ArticleBMJ open2026
Age-related histopathological and immunophenotypic variations in early-stage mycosis fungoides: a multicentre retrospective study in Türkiye.
Article in BMJ open, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
objectivesEarly-stage mycosis fungoides (MF) is diagnostically challenging due to overlap with inflammatory dermatoses. Age-related immunological and cutaneous changes may modify histopathological presentation. We aimed to compare clinical, histopathological and immunophenotypic features of early-stage MF between geriatric and non-geriatric patients.
designMulticentre retrospective cross-sectional study.
settingDermatology departments of tertiary centres in Türkiye.
participantsA total of 541 patients diagnosed with early-stage MF were included and stratified into geriatric (≥65 years) and non-geriatric (18-64 years) groups. PRIMARY AND SECONDARY OUTCOME MEASURES: The primary outcomes were age-related differences in histopathological and immunohistochemical features. Secondary outcomes included clinical characteristics and quality of life measures. Primary endpoints were prespecified a priori (epidermotropism, basilar lymphocytes, epidermal atrophy, dermal lymphocytic infiltration, papillary dermal fibrosis and CD4-dominant versus CD8(+)/CD4(-) phenotypes); all other comparisons were considered exploratory.
resultsThe geriatric group had a higher proportion of males (59.5% vs 47.1%; p=0.004), while lesion type, duration, surface involvement and Dermatology Life Quality Index scores did not differ between groups. Histopathologically, epidermotropism (81.3% vs 63.3%), basilar lymphocytes (57.1% vs 45.7%), epidermal atrophy (26.6% vs 13.8%), dermal lymphocytic infiltration (75.8% vs 58.5%) and papillary dermal fibrosis (55.2% vs 38.4%) were more frequent in geriatric patients (all p<0.05). Plasma cells (13.5% vs 6.2%) and eosinophils (21.8% vs 13.8%) were also increased. A CD4-dominant phenotype was more common in geriatric patients (70.2% vs 60.6%; p=0.043), whereas a CD8-positive/CD4-negative phenotype was more frequent in non-geriatric patients (8.5% vs 2.6%; p=0.012). However, histopathological and immunohistochemical variables were extracted from existing routine pathology reports without central slide re-review, harmonised scoring criteria or adjudication; therefore, the reported frequencies may partly reflect intercentre/interobserver reporting practices and temporal changes in diagnostic work-up (eg, immunohistochemistry panels and reporting terminology) in addition to biological differences.
conclusionsAlthough clinical characteristics were comparable across age groups, geriatric patients showed differences in reported histopathological and immunophenotypic features; these observations may facilitate clinicopathological recognition of early-stage MF in older individuals. However, some features (particularly epidermal atrophy and superficial/papillary fibrosis) are not MF-specific and may partly reflect background age- and site-related changes.
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