• Applied Microscopy
• /
• 제12권1호
• /
• pp.41-47
• /
• 1982

Mycosis fungoides is an uncommon, chronic fatal disease of lymphoreticular system associated with primary ski3 involvement for many years and terminating as a malignant lymphoma with involvement of lymph nodes and viscerae. On occasion it simulates numerous other nonspecific benign skin lesions, thus it may be impossible to decide whether the infiltrate represents early mycosis fungoides or nonspecific on the histopathologic ground alone. A case of mycosis fungoides was confirmed by electron microscopy and reported here. The patient was 69-years-old male who had suffered from erythematous scaly eruption on the whole body since 10 years. Skin biopsies of 4 times showed focal ulceration with chronic nonspecific inflammation and polymorphic cell infiltration in lower dermis, thus possibility of mycosis fungoides could not be completely ruled out. Electron microscopically several atypical lymphoid cells, which had a large cerebriform nucleus with peripheral condensation of dense chromatin and scant cytoplasm, were noted in the upper dermis. Intraepidermal infiltration of these atypical cells was also seen. It was thought that the electron microscopic study may be very helpful to differentiate equivocal mycosis fungoides from the nonspecific dermatosis.

• 대한피부과학회지
• /
• 제56권10호
• /
• pp.636-639
• /
• 2018

Mycosis fungoides is the most common type of cutaneous T-cell lymphoma. Patients with early stage disease usually respond well to conventional therapies, with a relatively favorable prognosis. However, a few patients are refractory to treatment and need alternative strategies, even at the patch and plaque stages. We report the case of a middle-aged woman with long-standing and refractory mycosis fungoides that responded to combination therapy with the 308-nm excimer laser and oral alitretinoin.

• Radiation Oncology Journal
• /
• 제36권2호
• /
• pp.153-162
• /
• 2018

Purpose: We aimed to evaluate clinical outcomes including progression-free survival (PFS), overall survival (OS), partial response, and complete response in patients who underwent radiation therapy (RT) for mycosis fungoides (MF). Also, we sought to find prognostic factors for clinical outcomes. Materials and Methods: Total 19 patients confirmed with MF between 1999-2015 were retrospectively reviewed. Clinical and treatment characteristics, clinical outcomes, and and toxicities were analyzed. Results: Eleven patients were treated with total skin electron beam radiotherapy (TSEBT) and 8 patients with involved field radiation therapy (IFRT) with median dose of 30 Gy, respectively. The median time interval from diagnosis to RT was 2.6 months (range, 0.4 to 87.3 months). The overall response rate was 100%; 11 patients (57.9%) had a complete response and 8 patients (42.1%) a partial response. The presence of positive lymph node at the time of consultation of RT was associated with lower OS (p = 0.043). In multivariate analysis, PFS was significantly lower for patients with increased previous therapies experienced following RT (p = 0.019) and for patients showing PR during RT (p = 0.044). There were no reported grade 3 or more skin toxicities related with RT. Conclusion: Both IFRT and TSEBT are effective treatment for MF patients. Patients with short disease course before RT or complete response during RT are expected to have longer PFS. Positive lymph node status at the initiation of RT was associated woth poor OS, suggesting other treatment modalities such as low-dose RT for patients with low life-expectancy.

• Radiation Oncology Journal
• /
• 제10권1호
• /
• pp.107-113
• /
• 1992

4-5MeV의 전자선은 피부표면의 흡수선량을 증가시키고 표면하 10mm 내외에서 급속히 감소함으로 Mycosis fungoides, Kaposi's sarcoma등 전신피부암에 대한 가장적당한 치료방사선으로 알려져왔다. 그러나 평면이 아니고 굴곡이 심한 인체표면에 균일한 선량을 계획하기는 많은 어려움이 있었다. 연세암센터에서는 1980년부터 시행하여왔던 6MeV 전자선의 마름모형, 네방향 조사방법을 개량하고 많은 문헌을 참고하여 상하 양방향의 조사면과 환자위치를 각각 여섯가지 자세로 나누어 조사(Six-Dual-Field)하는 방법을 사용하였으며 이에따른 전신피부표면의 선량과 선량분포를 측정하였다. 선형가속기에서 발생되는 6MeV 전자선을 0.5 cm 두께의 아크릴판으로 감약시키고 콜리메터가 완전히 열린 조사면을 상하 $19^{\circ}$씩 옮기므로서 타겟트에서 3m 거리에 약 $2m{\times}1m$의 균일한선량의 조사면(평탄도 $+3\%$)과 10 mm 내외의 실효깊이 ($80\%$, 선량지점) 및 산란선에 의한 피부표면선량을 증가시킬 수 있었다. 환자는 일부피부가 가려지지 않도록 팔과 다리를 적당한 자세로 고정시키고 전자선을 여섯방향에서 각각 2회씩 상하로 조사시키므로서 피부표면에 균일한 선량분포(표준편차 $5\%$)가 가능하였으며 $80\%$,의 심부율이 $8\~10mm$에서 측정되었다. 모든 측정은 인체등가팬텀과 폴리스틸렌팬텀을 사용하였으며 필름, 평형전리측정기 및 표준전리측정기를 이용하였다. 특히 환자피부표면의 흡수선량분포를 확인하기 위하여 열형광측정기와 반도체측정기를 이용하였으며 $6\~20$개의 소형 측정기를 환자 피부표면에 부착시킨후 전자선 치료과정 동안 피폭 시켜 측정하였고 그결과 차폐된 부위를 제외하고 평균 $10\%$, 이 내의 균일한 선량분포를 얻을수 있었다.

