Tuberculosis (TB) is a major public health problem worldwide and a large number of fatal cases are still reported. Immunocompetent individuals are naturally susceptible to TB, and immunocompromised patients have a gre...Tuberculosis (TB) is a major public health problem worldwide and a large number of fatal cases are still reported. Immunocompetent individuals are naturally susceptible to TB, and immunocompromised patients have a greater risk of infection. Although patients with adult T-cell leukemia/lymphoma (ATL) are in an immunosuppressed condition, there is only one reported case of TB accompanied with ATL in the English- language literature in the field of dermatology. Here, we report two patients with chronic-type ATL infected with TB manifesting as cutaneous solitary masses. Case 1 was a 58-year-old woman diagnosed with lumbar abscess with pulmonary TB. Case 2 was an 84-year-old woman diagnosed with tuberculous lymphadenitis in the left cervical region. It is important to raise the differential diagnosis of TB and perform tissue culture for acid-fast bacilli as well as Interferon-Gamma release assay test when dermatologists encounter mass lesions in patients with ATL.展开更多
Adult T-cell leukemia( ATL) is a mature T-cell malignancy caused by human T-cell leukemia virus type I infection, and 10%-25% of patients show central nervous system( CNS) involvement. CNS involvement significantly re...Adult T-cell leukemia( ATL) is a mature T-cell malignancy caused by human T-cell leukemia virus type I infection, and 10%-25% of patients show central nervous system( CNS) involvement. CNS involvement significantly reduces survival and there are no effective treatments for CNS involvement. Therefore, an appropriate animal model is required to evaluate the inhibitory effects of novel drugs on the progression of ATL with CNS involvement. Here, we established a mouse model of ATL with CNS involvement using NOD.Cg-Prkdc~ (scid) Il2 rg ^(tm1Wjl)/SzJ mice inoculated with ATL cells intramuscularly in the postauricular region, and these mice showed paraparesis. Of the 10 mice inoculated with ATL cells intramuscularly(I.M.) at 5 weeks of age, 8(80%) showed paraparesis, whereas none of the 10 mice inoculated with ATL cells subcutaneously(S.C.) showed paraparesis. In the I.M. group, PCR detected HTLV-1-specific genes in the thoracic and lumbar vertebrae; however, in the S.C. group, the vertebrae were negative for HTLV-1 genes. Histological analysis revealed a particularly high incidence of tumors, characterized by accumulation of the injected cells, in the thoracic vertebrae of mice in the I.M. group. Tumor cell infiltration was relatively high in the bone marrow. Spinal cord compression caused by invasion of the tumor mass outside the pia mater was observed in the thoracic vertebrae of the spinal cord. In conclusion, we have reported a mouse model of tumor growth with paraparesis that may be used to assess novel therapeutic agents for ATL with CNS involvement.展开更多
