Turkish Journal of Pathology

Türk Patoloji Dergisi

Turkish Journal of Pathology

Turkish Journal of Pathology

2023, Vol 39, Num, 1     (Pages: 015-022)

TOX Outperforms FOXP3, CD4 and GATA3 in Histopathological Diagnosis of Early Mycosis Fungoides

Mona Mostafa AHMED 1 , Abdelmonem Awad HEGAZY 2,3, Ahmed EMBABY 4, Esraa Mohammad NAWWAR 5, Salwan Abdelmonem HEGAZY 6, Hanaa M. IBRAHIM 1, Mai Ahmed GOBRAN 1

1 Department of Pathology, Zagazig University, Faculty of Medicine, ZAGAZIG, EGYPT
2 Department of Human Anatomy and Embryology, Zagazig University, Faculty of Medicine, ZAGAZIG, EGYPT
3 Department of Medical Biotechnology, Misr University for Science and Technology (MUST), College of Biotechnology, SIX OF OCTOBER CITY, EGYPT
4 Department of Internal Medicine, Faculty of Medicine, Zagazig University, ZAGAZIG, EGYPT
5 Department of Dermatology, Al-Ahrar Teaching Hospital and Zagazig University Hospitals, ZAGAZIG, EGYPT
6 Zagazig University, Faculty of Medicine, ZAGAZIG, EGYPT

DOI: 10.5146/tjpath.2022.01578
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Objective: Mycosis fungoides (MF) is the most common type of cutaneous lymphoma. The early stage of MF is a difficult diagnostic case, as it is often confused with many benign inflammatory dermatoses (BID). The study aimed to evaluate the diagnostic utility of TOX, FOXP3, CDD4 and GATA3 in differentiating early stages of MF from histologically overlapping BID lesions.

Material and Method: A retrospective cross-sectional study was performed, in which immunohistochemistry (IHC) was used to evaluate the expression of TOX, FOXP3, CD4 and GATA3 in formalin-fixed paraffin-embedded (FFPE) sections of skin lesions from 30 cases with BID and 30 patients with early-stage MF.

Results: The association between TOX expression and early-stage MF was statistically significant (P <0.001). TOX had the highest sensitivity of 96.77% and accuracy of 85.71% in diagnosis of MF; followed by CD4 with sensitivity of 85.71% and accuracy of 78.95%; and then, GATA3 with sensitivity of 76.7% and finally FOXP3 with sensitivity of 70.0%.

Conclusion: TOX is suggested to be of higher diagnostic value in the early stages of MF than the conventionally used CD4 and other markers examined.

Keywords : Mycosis fungoides, Benign inflammatory dermatoses, Differential histopathological diagnosis, Immunohistochemical markers