title: Adult T-cell leukemia/lymphoma with multiple integration of HTLV-1 provirus presenting as an isolated paranasal sinus tumor: a case report.
abstract: BACKGROUND
  Adult T-cell leukemia/lymphoma (ATLL) is a highly aggressive T-cell lymphoma and etiologically associated with human T-lymphotropic virus type 1 (HTLV-1). Patients with ATLL commonly present with leukemic changes, systemic lymphadenopathy, and/or extranodal lesion and have very poor prognosis.
  
  
  RESULTS
  We describe a rare case of ATLL presenting as an isolated paranasal mass. Southern blot analysis of the biopsied specimens demonstrated multiple integration bands of HTLV-1 provirus of different intensities. Chemotherapy resulted in complete resolution of the paranasal mass. Thereafter, the patient showed an indolent clinical course with leukemic changes and pulmonary and cutaneous ATLL lesions and remains alive more than 5 years from diagnosis.
  
  
  CONCLUSIONS
  ATLL should be included in the differential diagnosis of sinonasal lymphoma, although the event is rare. Multiple HTLV-1 provirus integrations of different intensities may be indicative of good prognosis for ATLL.
authors.affiliation: Department of Endocrinology and Metabolism, Internal Medicine, University of the Ryukyus School of Medicine, Okinawa, Japan. anaga@ryudai2nai.com
authors.forename: Akitoshi
authors.initials: A
authors.lastname: Nagasaki
authors.forename: Takashi
authors.initials: T
authors.lastname: Miyagi
authors.forename: Tamiko
authors.initials: T
authors.lastname: Taira
authors.forename: Akihiko
authors.initials: A
authors.lastname: Shinhama
authors.forename: Shizuo
authors.initials: S
authors.lastname: Kojya
authors.forename: Mikio
authors.initials: M
authors.lastname: Suzuki
authors.forename: Miyuki
authors.initials: M
authors.lastname: Aonahata
authors.forename: Naoki
authors.initials: N
authors.lastname: Yoshimi
authors.forename: Nobuyuki
authors.initials: N
authors.lastname: Takasu
mesh_terms: D000328:Adult; D015368:Human T-lymphotropic virus 1 / Q000502:physiology*; D006801:Humans; D015459:Leukemia-Lymphoma, Adult T-Cell / Q000175:diagnosis* / Q000628:therapy / Q000821:virology; D008297:Male; D010255:Paranasal Sinus Neoplasms / Q000175:diagnosis* / Q000628:therapy / Q000821:virology; D011533:Proviruses / Q000502:physiology*; D016662:Virus Integration