Multiple lymphomatous polyposis (MLP) is an unusual form of non-Hodgkin's lymphoma characterized by polyps throughout the gastrointestinal tract. It has been reported that most MLP are observed in cases with mantl...Multiple lymphomatous polyposis (MLP) is an unusual form of non-Hodgkin's lymphoma characterized by polyps throughout the gastrointestinal tract. It has been reported that most MLP are observed in cases with mantle cell lymphoma of B-cell type. We herein present a case of a 66-year-old man with adult T-cell leukemia/lymphoma (ATLL). Colonoscopy revealed MLP throughout the colon and histopathological findings of ATLL cell infiltration. The patient died despite combination of chemotherapy. The literature of manifestations of colonic involvement of ATLL isreviewed and the importance of endoscopic evaluation to differentiate ATLL intestinal lesions from opportunistic infectious enterocolitis is discussed.展开更多
AIM: To review the characteristics of hematological malignancies in tropical areas, and to focus on the specific difficulties regarding their management. METHODS: This is a retrospective narrative review of cases of p...AIM: To review the characteristics of hematological malignancies in tropical areas, and to focus on the specific difficulties regarding their management. METHODS: This is a retrospective narrative review of cases of patients with hematological malignancies. All medical files of patients with malignant disease whose treatment was coordinated by the HematoOncology service of the Cayenne Hospital in French Guiana between the 1st of January 2010 and the 31 st of December 2012 were reviewed. Clinical data were extracted from the medical files and included: Demographic data, comorbidities, serological status for human immunodeficiency virus, human T-lymphotropic virus 1(HTLV1), hepatitis B virus and hepatitis C virusinfections, cytology and pathology diagnoses, disease extension, treatment, organization of disease management, and follow-up. The subgroup of patients with hematological malignancies and virus-related malignancies were reviewed. Cases involving patients with Kaposi sarcoma, and information on solid tumor occurrence in virus-infected patients in the whole patient population were included. Since the data were rendered anonymous, no informed consent was obtained from the patients for this retrospective analysis. Data were compiled using EXCEL® software, and the data presentation is descriptive only. The references search was guided by the nature of the data and discussion. RESULTS: In total, the clinical files of 594 patients(pts) were reviewed. Hematological malignancies were observed in 87 patients, and Kaposi sarcoma in 2 patients. In total, 70 patients had a viral infection, and 34 of these also had hematological malignancies. The hematological diagnoses were: Multiple myeloma in 27 pts, lymphoma(L) in 43 pts, myeloproliferative disorders in 17 pts and Kaposi sarcoma in two patients. The spectrum of non-Hodgkin lymphomas(NHL) was: Burkitt L(1 pt), follicular L(5 pts), chronic lymphocytic leukemia(5 pts), high-grade NHL(9 pts), mucosa-associated lymphoid tissue NHL(4 pts), T-cell lymphoma(4 pts), Adult T-cell lymphoma-leukemia(ATL)/lymphoma/leukemia(12 pts); three patients had Hodgkin disease. The spectrum of myeloproliferative diseases was: Chronic myelogenous leukemia(8 pts), thrombocytemia(5 pts) and acute leukemia(4 pts). There were no polycythemia vera, myelosclerosis, and myelodysplastic diseases. This appears to be due to bias in the recruitment process. The most important observations were: The specificity of HTLV1- related ATL malignancies, and the high incidence of virus infections in patients with hematological malignancies. Further, we noted several limitations regarding the