Abstract |
Adult T-cell leukemia/lymphoma (ATL) is an aggressive type of leukemia/ lymphoma associated with the human T-cell lymphotropic virus (HTLV-I). We describe an adult male patient clinically and pathologically diagnosed as mycosis fungoides and treated with chemotherapy after which complete involution of the lesions occurred. The disease relapsed with confluent dyshidrosis-like vesicles on the palmoplantar regions, followed by disseminated vesiculopapules and associated lymphocytosis. A serological test performed at this time revealed HTLV-I infection, and a diagnosis of chronic ATL was made. Monoclonal integration of HTLV-I was detected in peripheral blood mononuclear cells by inverse long polymerase chain reaction. A skin biopsy revealed spongiosis, Pautrier abscesses, and intraepidermal vesicles with atypical lymphocytes and an infiltration of small and atypical CD4 lymphocytes in the superficial dermis. Proliferative index (Ki-67) was 70%. This is the first reported vesicular cutaneous ATL with confirmation of HTLV-I proviral integration. The delay that occurred in diagnosing ATL was due to the fact that mycosis fungoides and ATL may present the same clinical, histopathological, and immunohistochemical features.
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Authors | Achiléa L Bittencourt, Karla Mota, Rodrigo F Oliveira, Lourdes Farré |
Journal | The American Journal of dermatopathology
(Am J Dermatopathol)
Vol. 31
Issue 8
Pg. 834-7
(Dec 2009)
ISSN: 1533-0311 [Electronic] United States |
PMID | 19770630
(Publication Type: Case Reports, Journal Article, Research Support, Non-U.S. Gov't)
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Chemical References |
- Interferon-alpha
- Zidovudine
- Vincristine
- Doxorubicin
- Cyclophosphamide
- Prednisone
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Topics |
- Adult
- Antineoplastic Combined Chemotherapy Protocols
(therapeutic use)
- Cyclophosphamide
- Diabetes Mellitus
- Diagnosis, Differential
- Doxorubicin
- Eczema, Dyshidrotic
(pathology, virology)
- HTLV-I Infections
(complications, pathology)
- Human T-lymphotropic virus 1
- Humans
- Immunohistochemistry
- Interferon-alpha
(therapeutic use)
- Leukemia-Lymphoma, Adult T-Cell
(drug therapy, pathology, virology)
- Male
- Mycosis Fungoides
(drug therapy, pathology)
- Polymerase Chain Reaction
- Prednisone
- Skin Neoplasms
(drug therapy, pathology, virology)
- Vincristine
- Zidovudine
(therapeutic use)
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