CC BY-NC-ND 4.0 · Indian J Med Paediatr Oncol 2009; 30(03): 108-112
DOI: 10.4103/0971-5851.64257

Follicular mycosis fungoides - A report of four Indian cases

T Rajalakshmi
Department of Pathology, St. John′s Medical College and Hospital, Bangalore - 560 034, India
Y.K. Inchara
Department of Pathology, St. John′s Medical College and Hospital, Bangalore - 560 034, India
Meryl Antony
Department of Dermatology, St. John′s Medical College and Hospital, Bangalore - 560 034, India
› Author Affiliations


Background:Follicular Mycosis Fungoides (FMF) is an under-recognized disease in India. Its clinical mimics include Hansen′s disease and Sarcoidosis.Aims:To describe the clinical and pathological features of FMF.Materials and Methods:All cases of FMF between January and December 2007 were retrieved. Cases of conventional epidermotropic MF with a minor follicular component were excluded. Slides were reviewed by two observers. The following criteria were assessed: degree and density of folliculotropism of lymphocytes, location of folliculotropism (infundibular / isthmic / bulbar), follicular mucin, eosinophils, granulomas, and conventional epidermotropism. Each feature was assigned a semi-quantitative grade.Results:There were four cases of FMF, with an equal gender distribution and a mean age of 17.5 years. All lesions were on the face. They presented as: hypopigmented patches (2) and erythematous plaques (2). Alopecia was seen in two cases. The clinical diagnosis was Hansen′s disease in all four, with a differential of Alopecia mucinosa / Sarcoidosis in two cases.The histological features seen were: disproportionate folliculotropism, lymphocyte tagging with haloes, follicular mucin, and nucleomegaly / convolution in all four cases, prominent eosinophils (2), epithelioid granulomas (1), eccrine infiltration (4), parakeratosis at the follicular ostia (2), and sebaceotropism (1). The infiltrate was bulbar (4) and isthmic (2). The rest of the epidermis showed no hint of conventional MF.Conclusion:The preferential features for FMF were involvement of face, dominant folliculotropism, nuclear atypia and convolution, and follicular mucin. Presence of granulomas and eosinophils necessitated exclusion of infectious causes. The absence of findings of MF in the rest of the epidermis should not deter pathologists from rendering this diagnosis.

Publication History

Article published online:
19 November 2021

© 2009. Indian Society of Medical and Paediatric Oncology. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial-License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (

Thieme Medical and Scientific Publishers Pvt. Ltd.
A-12, 2nd Floor, Sector 2, Noida-201301 UP, India

  • References

  • 1 Laxman M. Patch stage of mycosis fungoides. Indian J Derm Venereol Leprol 2001;67:98-9.
  • 2 Sanchez JL, Ackerman AB. The patch stage of mycosis fungoides: Criteria for histologic diagnosis. Am J Dermatopathol 1979;1:5-26.
  • 3 Massone C, Kodama K, Kerl H, Cerroni L. Histopathologic features of early (patch) lesions of mycosis fungoides. Am J Surg Pathol 2005;29:550-60.
  • 4 Kim SY. Follicular mycosis fungoides. Am J Dermatopathol 1985;7:300-1.
  • 5 Flaig MJ, Cerroni L, Schuhmann K, Bertsch HP, Kind P, Kaudewitz P, et al. Follicular mycosis fungoides: A clinicopathologic analysis of nine cases. J Cutan Pathol 2001;28:525-30.
  • 6 Gσmez-Diez S, Maldonado C, Fueyo A, Vαzquez-Lσpez F, Fresno MF, Pιrez-Oliva N. Folliculotropic mycosis fungoides: Study of four cases. Actas Dermosifiliogr 2007;98:486-90.
  • 7 Johnson WC, Higdon S, Helwig EB. Alopecia mucinosa. Arch Dermatol 1959;79:61-72.
  • 8 Gerami P, Rosen S, Kuzel T, Boone SL, Guitart J. Folliculotropic mycosis fungoides: An aggressive variant of cutaneous T-Cell lymphoma. Arch Dermatol 2008;144:738-46.
  • 9 Vergier B, Beylot-Barry M, Beylot C, de Mascarel A, Delaunay M, de Muret A, et al. Pilotropic cutaneous T-cell lymphoma without mucinosis. Arch Dermatol 1996;132:683-7.
  • 10 Arai E, Okubo H, Tsuchida T, Kitamura K, Katayama I. Pseudolymphomatous folliculitis. Am J Surg Pathol 1999;23:1313-9.
  • 11 Kato N, Matsue K. Follicular lymphomatoid papulosis. Am J Dermatopathol 1997;19:189-96.
  • 12 Gerami P, Guitart J. The Spectrum of histopathologic and immunohistochemical findings in folliculotropic mycosis fungoides. Am J Surg Pathol 2007;31:1430-8.
  • 13 Cerroni L, Fink-Puches R, Bδck B, Kerl H. Follicular mucinosis: A critical reappraisal of clinicopathologic features and association with mycosis fungoides and Sιzary syndrome. Arch Dermatol 2002;138:182-9.
  • 14 Boer A, Guo Y, Ackerman AB. Alopecia mucinosa is mycosis fungoides. Am J Dermatopathol 2004;26:33-52.
  • 15 Rongioletti F, Smoller B. The histologic value of adnexal (eccrine gland and follicle) infiltration in mycosis fungoides. J Cutan Pathol 2000;27:406-9.
  • 16 Van Doorn R, Scheffer E, Willemze R. Follicular mycosis fungoides, a distinct disease entity with or without associated follicular mucinosis a clinicopathologic and follow-up study of 51 patients. Arch Dermatol 2002;138:191-8.