treatment and organization of disease management. These were not related to the health care organization, but were due to a lack of board-certified hematooncology specialists, a lack of access to diagnostic tools(e.g., cytogenetic and molecular diagnosis, imaging techniques), the unavailability of radiotherapy, and the physical distance from mainland France. Yet the geography and cultures of the country also contributed to the encountered difficulties. These same limitations are seen in tropical countries with low and intermediate household incomes, but they are amplified by economic, social, and cultural issues. Thus, there is often little access to diagnostic procedures, adequate clinical management, and an unavailability of suitable medical treatments. Programs have been developed to establish centers of excellence, training in pathology diagnosis, and to provide free access to treatment.CONCLUSION: Management of hematological malignancies in tropical areas requires particular skills regarding specific features of these diseases and in terms of the affected populations, as well as solid public health policies.展开更多
目的:探讨成人T细胞白血病-淋巴瘤(adult T cell leukemia-lymphoma,ATL)的临床特征及治疗。方法:回顾分析我院1例ATL的临床病理特征、治疗转归,并进行相关文献复习。结果:患者女性,44岁,祖籍福建,以皮疹、腹胀及水肿为首发表现,影像学...目的:探讨成人T细胞白血病-淋巴瘤(adult T cell leukemia-lymphoma,ATL)的临床特征及治疗。方法:回顾分析我院1例ATL的临床病理特征、治疗转归,并进行相关文献复习。结果:患者女性,44岁,祖籍福建,以皮疹、腹胀及水肿为首发表现,影像学检查提示全身多发代谢增高肿大淋巴结、脾大,腋窝淋巴结、腹壁皮肤活检提示外周T细胞淋巴瘤;经预治疗及多次化疗后效果欠佳,行HTLV I-RNA检测为阳性,诊断ATL急性型明确,后选择其子作为供者行单倍型异基因造血干细胞移植,移植后随访15个月至2022年04月仍存活。结论:由于北方地区HTLV-1感染率较低,遇到化疗效果欠佳的外周T细胞淋巴瘤时需考虑到ATL可能,尽早行相关病毒学检测以尽快明确诊断。单倍型异基因造血干细胞移植可以为ATL患者改善长期预后带来希望。展开更多
Human T-cell leukemia virus type 1(HTLV-1),the first human retrovirus discovered,is the etiological agent of adult-T-cell leukemia/lymphoma.The HTLV-1 encoded Tax protein is a potent oncoprotein that deregulates gene ...Human T-cell leukemia virus type 1(HTLV-1),the first human retrovirus discovered,is the etiological agent of adult-T-cell leukemia/lymphoma.The HTLV-1 encoded Tax protein is a potent oncoprotein that deregulates gene expression by constitutively activating nuclear factor-κB(NF-κB).Tax activation of NF-κB is critical for the immortalization and survival of HTLV-1-infected T cells.In this review,we summarize the present knowledge on mechanisms underlying Tax-mediated NF-κB activation,with an emphasis on post-translational modifications of Tax.展开更多
目的探讨成人T细胞白血病/淋巴瘤(adult T celll eukemia/lymphoma,ATLL)的临床表现、病理形态学特征、诊断及鉴别诊断。方法收集福建省肿瘤医院病理科2017年10月至2018年5月诊断的4例ATLL蜡块,采用HE染色、免疫组织化学及聚合酶链反应(...目的探讨成人T细胞白血病/淋巴瘤(adult T celll eukemia/lymphoma,ATLL)的临床表现、病理形态学特征、诊断及鉴别诊断。方法收集福建省肿瘤医院病理科2017年10月至2018年5月诊断的4例ATLL蜡块,采用HE染色、免疫组织化学及聚合酶链反应(PCR)和测序技术,观察组织学特征、免疫表型,检测人类T细胞白血病病毒(HTLV)1前病毒DNA,并结合文献进行复习。结果4例ATLL患者,男性2例,女性2例,年龄38~80岁,均为福建省籍居民。主要临床表现为淋巴结肿大、肝脾肿大、皮肤损害、高钙血症、淋巴细胞增多等。光镜下正常结构完全破坏,不典型淋巴样细胞弥漫浸润,背景中炎性细胞稀少。不典型淋巴细胞中等大至大,具有明显的多形性,核不规则、染色质粗块状,核仁明显,部分病例细胞形态间变,可见特征性分叶状核的"花细胞"。夹杂转化的母细胞,散在伴扭曲或脑回样核的巨细胞。免疫组织化学示肿瘤细胞弥漫一致表达CD2、CD3、CD5、CD4、CD25,不表达CD7、CD8及细胞毒分子。3例仅转化的大细胞表达CD30,1例弥漫表达CD30。4例均为EB病毒编码的小RNA阴性,HTLV-1前病毒阳性。结论ATLL是一种少见并具有独特的临床和病理学特征的T细胞肿瘤,应与非特殊型外周T细胞淋巴瘤、间变性淋巴瘤激酶阴性间变性大细胞淋巴瘤、皮肤蕈样霉菌病等鉴别。高钙血症、全身性疾病,特征性"花细胞",以及免疫表型CD3^+、CD4^+、CD25^+、CD7^-高度提示为ATLL。HTLV-1前病毒基因检测阳性才可确诊ATLL。展开更多
用间接免疫荧光法对福建部分沿海地区1703人进行了嗜人 T 细胞病毒Ⅰ型(HTLV-Ⅰ)抗体测定。HTLV-Ⅰ的抗体阳性率为2.3%,其中白血病患者的抗体阳性率(71%)显著高于其他疾病患者(2.7%)和健康献血员(0.6%)。表明了该地区 HTLV-Ⅰ感染率明...用间接免疫荧光法对福建部分沿海地区1703人进行了嗜人 T 细胞病毒Ⅰ型(HTLV-Ⅰ)抗体测定。HTLV-Ⅰ的抗体阳性率为2.3%,其中白血病患者的抗体阳性率(71%)显著高于其他疾病患者(2.7%)和健康献血员(0.6%)。表明了该地区 HTLV-Ⅰ感染率明显高于国内其他地区的报道。部分病毒携带者的体征和实验室指标有明显增加。展开更多
