DIAGNOSTIC-CRITERIA IN SEZARYS SYNDROME - A MULTIPARAMETER STUDY OF PERIPHERAL-BLOOD LYMPHOCYTES IN 32 PATIENTS WITH ERYTHRODERMA

[摘要] In order to define additional diagnostic criteria for the early diagnosis of Sezary''s syndrome (SS), peripheral blood lymphocytes of 32 patients with erythroderma, including 8 patients with SS, 4 patients with erythrodermic mycosis fungoides, 14 patients with a erythroderma on the basis of atopic or chronic dermatitis, and 6 patients with erythrodermic psoriasis, were investigated by computer-assisted morphometry. The degree of nuclear indentation, expressed as a nuclear contour index (NCI), was measured on electron micrographs. The mean NCI and the percentages of cerebriform mononuclear cells (CMC), defined by a NCI .gtoreq. 6.5, were calculated. In addition, the percentages of lymphocytes, T and B cells, and the distribution of T-cell subpopulations as defined by Fc-receptors (T.mu., T.gamma.) and monoclonal antibodies (OKT3 [pan T cell phenotype], OKT4 [helper inducer T cell phenotype], OKT8 [cytotoxic suppressor T cell phenotype], HLA-DR) were determined. Statistical analysis showed as most discriminating parameters for the differentiation between SS and benign forms of erythroderma: high percentages of lymphocytes (50% or more), an expanded OKT3+, OKT4+ population with an OKT4/OKT8 ratio > 10, a mean NCI value .gtoreq. 5.5, the presence of > 20% CMC, as well as the presence of cells with a NCI .gtoreq. 11.5. The total leukocyte and lymphocyte counts, as well as the percentages of B, T, T.mu., and T.gamma. cells had limited value for the early diagnosis of SS.