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Demonstration of Clonal Disease in Early Mycosis Fungoides

Cutaneous T-cell lymphomas (CTCLs) are known to show monoclonal T-cell infiltrates late in the course of the disease. However, detection of monoclonal T-cell proliferation in early stages is difficult. To investigate the possibility that clones might appear only as minor subpopu lations. we analyzed the proliferative activity of T cells expressing certain variable (V) regions of the T-cell receptor (TCR). In biopsy specimens from 27 patients with CTCLs, all T cells expressing the V regions Vα2. Vβ5a, Vβ5b, Vβ6, Vβ8. and Vβ12 accounted for <5% of the total infiltrate. In the vast majority of the cases, <3% of the cells expressing one TCR V region proliferated. In one case of mycosis fungoides, however, an epidermo tropic clone expressing Vβ8 was detected. This clone was present in two distinct lesions from different anatomic sites and was found in an early relapse 1 year after complete remission following PUVA therapy. The case described here documents the possibility of clonal disease early in the course of mycosis fungoides.