Adult T-Cell Leukemia/Lymphoma with CLL-Like Morphology—A Case Report

Abstract

Adult T-cell Leukemia/Lymphoma (ATL) is rarely seen in the U.S. and Europe, usually limited to African Americans from the southeastern U.S. and immigrants from HTLV-1 endemic areas. Reaching an accurate and timely diagnosis of ATL in such nonendemic areas can be challenging, owing to limited exposure, diverse manifestations, and varying cell morphology. We present a case of chronic adult T-cell leukemia (ATL) with Chronic Lymphocytic Leukemia- (CLL-) like morphology that remained untreated for ten years and then developed treatment refractory acute ATL crisis.

Cytomorphological similarities between feline viral leukemia, bovine enzootic leukosis and adult T-cell leukemia/lymphoma: A review

“…ATL was then divided into four subtypes: indolent or smoldering (presence of less than 5% of atypical lymphocytes in peripheral blood and normal lymphocyte count), chronic form (presence of 5% or more of atypical lymphocytes in peripheral blood and lymphocytosis ), lymphomatous form (lymphocyte count within the reference values and differential count showing 1% or less of atypical lymphocytes) and acute form (considered the most aggressive form and based on the presence of numerous atypical lymphocytes). In addition, some cases of ATL due to HTLV-1 infection can cause cytomorphological changes similar to CLL (Tageja et al, 2010;Oliveira et al, 2016).…”

“…In these patients, as proposed by the pioneering study by Nowakowski et al (2009), the concentration of smudge cells is more than an artifact, since higher percentages of this finding are related to a lower life expectancy for these patients. In adult T-cell leukemia/lymphoma, some cells may also show atypical morphological patterns of chronic lymphocytic leukemia (Tageja et al, 2010;Oliveira et al, 2016). In the feline species, according to Almeida's research (2017), the fragility of the cells of some cats infected with FeLV can be accentuated, also inducing the frequent formation of smudge cells.…”