A dyshidrosis-like variant of adult T-cell leukemia/lymphoma with clinicopathological aspects of mycosis fungoides. A case report.

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.

• 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)

Chemical References

• Interferon-alpha
• Zidovudine
• Vincristine
• Doxorubicin
• Cyclophosphamide
• Prednisone

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)