Mycosis fungoides. A case of mycosis fungoides with death by rapidly progressed hepatic failure from diffusive invasion to the liver in end of progress over 20 years.

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We report a case of mycosis fungoides which diffusely invaded the liver for more than twenty years after the onset of the disease and which resulted in his death by the rapid progression of liver dysfunction. He was diagnosed as having mycosis fungoides by the long duration of parapsoriasis en plaque and histologic features of skin biopsy in seven years ago. However biopsy specimen of swollen axillary lymph node at that time included B-cell marker-positive Reed-Sternberg cell like-large cells and the histology resembled that of Hodgkin's disease or T-cell-rich B-cell lymphoma. The same histologic features were recognized in autopsy specimen of the extracutaneous lesions, such as lung, liver, spleen and abdominal lymph nodes. The investigation of gene rearrangement led us to the diagnosis of T cell lymphoma, but it was not defined whether it was the invasion of mycosis fungoides or another lymphoma originated in the lymph node. Interestingly EB virus infection was proven in Reed-Sternberg cell-like large cells, so that EB virus was suspected to play a roll in the making of the characteristic features of the extracutaneous lesions.