A dyshidrosis-like variant of adult T-cell leukemia/lymphoma with clinicopathological aspects of mycosis fungoides. A case report.
Adult T-cell leukemia/lymphoma (ATL) is an aggressive type of leukemia/lymphoma associated with the human T-cell lymphotropic virus (HTLV-I). We describe an adult male patient clinically and pathologically diagnosed as mycosis fungoides and treated with chemotherapy after which complete involution of the lesions occurred. The disease relapsed with confluent dyshidrosis-like vesicles on the palmoplantar regions, followed by disseminated vesiculopapules and associated lymphocytosis. A serological test performed at this time revealed HTLV-I infection, and a diagnosis of chronic ATL was made. Monoclonal integration of HTLV-I was detected in peripheral blood mononuclear cells by inverse long polymerase chain reaction. A skin biopsy revealed spongiosis, Pautrier abscesses, and intraepidermal vesicles with atypical lymphocytes and an infiltration of small and atypical CD4 lymphocytes in the superficial dermis. Proliferative index (Ki-67) was 70%. This is the first reported vesicular cutaneous ATL with confirmation of HTLV-I proviral integration. The delay that occurred in diagnosing ATL was due to the fact that mycosis fungoides and ATL may present the same clinical, histopathological, and immunohistochemical features.
Bittencourt
Achiléa L
AL
Department of Pathology, Federal University of Bahia, Salvador, Bahia, Brazil.
Mota
Karla
K
Oliveira
Rodrigo F
RF
Farré
Lourdes
L
D000328:Adult; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D003520:Cyclophosphamide; D003920:Diabetes Mellitus; D003937:Diagnosis, Differential; D004317:Doxorubicin; D011146:Eczema, Dyshidrotic / Q000473:pathology* / Q000821:virology; D015490:HTLV-I Infections / Q000150:complications / Q000473:pathology*; D015368:Human T-lymphotropic virus 1; D006801:Humans; D007150:Immunohistochemistry; D016898:Interferon-alpha / Q000627:therapeutic use; D015459:Leukemia-Lymphoma, Adult T-Cell / Q000188:drug therapy / Q000473:pathology* / Q000821:virology; D008297:Male; D009182:Mycosis Fungoides / Q000188:drug therapy / Q000473:pathology*; D016133:Polymerase Chain Reaction; D011241:Prednisone; D012878:Skin Neoplasms / Q000188:drug therapy / Q000473:pathology* / Q000821:virology; D014750:Vincristine; D015215:Zidovudine / Q000627:therapeutic use
D016898:Interferon-alpha; D015215:Zidovudine; D014750:Vincristine; D004317:Doxorubicin; D003520:Cyclophosphamide; D011241:Prednisone