Nasal-type natural killer cell lymphoma preceded by benign panniculitis arising in an asymptomatic HTLV-1 carrier.
We report a case of an Epstein-Barr virus (EBV)-associated nasal-type natural killer cell lymphoma (NKCL) preceded by benign panniculitis, which arose in a 48-year-old woman with an asymptomatic human T-cell leukemia/lymphoma virus type-1 (HTLV-1) infection. A biopsy of the initial panniculitis lesion demonstrated lobular panniculitis with a germinal center composed of benign mononuclear cells with a phenotype of CD4+CD45RO+CD5sCD3+ cCD3 epsilon + T-cell intracellular antigen-1 (TIA-1)- and granzyme B-. One year after oral prednisolone therapy, the patient developed subcutaneous nodules composed of atypical lymphoid cells with a phenotype of CD4-CD45RO+CD56+sCD3-cCD3 epsilon + (TIA-1)+ and granzyme B+. In the initial panniculitis lesion, neither EBV-encoded RNA (EBER-1) nor clonal proliferation of EBV-infected cells was identified. In later lesions, however, a large number of atypical cells were positive for EBER-1, and a clonal expansion of EBV-infected cells was detected. No clonal rearrangement of T-cell receptor-alpha, -beta, or -gamma genes was found in either specimen. This patient was an asymptomatic carrier of human T-cell leukemia/lymphoma virus type-1 (HTLV-1) without clonal integration of proviral HTLV-1 in neither the peripheral blood nor the skin lesions. These observations suggest that EBV-associated NKCL occurred subsequently in the clinical course of benign panniculitis under the influence of immunosuppression caused by prednisolone treatment and HTLV-1 infection.
Kunisada
M
M
Department of Dermatology, Hyogo Prefectural Kakogawa Hospital, Kakogawa, Japan.
Adachi
A
A
Matsumoto
S
S
Ogawa
Y
Y
Horikawa
T
T
Iwatsuki
K
K
D000914:Antibodies, Viral / Q000032:analysis / Q000097:blood; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000008:administration & dosage / Q000627:therapeutic use; D001932:Brain Neoplasms / Q000556:secondary; D003131:Combined Modality Therapy; D003520:Cyclophosphamide / Q000008:administration & dosage; D003937:Diagnosis, Differential; D004317:Doxorubicin / Q000008:administration & dosage; D017809:Fatal Outcome; D005260:Female; D015368:Human T-lymphotropic virus 1 / Q000276:immunology / Q000302:isolation & purification; D006801:Humans; D016867:Immunocompromised Host; D016410:Lymphoma, T-Cell, Cutaneous / Q000150:complications / Q000175:diagnosis* / Q000473:pathology / Q000628:therapy; D008875:Middle Aged; D015434:Panniculitis / Q000150:complications* / Q000188:drug therapy; D011239:Prednisolone / Q000009:adverse effects; D011241:Prednisone / Q000008:administration & dosage; D012878:Skin Neoplasms / Q000150:complications / Q000175:diagnosis* / Q000473:pathology / Q000628:therapy; D013848:Thigh; D014750:Vincristine / Q000008:administration & dosage
D000914:Antibodies, Viral; D014750:Vincristine; D004317:Doxorubicin; D003520:Cyclophosphamide; D011239:Prednisolone; D011241:Prednisone