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It has been demonstrated recently in mycosis fungoides and lichen planus that T lymphocyte subsets may be identified in cutaneous lymphocytic infiltrates using the immunoperoxidase technic in conjunction with monoclonal antibodies produced by the technic of Kohler and Milstein. This communication describes the application of this technic to cutaneous lymphoid infiltrates of parapsoriasis in which T cell predominance has been demonstrated previously. The lymphoid infiltrates of six patients with atrophic parapsoriasis were examined by the indirect immunoperoxidase technic using monoclonal antibodies (from two commercial sources) directed against "helper" and "suppressor" T cell subsets. Both "helper" and "suppressor" cells (as defined by a positive reaction with monoclonal antibodies) could be identified in cutaneous infiltrates. "Helper" cells predominated, but in varying degrees among patients. The relevance of these findings in relation to the possible development of clinical mycosis fungoides from atrophic parapsoriasis is discussed. In addition, factors causing difficulty in the consistent identification of cell subtypes are discussed. These factors suggest that in the present state of imperfection, difficulty will be experienced in using this technic for the accurate quantification of percentages of lymphocyte subsets in tissue sections.U

A monoclonal antibody (OKT10), which was developed recently, reacts with pro-thymocytes, T cell acute lymphoblastic leukemia (ALL) cells, cells in normal bone marrow (including plasma cells), and activated T cells. Tissues from patients with cutaneous T cell lymphoma were studied for the presence of OKT10-reactive cells with the use of an indirect immunoperoxidase technic. OKT10-reactive cells were identified in three of eight cases of mycosis fungoides, one of two cases of Sézary syndrome, with an equivocal reaction in one of ten cases of large-plaque parapsoriasis and in one of seven positive patch tests (allergic contact dermatitis). The biologic and possible clinical implications are discussed.

The development of a monoclonal antibody directed against HLA DR (Ia-like) antigens of B cells and monocytes but not against normal peripheral human T cells suggested that this antibody might be used as a marker of B cells and monocytes in tissue sections. The T cell nature of large plaque (atrophic) parapsoriasis has recently been demonstrated by the immunoperoxidase technic. Immunoperoxidase examination of serial sections of tissues from two cases of large plaque parapsoriasis with one T cell antiserum, two monoclonal T cell antibodies, and one monoclonal reagent directed against HLA DR indicated that T cells in the cutaneous infiltrates were also HLA DR-positive. Evidence is accumulating that HLA DR positivity may be expressed by activated T cells. The findings here therefore suggest that many of the T lymphoid cells in two cases of large plaque (atrophic) parapsoriasis examined were activated in nature, and that HLA DR may not be a specific marker for B cells and monocytes in certain pathologic conditions. Caution should therefore presently be exercised in attempting to use this marker for the specific identification of B cells and monocytes in pathologic specimens, without simultaneous testing for T cell markers.

In situ immunologic phenotyping of the cutaneous lymphoid infiltrates of five cases of mycosis fungoides (MF) was performed. This was done by the immunoperoxidase technic using monoclonal antibodies directed against normally expressed by mature peripheral T cells and T cells subsets. A significant proportion of the infiltrates reacted with peripheral T cell antibodies. In addition, "helper" predominance was demonstrated. However, cells reacting positively with "suppressor" antibodies were also demonstrated in three cases, indicating immunologic heterogeneity of the infiltrates. The presence of a significant component of the infiltrates yielding an equivocal or negative reaction with the mature T cell antibodies, especially in the infiltrates of one case which had a fatal outcome, suggests further heterogeneity with the presence of immature cells. Future investigation with monoclonal antibodies directed against immature T cell differentiation antigens will be of interest.

Infiltrates of five cases of mycosis fungoides (MF) were studied for the presence of cells reactive with a monoclonal antibody, OKT 6, which detects an antigen present on relatively immature thymocytes and Langerhans cells. In situ immunohistochemical staining was used for their demonstration. OKT 6-reactive cells formed a definite component of the dermal infiltrates of all patients examined. In three patients who showed numerous Pautrier microabscesses on routine histologic examination, OKT 6-positive cells were found to form a component of these abscesses. OKT 6-reactive cells have also recently been shown to be present in varying numbers in the dermal infiltrates of large plaque (atrophic) parapsoriasis (LPAP), a condition which may terminate in MF. The significance of these findings is discussed.

The T cell nature of mycosis fungoides and Sézary syndrome was established a decade ago. The recent advent of monoclonal antibodies to T cells and other lymphoid subpopulations has resulted in an explosion of knowledge on the biology of this group of disorders. These reagents have increased our knowledge on thymic differentiation status, pathogenesis, the phenotype of premalignant vs malignant lymphocytic infiltrates, the identification of other previously unrecognized cells within lymphomas, and the phenotype of circulating vs skin lymphocytes. Therapeutic applications may result. These new developments are discussed.

A monoclonal antibody, OKT 6, has been developed against an antigen which is expressed by immature T cells as part of their normal intrathymic differentiation, but not by mature peripheral T cells. It was though that a search for the expression of such an antigen might be worthwhile in prelymphomatous conditions. This communication describes the investigation of lymphocytic infiltrates of atropic parapsoriasis, lymphomatoid papulosis, and a small group of miscellaneous skin conditions with OKT 6 and the immunoperoxidase technic. OKT 6-positive cells were identified in the dermis in varying numbers in four cases of atrophic parapsoriasis and in one case of lymphomatoid papulosis, but not in any of the other disorders. Positive epidermal staining was noted in all tissues examined. The pattern obtained suggested that epidermal dendritic cells may react with OKT 6. The findings indicate that OKT 6-positive cells may be found outside the thymus in certain conditions. The observations in epidermis cast doubt on the exact nature of the positively reacting cells observed in dermis, suggesting that may either be immature thymocytes or possibly Langerhans cells.