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Brian J. Nickoloff, MD, PhD; Christopher E. M. Griffiths, MRCP; Ole Baadsgaard, MD; John J. Voorhees, MD; Curtis A. Hanson, MD; Kevin D. Cooper, MD

JAMA. 1989;261(15):2217-2221.

Abstract
In mycosis fungoides the malignant T cells express lymphocyte function-associated antigen-1, which allows them to bind to epidermal keratinocytes expressing the gamma interferon-inducible intercellular adhesion molecule-1. In this report, a patient with leukemic-stage mycosis fungoides (Sézary syndrome) had widespread erythematous dermal infiltrates containing malignant T cells, but without any epidermotropism. We discovered that the T cells expressed normal amounts of functional lymphocyte function-associated antigen-1, but the keratinocytes did not express significant levels of intercellular adhesion molecule-1, which was probably due to the inability of the malignant T cells to produce gamma interferon. These results support the concept that the inability of malignant T cells to enter the epidermis may contribute to emergence of more clinically aggressive T- cell clones that are no longer confined to the skin, but infiltrate the blood, lymph nodes, and viscera, as is seen in Sézary syndrome.

(JAMA. 1989;261:2217-2221)

Author Affiliations
From the Departments of Pathology (Drs Nickoloff and Hanson) and Dermatology (Drs Nickoloff, Griffiths, Baadsgaard, Voorhees, and Cooper), University of Michigan Medical Center, Ann Arbor; and the Ann Arbor Veterans Administration Hospital (Dr Cooper).

Footnotes
This case was mentioned in an editorial review (Arch Dermatol. 1988;124:1835-1843) by one of the authors (Dr Nickoloff) and presented at the 26th Annual Meeting of the American Society of Dermatopathology; December 1, 1988; Washington, DC (J Cutan Pathol. 1988; 15:331).

Reprint requests to Department of Pathology, M5242 Medical Science I, 1301 Catherine Rd, Ann Arbor, MI 48109-0602 (Dr Nickoloff).

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