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Multifaceted adult T-cell leukemia/lymphoma in India: a case series.

Khader A, Shaan M, Balakrishnan S, Ambooken B, Muhammed K, Rajan U - Indian J Dermatol (2015 Jan-Feb)

Bottom Line: Presence of epidermotropism did not correlate with the severity of disease.ATL manifest in myriad presentations and skin lesions are often the earliest manifestation.Cutaneous manifestations of ATL vary from subtle hypopigmented macules to florid nodular lesions, and HTLV-1 screening need to be carried out in all doubtful cases.

View Article: PubMed Central - PubMed

Affiliation: Department of Dermatology, Government Medical College, Calicut, Kerala, India.

ABSTRACT

Background: Adult T-cell leukemia/lymphoma (ATL) is caused by human T-cell lymphotropic virus type-1 (HTLV-1). India is considered as a nonendemic region for HTLV-1. Recent upsurge of cases have been noted in southern parts of India.

Aims and objectives: The objective was to describe skin manifestations in various types of ATL.

Materials and methods: Clinical examination, blood investigations, skin biopsies, lymph node biopsies, and immunohistochemistry were performed in five patients. Flow cytometry was performed in two cases.

Results: Serological testing was positive for HTLV-1 in all patients. All patients presented with skin lesions. Rare presentations of molluscum contagiosum like papules, purpuric macules and plaques, hypopigmented macules and verrucous papules were seen. Dermatophytic infections occurred in two patients. Mucosal lesion was seen in one patient. Histological features include dermal lymphoid infiltrate with or without epidermotropism. Presence of epidermotropism did not correlate with the severity of disease. All patients except one succumbed to illness within few months to 1 year period.

Conclusions: ATL manifest in myriad presentations and skin lesions are often the earliest manifestation. Cutaneous manifestations of ATL vary from subtle hypopigmented macules to florid nodular lesions, and HTLV-1 screening need to be carried out in all doubtful cases.

No MeSH data available.


Related in: MedlinePlus

Verrucous papules in patient 3 with acute ATL
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Figure 5: Verrucous papules in patient 3 with acute ATL

Mentions: A 62-year-old male whose mother died of lymphoma presented with pruritic skin lesions of 1 year duration and fever of 3 weeks duration. On examination, there were multiple verrucous and crusted papules [Figure 5] and plaques over forearm, dorsum of right hand and legs, cervical and axillary lymph node enlargement, and hepatosplenomegaly. He had elevated total leukocyte count with numerous atypical cells with cleaved nucleus in the peripheral smear and similar infiltrate in the bone marrow trephine biopsy which were CD3+, CD5+, CD25+ and CD7- by flow cytometry. Serum calcium, LDH, blood urea, serum uric acid, and serum ALP were elevated and serum albumin was low as 2.3 g. Skull X-ray was normal in spite of hypercalcemia. Skin biopsy revealed infiltrate of atypical lymphocytes in the dermis without epidermotropism and similar infiltrate in lymph node biopsy which showed CD3+, CD4+, CD8-, and CD2O- on immunohistochemistry. HTLV-1 antibody was positive by ELISA and screening for HIV negative.


Multifaceted adult T-cell leukemia/lymphoma in India: a case series.

Khader A, Shaan M, Balakrishnan S, Ambooken B, Muhammed K, Rajan U - Indian J Dermatol (2015 Jan-Feb)

Verrucous papules in patient 3 with acute ATL
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4318027&req=5

Figure 5: Verrucous papules in patient 3 with acute ATL
Mentions: A 62-year-old male whose mother died of lymphoma presented with pruritic skin lesions of 1 year duration and fever of 3 weeks duration. On examination, there were multiple verrucous and crusted papules [Figure 5] and plaques over forearm, dorsum of right hand and legs, cervical and axillary lymph node enlargement, and hepatosplenomegaly. He had elevated total leukocyte count with numerous atypical cells with cleaved nucleus in the peripheral smear and similar infiltrate in the bone marrow trephine biopsy which were CD3+, CD5+, CD25+ and CD7- by flow cytometry. Serum calcium, LDH, blood urea, serum uric acid, and serum ALP were elevated and serum albumin was low as 2.3 g. Skull X-ray was normal in spite of hypercalcemia. Skin biopsy revealed infiltrate of atypical lymphocytes in the dermis without epidermotropism and similar infiltrate in lymph node biopsy which showed CD3+, CD4+, CD8-, and CD2O- on immunohistochemistry. HTLV-1 antibody was positive by ELISA and screening for HIV negative.

Bottom Line: Presence of epidermotropism did not correlate with the severity of disease.ATL manifest in myriad presentations and skin lesions are often the earliest manifestation.Cutaneous manifestations of ATL vary from subtle hypopigmented macules to florid nodular lesions, and HTLV-1 screening need to be carried out in all doubtful cases.

View Article: PubMed Central - PubMed

Affiliation: Department of Dermatology, Government Medical College, Calicut, Kerala, India.

ABSTRACT

Background: Adult T-cell leukemia/lymphoma (ATL) is caused by human T-cell lymphotropic virus type-1 (HTLV-1). India is considered as a nonendemic region for HTLV-1. Recent upsurge of cases have been noted in southern parts of India.

Aims and objectives: The objective was to describe skin manifestations in various types of ATL.

Materials and methods: Clinical examination, blood investigations, skin biopsies, lymph node biopsies, and immunohistochemistry were performed in five patients. Flow cytometry was performed in two cases.

Results: Serological testing was positive for HTLV-1 in all patients. All patients presented with skin lesions. Rare presentations of molluscum contagiosum like papules, purpuric macules and plaques, hypopigmented macules and verrucous papules were seen. Dermatophytic infections occurred in two patients. Mucosal lesion was seen in one patient. Histological features include dermal lymphoid infiltrate with or without epidermotropism. Presence of epidermotropism did not correlate with the severity of disease. All patients except one succumbed to illness within few months to 1 year period.

Conclusions: ATL manifest in myriad presentations and skin lesions are often the earliest manifestation. Cutaneous manifestations of ATL vary from subtle hypopigmented macules to florid nodular lesions, and HTLV-1 screening need to be carried out in all doubtful cases.

No MeSH data available.


Related in: MedlinePlus