Adult T-cell leukaemia/lymphoma can mimic other lymphomas in a non-endemic area: dilemmas in diagnosis and treatment

作者：Huang C T; Lee Y H; Chow K C; Yang C F; Chen P C H; Hsiao L T; Gau J P; Tzeng C H; Liu C Y; Chiou T J^*

来源：Internal Medicine Journal, 2014, 44(4): 374-383.

DOI：10.1111/imj.12394

• Adult T-cell leukaemia
• lymphoma
• human T-cell leukaemia virus type 1
• Hodgkin disease
• in situ hybridisation
• Reed-Sternberg-like cell

BackgroundThe diagnosis of Adult T-cell leukaemia/lymphoma (ATL) in non-endemic regions is challenging. %26lt;br%26gt;AimThis study analyses the clinicopathologic features and diagnostic processes of ATL patients in Taiwan. %26lt;br%26gt;MethodsATL patients diagnosed and treated at Taipei Veterans General Hospital from 1998 through 2010 were retrospectively identified. The diagnosis of ATL was confirmed by in situ detection of human T-cell leukaemia virus type 1 (HTLV-1) when necessary. Patients%26apos; data were reviewed and analysed. %26lt;br%26gt;ResultsFourteen ATL patients were identified, among whom six (42.9%) had an antecedent diagnosis of other malignant lymphomas before the ATL diagnosis, including two diagnosed with Hodgkin disease (HD), one with peripheral T-cell lymphoma, two with chronic lymphocytic leukaemia and one with angioimmunoblastic T-cell lymphoma. Of the 14 patients, eight (57%) were subclassified as the acute type, three (21.4%) as the lymphoma type, and three (21.4%) as the chronic type ATL. Five of six (83.3%) patients with initial non-ATL misdiagnosis were diagnosed with non-acute type ATL. In particular, a patient with an antecedent diagnosis of HD presented with typical Reed-Sternberg (RS)-like cells harbouring Epstein-Barr virus genomes in affected lymph nodes. The patient progressed to acute type ATL 3 years after the initial diagnosis, and HTLV-1 genomes were identified in the previous RS-like cells. %26lt;br%26gt;ConclusionIn non-endemic areas, such as Taiwan, ATL, particularly the non-acute type, may mimic other lymphomas and easily be misdiagnosed. HTLV-1 serology should be routinely screened in all malignant lymphoma patients. In situ detection of HTLV-1 is helpful in cases with diagnostic dilemmas.

• 出版日期2014-4