title: A case of adult T cell leukemia and lymphoma in an Italian woman showing different malignant clones in tumor mass and in blood.
abstract: HTLV-1 infections and their associated diseases are very rare in Italy, as well as in most parts of Europe, occurring prevalently in subjects related to endemic areas. The HTLV-1-associated leukemia/lymphoma, ATLL, is a very aggressive T-cell non-Hodgkin's lymphoma which can be difficult to recognize in non-endemic areas. Here we describe the case of an elderly Italian woman, with no apparent risk factors, affected by a rapidly fatal ATLL who presented with an abdominal lymphomatous mass and circulating leukemic cells. The simultaneous presence of different T-cell clones in the tumor mass and in the blood was demonstrated by T-cell receptor gene rearrangement analysis and HTLV-1 integration pattern studies. After surgery, all the T-cell clones were present in the blood, indicating that tumor cells had spread from the mass. Phylogenetic analysis, using the complete LTR sequence, showed that the patient's HTLV-1 isolate belongs to the cosmopolitan subtype A.
authors.affiliation: Cytodiagnostic and Molecular Oncology Unit, Azienda Ospedaliera di Padova, via Gattamelata 64, 35128 Padova, Italy.
authors.forename: Chiara
authors.initials: C
authors.lastname: Menin
authors.forename: Pietro
authors.initials: P
authors.lastname: Bulian
authors.forename: Fausto
authors.initials: F
authors.lastname: Filippi
authors.forename: Mauro
authors.initials: M
authors.lastname: Buttarello
authors.forename: Concepcion
authors.initials: C
authors.lastname: Casado
authors.forename: Cecilio
authors.initials: C
authors.lastname: Lopez-Galindez
authors.forename: Anita
authors.initials: A
authors.lastname: De Rossi
authors.forename: Luigi
authors.initials: L
authors.lastname: Chieco-Bianchi
authors.forename: Annarosa
authors.initials: A
authors.lastname: Del Mistro
mesh_terms: D000328:Adult; D000368:Aged; D001773:Blood Cells / Q000276:immunology; D002999:Clone Cells; D005260:Female; D015329:Gene Rearrangement, T-Lymphocyte; D015368:Human T-lymphotropic virus 1 / Q000145:classification / Q000235:genetics / Q000302:isolation & purification; D006801:Humans; D007558:Italy; D015459:Leukemia-Lymphoma, Adult T-Cell / Q000175:diagnosis* / Q000276:immunology / Q000473:pathology; D010802:Phylogeny; D013601:T-Lymphocytes / Q000276:immunology; D016662:Virus Integration