Objective To study 4 cases of adult T cell leukemia/lymphoma (ATLL) as sociated with cutaneous lesions for clinicopathology, immunophenotype, human T cell leukemia/lymphoma virus type Ⅰ (HTLV Ⅰ) provirus DNA an...Objective To study 4 cases of adult T cell leukemia/lymphoma (ATLL) as sociated with cutaneous lesions for clinicopathology, immunophenotype, human T cell leukemia/lymphoma virus type Ⅰ (HTLV Ⅰ) provirus DNA and their ultrastru cture. At the same time, HTLV Ⅰ provirus DNA of ATLL patients were also compar ed with 18 cases of cutaneous lymphoma (CL), two cases of actinic reticuloid as well as two cases of lymphocytic infiltration.Methods Immunohistochemistry studies were carried out on the infiltrati ng cells using monoclonal antibodies against CD45 RO, CD20, CD68 on paraffin e mbedded sections by ABC method and using monoclonal antibodies against CD3, CD4 and CD8 with indirect immunofluorescence (IIF) on frozen sections. Skin biopsies were examined by electron microscope. Serum and bone marrow cells were tested f or antibodies against HTLV Ⅰ associated antigen by IIF, and HTLV Ⅰ provirus DNA was examined by PCR method.Results The research showed four patients with ATLL manifesting cutaneo u s lesions, were subsequently found with additional systemic symptoms, as extensi vely enlarged superficial lymph node, abnormal increased IL 2 receptor, flower like cells in their peripheral blood and marrow. The HTLV Ⅰ provirus DNA was positi ve in the peripheral blood, bone marrow, cutaneous lesions and lymph node biopsy specimens by using PCR amplification of specific HTLV Ⅰ fragment while 18 cas es of the CL were negative for HTLV Ⅰ. The special ultrastructure of skin lesi ons was also found in ATLL patients.Conclusions The cutaneous involvement in ATLL is a type of cutaneous T cell lymphoma (CTCL) but shows some differential immunological markers for diffe rential diagnosis. The examination of HTLV Ⅰ antibodies or HTLV Ⅰ provirus D NA is necessary for diagnosis of ATLL. The ultrastrustural characteristics in skin lesions of ATLL were of atypic al lymphocytes and mononuclear cells invading the epidermis, and the mononuclear cells are possessing the phagocytic function and phagocytizing the degenerated epidermic cells or lymphocytes.展开更多
文摘Tuberculosis (TB) is a major public health problem worldwide and a large number of fatal cases are still reported. Immunocompetent individuals are naturally susceptible to TB, and immunocompromised patients have a greater risk of infection. Although patients with adult T-cell leukemia/lymphoma (ATL) are in an immunosuppressed condition, there is only one reported case of TB accompanied with ATL in the English- language literature in the field of dermatology. Here, we report two patients with chronic-type ATL infected with TB manifesting as cutaneous solitary masses. Case 1 was a 58-year-old woman diagnosed with lumbar abscess with pulmonary TB. Case 2 was an 84-year-old woman diagnosed with tuberculous lymphadenitis in the left cervical region. It is important to raise the differential diagnosis of TB and perform tissue culture for acid-fast bacilli as well as Interferon-Gamma release assay test when dermatologists encounter mass lesions in patients with ATL.
