The symptoms of T-cell leukemia/lymphoma

Multiple lymphomatous polyposis (MLP) is an unusual form mantle cell lymphoma characterized by polyps throughout the gastrointestinal tract. Adult T-cell leukemia/lymphoma (ATLL) is a malignancy associated with retrovirus, human T-cell lymphotropic virus type 1 (HTLV-1). Although it is well-known that ATLL cells infiltrate into systemic organs including gastrointestinal (GI) tract, colonic involvement has not been fully documented.

A research team led by Dr. Akira Hokama from University of the Ryukyus, reported a case of a 66-year-old man with adult T-cell leukemia/lymphoma (ATLL). This will be published on November 14, 2008 in the World Journal of Gastroenterology.

A 48-year-old man presented with fever and watery diarrhea of a history for three weeks. He had been diagnosed as having smouldering ATLL with erythematopapular cutaneous lesions, in which monoclonal integration of proviral DNA of HTLV-1 into the host genome was confirmed by the Southern blot analysis. He had been managed conservatively without leukemic change or visceral invasion for 20 years. Strongyloides stercoralis were negative. Colonoscopy disclosed multiple whitish polyps throughout the colon. Indigo carmine dye spraying showed a central depression on the polyps. Pedunculated colonic mucosal tissue was replaced by diffuse proliferation of large lymphoid cells with pleomorphic nuclei and pale cytoplasmAbdominal examination showed hyper bowel sounds, but no hepatosplenomegaly. The patient died despite combination of chemotherapy 3 moth later.

Although this case is rare, ATLL should be included in the differential diagnosis of MLP. They emphasize the importance of endoscopic evaluation to differentiate neoplastic intestinal lesions from infectious enterocolitis for abdominal symptoms in patients with leukemia/lymphoma.

Reference: Hokama A, Tomoyose T, Yamamoto Y, Watanabe T, Hirata T, Kinjo F, Kato S, Ohshima K, Uezato H, Takasu N, Fujita J. Adult T-cell leukemia/lymphoma presenting multiple lymphomatous polyposis. World J Gastroenterol 2008; 14(42): 6584-6588 http://www.wjgnet.com/1007-9327/14/6584.asp

Correspondence to: Akira Hokama, Department of Medicine and Therapeutics (First Department of Internal Medicine), Control and Prevention of Infectious Disease, Faculty of Medicine, University of the Ryukyus, 207 Uehara, Nishihara, Okinawa 903-0215, Japan. hokama-a@med.u-ryukyu.ac.jp Telephone: +81-98-8951144 Fax: +81-98-8951414

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