title: Formation of Segmental Rounded Nodules During Infiltration of Adult T-Cell Leukemia Cells Into the Ocular Mucous Membrane.
abstract: OBJECTIVE
  To document a case of adult T-cell leukemia (ATL) cell infiltration into the ocular mucous membrane that presented with rounded nodule formation.
  
  
  METHODS
  Observational case report.
  
  
  RESULTS
  A 36-year-old woman presented with bilateral conjunctival hyperemia and small papules on the legs and face. After complaining of significant fatigue at 6 months, she was diagnosed with high-risk chronic-type ATL. Ophthalmic examination revealed the formation of bilateral segmental rounded nodules, which were located both at the bulbar conjunctiva around the corneal limbus and at the palpebral conjunctiva around each lacrimal punctum. Although cellular infiltrations were also seen at the corneal subepithelium and stroma, no cellular infiltrations were observed in the anterior chamber, vitreous, or retina. Biopsy was performed of the bulbar and palpebral conjunctiva, and the polymerase chain reaction detected HTLV-1 proviral DNA and monoclonal T-cell receptor γ-chain gene rearrangement in both samples. Pathological evaluations identified atypical lymphoid cells that were consistent with ATL cells. These analyses confirmed that the rounded nodules were formed in conjunction with the infiltration of ATL cells.
  
  
  CONCLUSIONS
  The formation of multiple rounded nodules during ATL cell infiltration into the ocular mucous membrane, especially at the palpebral conjunctiva around the lacrimal punctum, may be a distinguishing feature of ATL.
authors.affiliation: *Department of Ophthalmology and Visual Science, Graduate School of Medical and Dental Science, Tokyo Medical and Dental University, Tokyo, Japan; †Department of Ophthalmology, Research Hospital, The Institute of Medical Science, The University of Tokyo, Tokyo, Japan; ‡Department of Human Pathology, Graduate School of Medical and Dental Science, Tokyo Medical and Dental University, Tokyo, Japan; and §Department of Hematology/Oncology, Research Hospital, The Institute of Medical Science, The University of Tokyo, Tokyo, Japan.
authors.forename: Koju
authors.initials: K
authors.lastname: Kamoi
authors.forename: Yoichi
authors.initials: Y
authors.lastname: Nagata
authors.forename: Manabu
authors.initials: M
authors.lastname: Mochizuki
authors.forename: Daisuke
authors.initials: D
authors.lastname: Kobayashi
authors.forename: Nobuhiro
authors.initials: N
authors.lastname: Ohno
authors.forename: Kaoru
authors.initials: K
authors.lastname: Uchimaru
authors.forename: Arinobu
authors.initials: A
authors.lastname: Tojo
authors.forename: Kyoko
authors.initials: K
authors.lastname: Ohno-Matsui
mesh_terms: D000328:Adult; D003228:Conjunctiva / Q000473:pathology*; D005128:Eye Diseases / Q000209:etiology / Q000473:pathology*; D005260:Female; D006801:Humans; D015459:Leukemia-Lymphoma, Adult T-Cell / Q000150:complications / Q000473:pathology*; D016850:Limbus Corneae / Q000473:pathology*; D008214:Lymphocytes / Q000473:pathology*; D009092:Mucous Membrane / Q000473:pathology