基金Japan Leukemia Research FundGrant-in-Aid for Scientific Research from the Japan Society for the Promotion of Science,Grant/Award Number:No.24500493
文摘Adult T-cell leukemia( ATL) is a mature T-cell malignancy caused by human T-cell leukemia virus type I infection, and 10%-25% of patients show central nervous system( CNS) involvement. CNS involvement significantly reduces survival and there are no effective treatments for CNS involvement. Therefore, an appropriate animal model is required to evaluate the inhibitory effects of novel drugs on the progression of ATL with CNS involvement. Here, we established a mouse model of ATL with CNS involvement using NOD.Cg-Prkdc~ (scid) Il2 rg ^(tm1Wjl)/SzJ mice inoculated with ATL cells intramuscularly in the postauricular region, and these mice showed paraparesis. Of the 10 mice inoculated with ATL cells intramuscularly(I.M.) at 5 weeks of age, 8(80%) showed paraparesis, whereas none of the 10 mice inoculated with ATL cells subcutaneously(S.C.) showed paraparesis. In the I.M. group, PCR detected HTLV-1-specific genes in the thoracic and lumbar vertebrae; however, in the S.C. group, the vertebrae were negative for HTLV-1 genes. Histological analysis revealed a particularly high incidence of tumors, characterized by accumulation of the injected cells, in the thoracic vertebrae of mice in the I.M. group. Tumor cell infiltration was relatively high in the bone marrow. Spinal cord compression caused by invasion of the tumor mass outside the pia mater was observed in the thoracic vertebrae of the spinal cord. In conclusion, we have reported a mouse model of tumor growth with paraparesis that may be used to assess novel therapeutic agents for ATL with CNS involvement.
文摘Multiple lymphomatous polyposis (MLP) is an unusual form of non-Hodgkin's lymphoma characterized by polyps throughout the gastrointestinal tract. It has been reported that most MLP are observed in cases with mantle cell lymphoma of B-cell type. We herein present a case of a 66-year-old man with adult T-cell leukemia/lymphoma (ATLL). Colonoscopy revealed MLP throughout the colon and histopathological findings of ATLL cell infiltration. The patient died despite combination of chemotherapy. The literature of manifestations of colonic involvement of ATLL isreviewed and the importance of endoscopic evaluation to differentiate ATLL intestinal lesions from opportunistic infectious enterocolitis is discussed.
文摘AIM: To review the characteristics of hematological malignancies in tropical areas, and to focus on the specific difficulties regarding their management. METHODS: This is a retrospective narrative review of cases of patients with hematological malignancies. All medical files of patients with malignant disease whose treatment was coordinated by the HematoOncology service of the Cayenne Hospital in French Guiana between the 1st of January 2010 and the 31 st of December 2012 were reviewed. Clinical data were extracted from the medical files and included: Demographic data, comorbidities, serological status for human immunodeficiency virus, human T-lymphotropic virus 1(HTLV1), hepatitis B virus and hepatitis C virusinfections, cytology and pathology diagnoses, disease extension, treatment, organization of disease management, and follow-up. The subgroup of patients with hematological malignancies and virus-related malignancies were reviewed. Cases involving patients with Kaposi sarcoma, and information on solid tumor occurrence in virus-infected patients in the whole patient population were included. Since the data were rendered anonymous, no informed consent was obtained from the