Synchronous presentation of Epstein-Barr virus-associated Hodgkin's disease and adult T-cell leukemia/lymphoma (ATLL) in a patient from an endemic area of ATLL.
We report a patient from an endemic area of adult T-cell leukemia/lymphoma (ATLL), who developed lymphoma with features characteristic of Hodgkin's disease (HD). Large atypical Reed-Sternberg/Hodgkin's cells (RS/H cells) had a CD3-CD15+CD20-CD30+CD45RO- immunophenotype. Epstein-Barr virus (EBV) latent membrane protein and EBV-encoded small RNA were detected in the RS/H cells. The patient received C-MOPP/ABVD chemotherapy for the HD resulting in a partial response. However, relapse occurred and he died of disease progression associated with serious bacterial infection. Although serial lymph node biopsies revealed consistent presence of the EBV-positive RS/H cells, the background small lymphocytes showed progressive increase in pleomorphism and nuclear irregularity. The lymphocytes had the T-cell phenotype, CD3+CD4+CD7-CD8-. Southern blot analysis using DNA probes for the human T-cell lymphotrophic virus-I (HTLV-I) and the T-cell receptor beta-chain gene demonstrated expansion of the HTLV-I infected monoclonal T-cells with the disease progression. We concluded that the patient synchronously presented two independent lymphoproliferative disorders; EBV-associated HD and ATLL resulting from HTLV-I infection.
Department of Internal Medicine, Kyoto University, Japan.
T
T
Hayashi
H
H
Yamabe
H
H
Haga
T
T
Akasaka
N
N
Kadowaki
H
H
Ohno
M
M
Okuma
S
S
Fukuhara
D015703:Antigens, CD / Q000032:analysis; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000009:adverse effects / Q000627:therapeutic use; D001761:Bleomycin / Q000008:administration & dosage; D003520:Cyclophosphamide / Q000008:administration & dosage; D003606:Dacarbazine / Q000008:administration & dosage; D004317:Doxorubicin / Q000008:administration & dosage; D017809:Fatal Outcome; D006566:Herpesviridae Infections / Q000150:complications* / Q000821:virology; D004854:Herpesvirus 4, Human / Q000302:isolation & purification*; D006689:Hodgkin Disease / Q000150:complications* / Q000188:drug therapy; D015368:Human T-lymphotropic virus 1 / Q000302:isolation & purification*; D006801:Humans; D016130:Immunophenotyping; D007564:Japan / Q000453:epidemiology; D015459:Leukemia-Lymphoma, Adult T-Cell / Q000150:complications* / Q000453:epidemiology; D008198:Lymph Nodes / Q000473:pathology; D008297:Male; D008875:Middle Aged; D014411:Neoplastic Stem Cells / Q000737:chemistry; D011241:Prednisone / Q000008:administration & dosage; D011344:Procarbazine / Q000008:administration & dosage; D012367:RNA, Viral / Q000032:analysis; D016539:Reed-Sternberg Cells / Q000737:chemistry / Q000821:virology; D014412:Tumor Virus Infections / Q000150:complications* / Q000821:virology; D014747:Vinblastine; D014750:Vincristine / Q000008:administration & dosage; D014763:Viral Matrix Proteins / Q000032:analysis; D014775:Virus Activation / Q000187:drug effects
D015703:Antigens, CD; C037662:EBV-associated membrane antigen, Epstein-Barr virus; D012367:RNA, Viral; D014763:Viral Matrix Proteins; D001761:Bleomycin; D011344:Procarbazine; D014750:Vincristine; D014747:Vinblastine; D003606:Dacarbazine; D004317:Doxorubicin; D003520:Cyclophosphamide; D011241:Prednisone