J Korean Med Sci.  2000 Apr;15(2):233-239. 10.3346/jkms.2000.15.2.233.

Adult T cell leukemia/lymphoma with lymphopenia in a Korean

• Jeon HJ
• Lee MJ
• Jeong YK
• Lee DM
• Oh YK
• Kim CW

• KMID: 648130
• DOI: http://doi.org/10.3346/jkms.2000.15.2.233

Abstract

We experienced a case of adult T cell leukemia/lymphoma (ATLL) in a 48-year-old Korean female, who has never been abroad since birth and no history of blood transfusion. The patient had hypercalcemia and multiple lymphadenopathy. Histopathologic study of left cervical lymph node (LN) and bone marrow (BM) revealed that infiltrates of malignant lymphoid cells were composed of small, medium and large cells with pleomorphic nuclei. Smears of peripheral blood (PB) showed lymphopenia (16%) with the appearance of a few atypical lymphoid cells (less than 2%), but not the typical clover leaf cells seen in ATLL. Immunophenotypic study of LN and BM revealed T cell phenotype. PB showed increased CD4+ T cell (T(H), CD3/CD4+, 57%) and decreased CD8+ T cell counts (T(S), CD3/CD8+, 6.7%). The sera of the patient and her family were reactive for HTLV-I antibody. The specific sequences of pol, env, and tax of HTLV-I DNA were detected in the lymphoma cells and peripheral blood mononuclear cells (PBMC) using polymerase chain reaction. Ultrastructural examination of PBMC confirmed numerous type c virus particles in extracellular space. This case was an acute type of ATLL without overt leukemic features in PB. Despite chemotherapy and intensive conservative treatment, she died 3 months after admission.

Keyword

Leukemia/Lymphoma, Adult T-Cell; HTLV-I; Polymerase Chain Reaction; Flow Cytometry; Hypercalcemia

MeSH Terms

Biopsy
Bone Marrow/pathology
Case Report
DNA, Viral/analysis
Fatal Outcome
Female
Flow Cytometry
Gene Products, env/genetics
Gene Products, pol/genetics
Gene Products, tax/genetics
HTLV-BLV Infections/pathology
HTLV-I
Human
Hypercalcemia/virology
Hypercalcemia/pathology
Immunophenotyping
Korea
Leukemia, T-Cell/virology
Leukemia, T-Cell/pathology*
Leukemia, T-Cell/immunology
Lymph Nodes/pathology
Lymphopenia/virology
Lymphopenia/pathology*
Lymphopenia/immunology
Microscopy, Electron
Middle Age
Support, Non-U.S. Gov't
T-Lymphocytes/virology
T-Lymphocytes/ultrastructure
T-Lymphocytes/pathology