patients for this retrospective analysis. Data were compiled using EXCEL® software, and the data presentation is descriptive only. The references search was guided by the nature of the data and discussion. RESULTS: In total, the clinical files of 594 patients(pts) were reviewed. Hematological malignancies were observed in 87 patients, and Kaposi sarcoma in 2 patients. In total, 70 patients had a viral infection, and 34 of these also had hematological malignancies. The hematological diagnoses were: Multiple myeloma in 27 pts, lymphoma(L) in 43 pts, myeloproliferative disorders in 17 pts and Kaposi sarcoma in two patients. The spectrum of non-Hodgkin lymphomas(NHL) was: Burkitt L(1 pt), follicular L(5 pts), chronic lymphocytic leukemia(5 pts), high-grade NHL(9 pts), mucosa-associated lymphoid tissue NHL(4 pts), T-cell lymphoma(4 pts), Adult T-cell lymphoma-leukemia(ATL)/lymphoma/leukemia(12 pts); three patients had Hodgkin disease. The spectrum of myeloproliferative diseases was: Chronic myelogenous leukemia(8 pts), thrombocytemia(5 pts) and acute leukemia(4 pts). There were no polycythemia vera, myelosclerosis, and myelodysplastic diseases. This appears to be due to bias in the recruitment process. The most important observations were: The specificity of HTLV1- related ATL malignancies, and the high incidence of virus infections in patients with hematological malignancies. Further, we noted several limitations regarding the treatment and organization of disease management. These were not related to the health care organization, but were due to a lack of board-certified hematooncology specialists, a lack of access to diagnostic tools(e.g., cytogenetic and molecular diagnosis, imaging techniques), the unavailability of radiotherapy, and the physical distance from mainland France. Yet the geography and cultures of the country also contributed to the encountered difficulties. These same limitations are seen in tropical countries with low and intermediate household incomes, but they are amplified by economic, social, and cultural issues. Thus, there is often little access to diagnostic procedures, adequate clinical management, and an unavailability of suitable medical treatments. Programs have been developed to establish centers of excellence, training in pathology diagnosis, and to provide free access to treatment.CONCLUSION: Management of hematological malignancies in tropical areas requires particular skills regarding specific features of these diseases and in terms of the affected populations, as well as solid public health policies.
文摘目的:探讨成人T细胞白血病-淋巴瘤(adult T cell leukemia-lymphoma,ATL)的临床特征及治疗。方法:回顾分析我院1例ATL的临床病理特征、治疗转归,并进行相关文献复习。结果:患者女性,44岁,祖籍福建,以皮疹、腹胀及水肿为首发表现,影像学检查提示全身多发代谢增高肿大淋巴结、脾大,腋窝淋巴结、腹壁皮肤活检提示外周T细胞淋巴瘤;经预治疗及多次化疗后效果欠佳,行HTLV I-RNA检测为阳性,诊断ATL急性型明确,后选择其子作为供者行单倍型异基因造血干细胞移植,移植后随访15个月至2022年04月仍存活。结论:由于北方地区HTLV-1感染率较低,遇到化疗效果欠佳的外周T细胞淋巴瘤时需考虑到ATL可能,尽早行相关病毒学检测以尽快明确诊断。单倍型异基因造血干细胞移植可以为ATL患者改善长期预后带来希望。
基金Supported by Grants from the United States Public Health Service/National Institutes of Health,No.RO1CA135362,RO1GM083143 and PO1CA128115
文摘Human T-cell leukemia virus type 1(HTLV-1),the first human retrovirus discovered,is the etiological agent of adult-T-cell leukemia/lymphoma.The HTLV-1 encoded Tax protein is a potent oncoprotein that deregulates gene expression by constitutively activating nuclear factor-κB(NF-κB).Tax activation of NF-κB is critical for the immortalization and survival of HTLV-1-infected T cells.In this review,we summarize the present knowledge on mechanisms underlying Tax-mediated NF-κB activation,with an emphasis on post-translational modifications of Tax.
