[Indolent primary gastric adult T-cell leukemia/lymphoma with recurrent lesions limited to the stomach and duodenum].
A 75-year-old man visited our hospital complaining of heartburn in November 1997. Gastroscopical examination revealed ulcerous protruding extended from the gastric antrum to body and a flat, elevated lesion in the greater curvature of the stomach. Biopsy specimens revealed a CD4-positive malignant lymphoma. The serum anti-human T-lymphotrophic virus type I (HTLV-I) antibody test was positive. He was diagnosed as having primary gastric adult T-cell leukemia/lymphoma (ATLL; acute type). Complete remission was achieved with chemotherapy. In December 1998, the patient experienced a relapse. The lesions were limited to the region between the upper gastric body and the fornix and disappeared with radiation therapy. A second relapse was detected in the gastric greater curvature and descending portion of the duodenum in May 1999 but spontaneously disappeared in 5 months. The third relapse in May 2000 was systemic. Monoclonal integration of the HTLV-I provirus was observed in DNA extracted from ascitic lymphocytes. Chemotherapy was resumed, but the response was poor. The patient subsequently died of respiratory failure as a result of pneumonia. Although gastrointestinal involvement is frequent in ATLL, this appears to be a rare case of an idolent clinical course with lesions limited to the stomach and duodenum for 30 months.
Ishitsuka
Kenji
K
Division of Internal Medicine, Saiseikai Sendai Hospital, First Department of Internal Medicine, Fukuoka University.
Utsunomiya
Atae
A
Aosaki
Shin-ichiro
S
Tashiro
Yukie
Y
Takeshita
Taketsugu
T
D000368:Aged; D004379:Duodenal Neoplasms / Q000473:pathology*; D006801:Humans; D015459:Leukemia-Lymphoma, Adult T-Cell / Q000473:pathology*; D008297:Male; D009364:Neoplasm Recurrence, Local; D013274:Stomach Neoplasms / Q000473:pathology*