Cutaneous plaque in adult T cell leukemia/lymphoma

Abstract

Rationale: The rarity of adult T cell leukemia/lymphoma (ATLL) in China, coupled with its clinicopathologic mimicry of primary skin disease, poses a diagnostic challenge. The method of diagnosis and mechanism of immune regulation in ATLL are discussed in the present report. Patient concerns: A 51-year-old Chinese man was admitted to the hospital with 2-years history of systemic plaque lesions and 1-year history of left ankle joint pain. Diagnoses: The patient was diagnosed with ATLL based on the results of flow cytometry immunophenotype and human T-cell lymphotropic virus type 1 (HTLV-1) serology. Interventions: The patient received 3 cycles of cyclophosphamide, epirubicin/ vinorelbine, and dexamethasone (CHOP) chemotherapy. However, he relapsed and did not respond to epirubicin, vindesine, etoposide, dexamethasone (EPOCH) chemotherapy. Outcomes: His family discontinued the treatment and opted for hospice care. Lessons: Patch and plaque ATLL types exhibits a better survival rate, but atypical skin patches delays the diagnosis of ATLL and negatively affects the patient survival. Based on the present findings, we suggest that patients with petal-like nuclear lymphocytes in blood smears, a high CD4: CD8 ratio, and strong CD25 expression should undergo HTLV-1 serology testing.

Заболевания, Ассоциированные С Т-Лимфотропным Вирусом Типа 1 Человека (HTLV-1)

“…Атипичные поражения участков кожи тормозят постановку диагноза ATLL и негативно влияют на выживаемость пациентов [27]. Скрининг на HTLV-1 рекомендован пациентам с инфекционным дерматитом, стойкой гиперрефлексией, нарушениями походки и лицам, прибывшим из эндемичных зон [28].…”

Genome-wide identification of alternative splicing associated with histone deacetylase inhibitor in cutaneous T-cell lymphomas

“…The typical early presentation of MF is erythema resembling eczema. As the disease progresses, the clinical manifestations gradually transit from the erythema stage to the plaque stage and finally enter the tumor stage; a malignant skin tumor develops and invades the circulatory, lymphatic, and visceral tissues ( Lei et al, 2020 ; Weiner et al, 2021 ). In contrast, SS is considered a more aggressive form of the disease and is associated with shorter survival ( Larocca and Kupper, 2019 ).…”