Bullous adult T-cell lymphoma/leukemia and human T-cell lymphotropic virus-1 associated myelopathy in a 60-year-old man

Vesicular Lymphomatoid Papulosis With DUSP22-IRF4 Rearrangement on Chromosome 6p25.3: A Case Report

ABSTRACT

Lymphomatoid papulosis (LyP) with DUSP22-IRF4 rearrangement on chromosome 6p25.3 is a newly identified subtype of LyP. It is characterized by an older age of onset, localized skin lesions, with good prognosis, and it resembles a hybrid of LyP types B and C in histopathology. A limited number of cases have been reported so far. In this article, we reported a case of a 72-year-old man with recurrent episodes of widespread multiple discrete papular or vesicular eruptions on a region of the head, trunk, and 4 extremities for about 3 years. Histopathological examination of a vesicle revealed a subepidermal blister with abundant atypical lymphocytes in the vesicular space, band-like infiltrates in the papillary dermis, along with epidermotropism and pilosebaceous structure involvement. Fluorescence in situ hybridization analysis further demonstrated DUSP22-IRF4 rearrangement on chromosome 6p25.3. A diagnosis of vesicular LyP with this rare subtype was made according to the clinical and pathological findings.

Cutaneous manifestations of adult T-cell leukemia/lymphoma

Adult T-cell leukemia/lymphoma (ATLL) is an aggressive peripheral T-cell lymphoma caused by the human T-lymphotropic virus type-1 (HTLV-1). The skin is affected in approximately half of ATLL patients, and it may be the first manifestation of the disease. The skin lesions of ATLL are polymorphous, and depending on the type of skin eruption, it is possible to predict the prognosis of the disease. Besides specific skin lesions, other non-specific lesions and increased risk of cutaneous and systemic infections are observed. In this article, we describe the different skin lesions of ATLL patients (specific, non-specific, and infectious lesions), the different histopathological patterns, and the association of clinicopathological characteristics with prognosis. Recognition of ATLL skin lesions is essential for the correct management and the search for the virus, even in non-endemic regions, where global migration may bring HTLV-1 infected individuals.

Adult T-Cell Leukemia/Lymphoma. Review of the Literature

Adult T-cell Leukemia/Lymphoma (ATLL) is an aggressive neoplasm of T lymphocytes associated with Human T-lymphotropic virus type1 (HTLV-1) infection. HTLV-1 is a public health problem because it is endemic in native groups in Latin America, and its infection leads to several chronic diseases as ATLL. We aimed to review current literature of ATLL in order to consider it as a differential diagnosis in front of patients with compatible symptoms. Prognosis is still poor in aggressive and indolent variants, with survival rates from months to few years. Treatment based on chemotherapy, antiretroviral, and allogenic stem cell transplantation are currently improving survival rates, but with limited results.

A Clinicopathological Analysis of Primary Cutaneous Lymphomas: A 6-year Observational Study at a Tertiary Care Center of South India

BACKGROUND

Little data are available concerning clinical and pathological patterns of cutaneous lymphomas in India.

AIM

To analyze the clinical and histopathological characteristics of cutaneous lymphomas in Indian patients.

MATERIALS AND METHODS

This is a single-center, prospective, observational study carried out from January 1, 2010, to December 31, 2015. The patients underwent clinical examination, human T-cell lymphotropic virus-1 (HTLV-1) screening, skin biopsy with hematoxylin and eosin and immunohistochemistry staining.

RESULTS

Among 35 cases, 33 (94.3%) were T-cell, and 2 (5.7%) were B-cell lymphomas. The mean age was 52.66, and the male to female ratio was 2.5:1. The most common types of T-cell lymphomas included mycosis fungoides (MF) (57.1%) followed by adult T-cell lymphoma/leukemia (ATL) (17.1%). Primary cutaneous peripheral T-cell lymphoma not otherwise specified was diagnosed in 17.1% and anaplastic large cell lymphoma in 2.9%. The morphological types of MF included polymorphic, poikilodermatous, folliculotropic, hypopigmented, hyperpigmented, mixed, and purpuric. Skin manifestations of ATL included ulcerated plaques and erythroderma. Epidermotropism was very marked in ATL (83.3%) than in MF (70%). Larger Pautrier's microabscess was noted in ATL compared to smaller ones in MF. Markedly dense, diffuse infiltrate of atypical cells was noted in ATL in contrast to mild to moderate nodular or perivascular infiltrate in MF. ATL had an extremely poor prognosis.

LIMITATIONS

Identification of DNA integration of HTLV-1 by Southern blot could not be analyzed, and the number of cases studied is limited.

CONCLUSIONS

The study showed unique patterns of subtypes of cutaneous lymphomas in our country. Variations in the clinical pattern and histopathological analysis will help to differentiate T-cell lymphoma types which have prognostic implications.

Multifaceted adult T-cell leukemia/lymphoma in India: a case series

Background:

Adult T-cell leukemia/lymphoma (ATL) is caused by human T-cell lymphotropic virus type-1 (HTLV-1). India is considered as a nonendemic region for HTLV-1. Recent upsurge of cases have been noted in southern parts of India.

Aims and objectives:

The objective was to describe skin manifestations in various types of ATL.

Materials and Methods:

Clinical examination, blood investigations, skin biopsies, lymph node biopsies, and immunohistochemistry were performed in five patients. Flow cytometry was performed in two cases.

Results:

Serological testing was positive for HTLV-1 in all patients. All patients presented with skin lesions. Rare presentations of molluscum contagiosum like papules, purpuric macules and plaques, hypopigmented macules and verrucous papules were seen. Dermatophytic infections occurred in two patients. Mucosal lesion was seen in one patient. Histological features include dermal lymphoid infiltrate with or without epidermotropism. Presence of epidermotropism did not correlate with the severity of disease. All patients except one succumbed to illness within few months to 1 year period.

Conclusions:

ATL manifest in myriad presentations and skin lesions are often the earliest manifestation. Cutaneous manifestations of ATL vary from subtle hypopigmented macules to florid nodular lesions, and HTLV-1 screening need to be carried out in all doubtful cases.

Specific cutaneous manifestations in adult T-cell leukemia/lymphoma

BACKGROUND

Adult T-cell leukemia/lymphoma (ATLL) is an aggressive malignancy which may occur in individuals infected with human T-cell lymphotropic virus type-I (HTLV-I). HTLV-I is endemic in Khorasan, with a frequency of 2.3% in the general population. As specific cutaneous manifestations of lymphoma may occur in a significant number of patients, we studied these manifestations in ATLL patients admitted to the Hematology and Dermatology Departments of Ghaem Hospital, Mashhad, Iran, during 1995-2004.

METHODS

In this descriptive study, demographic and clinical information was obtained from 23 patients suffering from ATLL with specific cutaneous lesions (atypical lymphocytes on histopathology of cutaneous lesions), and was analyzed statistically.

RESULTS

Of the 23 patients, 11 were male and 12 were female. The mean age was 48.17 +/- 14.1 years. The birth place in over 85% of cases was the north of Khorasan. The most common type of specific skin lesion was a maculopapular eruption (11 cases; 47.8%); papular lesions were seen in four cases (17.4%). Other lesions included plaques, ichthyosis-like lesions, erythroderma, tumors, papules, and nodular lesions. In most patients (56.5%), the skin lesions were generalized.

CONCLUSION

The most common type of specific skin lesion in ATLL was maculopapular eruption, especially with a generalized distribution. Other types of specific skin lesion, in order of frequency, were papules, plaques, ichthyosis-like skin lesions, nodules, tumors, and erythroderma.