Clinical and Endoscopic Features of Adult T-cell Leukemia/Lymphoma With Duodenal Involvement

Abstract

We describe three cases of adult T-cell leukemia/lymphoma (ATLL) with duodenal involvement and provide a review of the literature. The first case, a 74-year-old woman with acute subtype of ATLL, had multiple polypoid lesions from the bulbus extending into the descending portion of the duodenum. The second case, a 70-year-old man with lymphoma subtype of ATLL, had a polypoid tumor in the descending portion of the duodenum and multiple protruded lesions in the small and large intestines. The third case, a 67-year-old man with lymphoma subtype of ATLL, had a flat-elevated lesion in the descending portion of the duodenum, as well as a gastric ulcerated lesion. Biopsies from these lesions showed mucosal invasion of ATLL cells in each case. All patients received combination chemotherapy, which was successful in the first and third cases, accompanied by the disappearance of gastroduodenal lesions.

Adult T-cell leukemia/lymphoma presenting multiple lymphomatous polyposis

“…In addition to the prior categories, tumor type [8,15] and colitis type [12] have been reported. A search of the MEDLINE database retrieved only 5 reported cases of ATLL with MLP [5,[9][10][11]13] . Although the molecular mechanisms which may influence phenotypes [8] 60/M ND Ulcerated tumor ND 15 mo, died Itsuno [9] 43/M Gastric ulcerated tumors MLP CPA, DXR, VCR 8 mo, died Gakiya [10] 62/M Duodenal MLP MLP CPA, PSL 1 mo, alive Isomoto [11] 70/M Duodenal polypoid tumor MLP CPA, DXR, VDS, VP-16 4 mo, alive Isomoto [12] 47/M Gastric protruding masses Granular, friable, and hyperemic mucosa CPA, DXR, VCR, PSL 12 mo, died Isomoto [13] 58/F Normal MLP CPA, DXR, VDS 7 mo, died Asada [14] 78/F ND Reddish, flat or slightly elevated lesion CPA, THP, VCR, VP-16 died Hidaka [15] 68/M ND Ulcerated tumor surgery, CPA, DXR, VDS, PSL 10 mo, alive Onishi [16] of colonic lesions have not been clarified, colonic MLP may be correlated with coexistence of upper gastrointestinal MLP or polypoid lesions (Table 1).…”

“…Especially, gastrointestinal involvement of ATLL was reported to be one of the poor prognostic factors in acute type ATLL [11,24] . Therefore, endoscopic evaluation may be important for estimating prognosis of ATLL patients.…”

Two Cases of Adult T-cell Leukemia/Lymphoma Involving the Terminal Ileum

“…Itsuno et al [7] reported a case of ATLL accompanied by several ulcerative tumorous lesions in the terminal ileum. More recently, we have reviewed the endoscopic findings of duodenal involvement by ATLL and documented that 92% (12 of 13) of the ATLL cases involving the duodenum had protruded (mostly polypoid) lesions [11]. These were often multifocal, typically manifesting as multiple lymphomatous polyposis [11].…”

The human T‐cell leukemia virus type 1 (HTLV‐1): New insights into the clinical aspects and molecular pathogenesis of adult t‐cell leukemia/lymphoma (ATLL) and tropical spastic paraparesis/HTLV‐associated myelopathy (TSP/HAM)

“…5). Pulmonary, CNS, and intestinal involvement are variably reported (Isomoto et al, 2001), as well as more unusual extranodal sites (Shimamoto and Yamaguchi, 1992).…”

“…Hypercalcemia is described in $30-60% of patients with ATLL, and is frequently associated with lytic bone lesions (Isomoto et al, 2001;Yamaguchi et al, 1990).…”