• Asian Pacific Journal of Cancer Prevention
• /
• 제16권13호
• /
• pp.5359-5364
• /
• 2015

Background: Multiple complex pathways are operable in the evolution of cutaneous T cell lymphomas (CTCLs). These pathways involve interaction between neoplastic T cells and cells of the immune system (especially dendritic cells and the non-malignant T cells). Granulysin is a proinflammatory antimicrobial peptide which has an immune alarmin function, activating dendritic cells, as well as an active role in tumor immunology and prognosis. FOXP3+ regulatory T cells Tregs are an important player in the immune system. Much controversy is found in the literature about the role of Tregs in CTCL. Aim: The present study aimed to investigate the expression of granulysin and FOXP3 in mycosis fungoides (MF), its precursor lesion large plaque parapsoriasis and its leukemic form ;$s\acute{e}ezary$ syndrome (SS). Materials and Methods: Immunohistochemical expression of granulysin and FOXP3 were assessed in lesional skin biopsies taken from 58 patients (4 large plaque parapsoriasis, 48 MF and 6 SS). Results: Granulysin positivity was cytoplasmic and higher in MF than in parapsoriasis en plaque and higher in the more advanced stages of MF (p<0.001). All groups showed significant differences between each other except between MF tumor stage and SS. FOXP3 positivity was nuclear and higher in early stage MF (plaque and patch stages) than in tumor stages and SS (p<0.001). However the FOXP3 count was lower in parapsoriasis en plaque than in other stages of MF. All the groups showed significant differences between each other except between parapsoriasis and SS and between patch and plaque stages of MF. Conclusions: The present study supports a role for granulysin in MF progression and proposes a novel hypothesis about the effect of FOXP3 +veTregs in the suppression of the activity of the neoplastic cells in MF.

• 한국의학물리학회지:의학물리
• /
• 제28권1호
• /
• pp.33-38
• /
• 2017

Creating individualized build-up material for superficial photon beam radiation therapy at irregular surface is complex with rice or commonly used flat shape bolus. In this study, we implemented a workflow using 3D printed patient specific bolus and describe our clinical experience. To provide better fitted build-up to irregular surface, the 3D printing technique was used. The PolyLactic Acid (PLA) which processed with nontoxic plant component was used for 3D printer filament material for clinical usage. The 3D printed bolus was designed using virtual bolus structure delineated on patient CT images. Dose distributions were generated from treatment plan for bolus assigned uniform relative electron density and bolus using relative electron density from CT image and compared to evaluate the inhomogeneity effect of bolus material. Pretreatment QA is performed to verify the relative electron density applied to bolus structure by gamma analysis. As an in-vivo dosimetry, Optically Stimulated Luminescent Dosimeters (OSLD) are used to measure the skin dose. The plan comparison result shows that discrepancies between the virtual bolus plan and printed bolus plan are negligible. (0.3% maximum dose difference and 0.2% mean dose difference). The dose distribution is evaluated with gamma method (2%, 2 mm) at the center of GTV and the passing rate was 99.6%. The OSLD measurement shows 0.3% to 2.1% higher than expected dose at patient treatment lesion. In this study, we treated Mycosis fungoides patient with patient specific bolus using 3D printing technique. The accuracy of treatment plan was verified by pretreatment QA and in-vivo dosimetry. The QA results and 4 month follow up result shows the radiation treatment using 3D printing bolus is feasible to treat irregular patient skin.

• Journal of Photoscience
• /
• 제9권2호
• /
• pp.503-505
• /
• 2002

Three patients suffering from widespread erythrodermic cutaneous T-cell lymphoma were treated with low-dose UVAI phototherapy with a single dose of 20 - 30J/$cm^2$, resulting in cumulative doses of 520 - 1890 J/$cm^2$. Two patients showed complete responses, while other had a partial improvement.

