary cell count with determination of the absolute number of Sézary cells and/or flow cytometry (including CD4+ / CD7- or CD4+ / CD26-)
If needed: TCR gene rearrangement and relatedness to any clone in skin
Radiologic tests
Radiologic tests are not necessary in patients with T1N0B0 or T2aN0B0 stage disease who are otherwise healthy and without complaints directed to a specific organ system.
In all other patients, contrast-enhanced CT scan of chest, abdomen, and pelvis (neck included if clinically indicated) or whole body integrated PET-CT is recommended to further evaluate any potential lymphadenopathy, visceral involvement, or abnormal laboratory tests; in patients unable to safely undergo CT scans, MRI may be substituted.
Lymph node biopsy
Excisional biopsy is indicated in those patients with a node that is at least 1.5 cm (confirmed by imaging) in diameter; and/or is firm, irregular, clustered, or fixed; and/or significantly PET avid.
Site of biopsy: Preference is given to the largest lymph node draining an involved area of the skin or if FDG-PET scan data are available, the node with highest standardized uptake value.
Analysis: Pathologic assessment by light microscopy, flow cytometry, and TCR gene rearrangement.
BSA: body surface area; TCR: T cell receptor; CBC: complete blood count; LDH: lactate dehydrogenase; CT: computed tomography; PET-CT: positron emission tomography/computed tomography; MRI: magnetic resonance imaging; FDG-PET: 18F-fluoro-2-deoxyglucose positron emission tomography.
*A more specific BSA calculation can be calculated using the "mSWAT" system: mSWAT = (percent BSA of patches) (1) + (percent BSA of plaques) (2) + (percent BSA of tumor) (4).
Adapted from:
  1. Olsen E, Vonderheid E, Pimpinelli N, et al. Revisions to the staging and classification of mycosis fungoides and Sézary syndrome: a proposal of the International Society for Cutaneous Lymphomas (ISCL) and the cutaneous lymphoma task force of the European Organization of Research and Treatment of Cancer (EORTC). Blood 2007; 110:1713.
This table was created using research originally published in Blood. Modified from: Prince HM, Whittaker S, Hoppe RT. How I treat my mycosis fungoides and Sézary syndrome. Blood 2009; 114:4337. Copyright © 2009 American Society of Hematology.
Graphic 75528 Version 5.0

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