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ALK Expression is a Rare Finding in Mycosis Fungoides

Covington, Morgan BA*; Cassarino, David MD, PhD; Abdulla, Farah MD*

American Journal of Dermatopathology: May 2017 - Volume 39 - Issue 5 - p 342–343
doi: 10.1097/DAD.0000000000000717
Original Study

Abstract: Mycosis fungoides (MF) is the most common form of cutaneous T-cell lymphoma. Although indolent in its early stages, MF is more aggressive in advanced stages, particularly if large cell transformation occurs. Histologically, transformed MF is similar to primary cutaneous anaplastic large cell lymphoma (pcALCL) and nodal ALCL (nALCL). MF had not been associated with immunohistochemical expression of anaplastic lymphoma kinase (ALK) until we previously reported a case documenting the presence of ALK by immunohistochemistry in a patient with stage IA MF and concurrent nALCL. This is a unique finding due to the fact that ALK positivity is usually found in nALCL. The goal of this study is to examine the extent to which ALK may be expressed in the different morphologic lesions of MF. One hundred three biopsies from 96 patients, including the patient from the original case, with confirmed MF representing various lesion stages and subtypes, were tested for ALK by immunohistochemical staining. Out of the 103 biopsies, only the original index case of Stage IA MF with concurrent nALCL expressed ALK. From these results, we conclude that ALK is not routinely present in MF in any lesion stage or variant type. Routine staining of ALK is therefore of no additional benefit for the workup of known early stage MF; however, its use may be beneficial in the initial workup of unspecified large cell lymphomas of the skin.

*Department of Dermatology, University of Chicago Hospital Medical Center, CA, IL; and

Department of Pathology, Southern Permanente Medical Group, LA, CA.

Reprints: Morgan Covington, BA, Department of Dermatology, University of Chicago Medical Center, 5020 South Lakeshore Drive, Apt 1605, Chicago, IL 60615 (e-mail: mcovington@uchicago.edu).

The authors declare no conflicts of interest.

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