文摘目的探讨成人T细胞白血病/淋巴瘤(adult T celll eukemia/lymphoma,ATLL)的临床表现、病理形态学特征、诊断及鉴别诊断。方法收集福建省肿瘤医院病理科2017年10月至2018年5月诊断的4例ATLL蜡块,采用HE染色、免疫组织化学及聚合酶链反应(PCR)和测序技术,观察组织学特征、免疫表型,检测人类T细胞白血病病毒(HTLV)1前病毒DNA,并结合文献进行复习。结果4例ATLL患者,男性2例,女性2例,年龄38~80岁,均为福建省籍居民。主要临床表现为淋巴结肿大、肝脾肿大、皮肤损害、高钙血症、淋巴细胞增多等。光镜下正常结构完全破坏,不典型淋巴样细胞弥漫浸润,背景中炎性细胞稀少。不典型淋巴细胞中等大至大,具有明显的多形性,核不规则、染色质粗块状,核仁明显,部分病例细胞形态间变,可见特征性分叶状核的"花细胞"。夹杂转化的母细胞,散在伴扭曲或脑回样核的巨细胞。免疫组织化学示肿瘤细胞弥漫一致表达CD2、CD3、CD5、CD4、CD25,不表达CD7、CD8及细胞毒分子。3例仅转化的大细胞表达CD30,1例弥漫表达CD30。4例均为EB病毒编码的小RNA阴性,HTLV-1前病毒阳性。结论ATLL是一种少见并具有独特的临床和病理学特征的T细胞肿瘤,应与非特殊型外周T细胞淋巴瘤、间变性淋巴瘤激酶阴性间变性大细胞淋巴瘤、皮肤蕈样霉菌病等鉴别。高钙血症、全身性疾病,特征性"花细胞",以及免疫表型CD3^+、CD4^+、CD25^+、CD7^-高度提示为ATLL。HTLV-1前病毒基因检测阳性才可确诊ATLL。
文摘用间接免疫荧光法对福建部分沿海地区1703人进行了嗜人 T 细胞病毒Ⅰ型(HTLV-Ⅰ)抗体测定。HTLV-Ⅰ的抗体阳性率为2.3%,其中白血病患者的抗体阳性率(71%)显著高于其他疾病患者(2.7%)和健康献血员(0.6%)。表明了该地区 HTLV-Ⅰ感染率明显高于国内其他地区的报道。部分病毒携带者的体征和实验室指标有明显增加。
文摘Objective To study 4 cases of adult T cell leukemia/lymphoma (ATLL) as sociated with cutaneous lesions for clinicopathology, immunophenotype, human T cell leukemia/lymphoma virus type Ⅰ (HTLV Ⅰ) provirus DNA and their ultrastru cture. At the same time, HTLV Ⅰ provirus DNA of ATLL patients were also compar ed with 18 cases of cutaneous lymphoma (CL), two cases of actinic reticuloid as well as two cases of lymphocytic infiltration.Methods Immunohistochemistry studies were carried out on the infiltrati ng cells using monoclonal antibodies against CD45 RO, CD20, CD68 on paraffin e mbedded sections by ABC method and using monoclonal antibodies against CD3, CD4 and CD8 with indirect immunofluorescence (IIF) on frozen sections. Skin biopsies were examined by electron microscope. Serum and bone marrow cells were tested f or antibodies against HTLV Ⅰ associated antigen by IIF, and HTLV Ⅰ provirus DNA was examined by PCR method.Results The research showed four patients with ATLL manifesting cutaneo u s lesions, were subsequently found with additional systemic symptoms, as extensi vely enlarged superficial lymph node, abnormal increased IL 2 receptor, flower like cells in their peripheral blood and marrow. The HTLV Ⅰ provirus DNA was positi ve in the peripheral blood, bone marrow, cutaneous lesions and lymph node biopsy specimens by using PCR amplification of specific HTLV Ⅰ fragment while 18 cas es of the CL were negative for HTLV Ⅰ. The special ultrastructure of skin lesi ons was also found in ATLL patients.Conclusions The cutaneous involvement in ATLL is a type of cutaneous T cell lymphoma (CTCL) but shows some differential immunological markers for diffe rential diagnosis. The examination of HTLV Ⅰ antibodies or HTLV Ⅰ provirus D NA is necessary for diagnosis of ATLL. The ultrastrustural characteristics in skin lesions of ATLL were of atypic al lymphocytes and mononuclear cells invading the epidermis, and the mononuclear cells are possessing the phagocytic function and phagocytizing the degenerated epidermic cells or lymphocytes.
