Premium
Adult T‐cell leukaemia/lymphoma can mimic other lymphomas in a non‐endemic area: dilemmas in diagnosis and treatment
Author(s) -
Huang CT.,
Lee YH.,
Chow KC.,
Yang CF.,
Chen P. CH.,
Hsiao LT.,
Gau JP.,
Tzeng CH.,
Liu CY.,
Chiou TJ.
Publication year - 2014
Publication title -
internal medicine journal
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.596
H-Index - 70
eISSN - 1445-5994
pISSN - 1444-0903
DOI - 10.1111/imj.12394
Subject(s) - medicine , lymphoma , disease , virus , pathology , immunology
Background The diagnosis of Adult T ‐cell leukaemia/lymphoma ( ATL ) in non‐endemic regions is challenging. Aim This study analyses the clinicopathologic features and diagnostic processes of ATL patients in T aiwan. Methods ATL patients diagnosed and treated at T aipei V eterans G eneral H ospital 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' data were reviewed and analysed. Results Fourteen 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 H odgkin 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 E pstein– B arr 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. Conclusion In non‐endemic areas, such as T aiwan, 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.