Acute T-cell leukemia/lymphoma mimicking Hodgkin's disease with secondary HTLV-I seroconversion

Article Abstract:

Human T-cell leukemia virus type I (HTLV I) does not cause leukemia in all persons who are infected. Indeed, the majority of infected individuals do not have any symptoms. However, a few infected persons, although asymptomatic, may be found upon examination to have an atypical T-lymphocytosis which may either spontaneously remit or may progress to an aggressive adult T-cell leukemia or lymphoma. The recent case of a 38-year-old black woman illustrates some of the features which may complicate the diagnosis of HTLV-related T-cell leukemia. The patient lived in French Guyana, an endemic region for HTLV I infection. She was initially found to have abnormalities of the lymph nodes of the neck and back, and biopsy revealed cells which on first examination appeared to be Hodgkin's lymphoma. The patient did not have antibodies to HTLV I. She was placed on chemotherapy, but the disease progressed and the patient died three months after diagnosis. During the chemotherapy for Hodgkin's disease, the patient developed antibodies against HTLV I, which prompted a reexamination of the biopsy material. With the help of hindsight, some convoluted cells were observed which were determined to be pleiomorphic T-cell lymphoma cells. Material extracted from the biopsy samples was shown to contain genomic DNA of the HTLV I, which made it clear that the virus was present from the outset and that the patient was already infected prior to the chemotherapy. The exact relationship between the appearance of HTLV I antibodies and the chemotherapeutic treatment is not clear, but two possibilities stand out. The immunosuppressive features of chemotherapy may have permitted the unopposed replication of some infected subsets of cells. Also possible is that the chemotherapy may have activated an infection with some cells which had been only latent up to that point. Other retroviruses, including the human immunodeficiency virus (HIV), may exist only as latent genes which are not expressed until activated by some chemical or biological event. (Consumer Summary produced by Reliance Medical Information, Inc.)

HTLV-I infections, Adult T-cell leukemia-lymphoma

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Primary pulmonary Hodgkin's disease

Article Abstract:

Although involvement of the lungs in Hodgkin's disease is common, primary Hodgkin's disease of the lung is very rare; only 61 cases have been reported in the medical literature worldwide. One such case is described. A 67-year-old woman was found to have primary pulmonary Hodgkin's disease, and her medical history revealed that she had surgery to remove an epidermoid carcinoma from her lungs eight years previously. This is noteworthy, since second cancers are not rare but are often attributed to the radiotherapy given for the first. This woman did not receive radiotherapy, so her development of Hodgkin's disease may represent a predilection towards tumors. A review of the literature on primary pulmonary Hodgkin's disease reveals that for an effective differential diagnosis, the tissue must be examined. Even then, care must be taken not to confuse Hodgkin's with T-cell non-Hodgkin's lymphomas. Immunological stains may aid in differentiating between these two tumors. It should be noted that Hodgkin's lymphomas often do not extrude into the airways in the lungs, and a negative sputum sample or a negative bronchoscopic examination demand additional evaluation. (Consumer Summary produced by Reliance Medical Information, Inc.)

Hodgkin's disease, Non-Hodgkin's lymphomas, Lung cancer

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