• Journal of Photoscience
• /
• 제9권2호
• /
• pp.506-508
• /
• 2002

Photodynamic therapy using topical 5-ALA has been used for non-melanoma skin cancers. Recently, the therapeutic method using incoherent light brought beneficial result in the treatment for mycosis fungoides. We used ALA-PDT for two Japanese patients suffering from lymphadenosis benigna cutis. In both cases, lesions were markedly faded and histologically, the number of infiltrated cells also decreased. We suggest that ALA-PDT can be used as an effective and safe modality in the treatment of benign cutaneous lymphoma.

• 한국의학물리학회지:의학물리
• /
• 제20권3호
• /
• pp.152-158
• /
• 2009

선형 가속기의 Total Skin Electron Beam Therapy (TSEBT)는 유용하게 사용 되어왔으며, 2에서 9 MeV 에너지 영역의 전자는 mycosis fungoides와 cutaneous lymphomas와 같은 신체의 큰 부분을 덮는 표면상의 병변 치료에 사용 되어져 왔다. 본 연구에서는 Stanford technique로 환자를 치료 하였으며, Stanford technique는 선형 가속기로 전자 빔을 수평 방향으로 조사하여 서 있는 환자의 주위에 $60^{\circ}$로 위치한 6개의 조사면(anterior, posterior, 그리고 4개의 obliques)으로 치료하는 TSEBT의 표준이 되는 방법이다. 각 조사면은 수평으로 하고 적절한 각도에 점을 맞춘 두 개 성분의 빔으로 이루어져있다. 치료시간을 짧게 하기 위해 환자는 하루에 세 개의 이중 조사면으로 치료한다. 첫째 날에는 anterior로 하나의 이중 조사면, posterior에서 두 개의 이중 조사면 그리고 그 다음날에 posterior에서 하나의 이중 조사면 그리고 anterior 경사에서 두 개의 이중 조사면으로 치료한다. 따라서 6개의 이중 조사면의 완전한 주기는 2일로 완성된다. 환자를 치료하기 전 먼저 선량 측정을 하기 위해 원통형 아크릴 팬텀을 제작하여 그 사이 선량계 필름을 삽입하고 환자가 치료 받는 6개 조사면 방향으로 조사를 한 후 선량 분포를 알아보았다. 그런 후 Rando 팬텀을 사용하여 열형광선량계(thermoluminescent dosimetry : TLD)를 앞 가슴, 좌우 옆구리, 등에 부착한 후 6개 조사면 방향으로 방사선을 조사한 후 선량을 측정 하였다.

• Radiation Oncology Journal
• /
• 제34권4호
• /
• pp.313-321
• /
• 2016

Purpose: Total scalp irradiation (TSI) is a rare but challenging indication. We previously reported that non-coplanar intensity-modulated radiotherapy (IMRT) was superior to coplanar IMRT in organ-at-risk (OAR) protection and target dose distribution. This consecutive treatment planning study compared IMRT with volumetric-modulated arc therapy (VMAT). Materials and Methods: A retrospective treatment plan databank search was performed and 5 patient cases were randomly selected. Cranial imaging was restored from the initial planning computed tomography (CT) and target volumes and OAR were redelineated. For each patients, three treatment plans were calculated (coplanar/non-coplanar IMRT, VMAT; prescribed dose 50 Gy, single dose 2 Gy). Conformity, homogeneity and dose volume histograms were used for plan. Results: VMAT featured the lowest monitor units and the sharpest dose gradient (1.6 Gy/mm). Planning target volume (PTV) coverage and homogeneity was better in VMAT (coverage, 0.95; homogeneity index [HI], 0.118) compared to IMRT (coverage, 0.94; HI, 0.119) but coplanar IMRT produced the most conformal plans (conformity index [CI], 0.43). Minimum PTV dose range was 66.8%-88.4% in coplanar, 77.5%-88.2% in non-coplanar IMRT and 82.8%-90.3% in VMAT. Mean dose to the brain, brain stem, optic system (maximum dose) and lenses were 18.6, 13.2, 9.1, and 5.2 Gy for VMAT, 21.9, 13.4, 14.5, and 6.3 Gy for non-coplanar and 22.8, 16.5, 11.5, and 5.9 Gy for coplanar IMRT. Maximum optic chiasm dose was 7.7, 8.4, and 11.1 Gy (non-coplanar IMRT, VMAT, and coplanar IMRT). Conclusion: Target coverage, homogeneity and OAR protection, was slightly superior in VMAT plans which also produced the sharpest dose gradient towards healthy tissue.