A dyshidrosis-like variant of adult T-cell leukemia/lymphoma with clinicopathological aspects of mycosis fungoides. A case report

Am J Dermatopathol. 2009 Dec;31(8):834-7. doi: 10.1097/DAD.0b013e3181ac04fe.

Abstract

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.

Publication types

  • Case Reports
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Antineoplastic Combined Chemotherapy Protocols / therapeutic use
  • Cyclophosphamide
  • Diabetes Mellitus
  • Diagnosis, Differential
  • Doxorubicin
  • Eczema, Dyshidrotic / pathology*
  • Eczema, Dyshidrotic / virology
  • HTLV-I Infections / complications
  • HTLV-I Infections / pathology*
  • Human T-lymphotropic virus 1
  • Humans
  • Immunohistochemistry
  • Interferon-alpha / therapeutic use
  • Leukemia-Lymphoma, Adult T-Cell / drug therapy
  • Leukemia-Lymphoma, Adult T-Cell / pathology*
  • Leukemia-Lymphoma, Adult T-Cell / virology
  • Male
  • Mycosis Fungoides / drug therapy
  • Mycosis Fungoides / pathology*
  • Polymerase Chain Reaction
  • Prednisone
  • Skin Neoplasms / drug therapy
  • Skin Neoplasms / pathology*
  • Skin Neoplasms / virology
  • Vincristine
  • Zidovudine / therapeutic use

Substances

  • Interferon-alpha
  • Zidovudine
  • Vincristine
  • Doxorubicin
  • Cyclophosphamide
  • Prednisone

Supplementary concepts

  • CHOP protocol