Cutaneous manifestations of human T-cell lymphotrophic virus type-1-associated adult T-cell leukemia/lymphoma: A single-center, retrospective study Journal Article

Authors: Marchetti, M. A.; Pulitzer, M. P.; Myskowski, P. L.; Dusza, S. W.; Lunning, M. A.; Horwitz, S. M.; Moskowitz, A. J.; Querfeld, C.
Article Title: Cutaneous manifestations of human T-cell lymphotrophic virus type-1-associated adult T-cell leukemia/lymphoma: A single-center, retrospective study
Abstract: Background: Limited data exist regarding cutaneous involvement of adult T-cell leukemia/lymphoma (ATLL), particularly in the United States. Objective: We sought to characterize clinical and histopathologic features of ATLL in patients with skin involvement. Methods: We retrospectively identified patients with ATLL from a single institution given a diagnosis during a 15-year period (1998-2013). Patients were categorized by the Shimoyama classification and stratified into skin-first, skin-second, and skin-uninvolved courses. Results: The study population included 17 skin-first, 8 skin-second, and 29 skin-uninvolved cases. Skin-first patients (6 acute, 1 lymphoma, 4 chronic, 6 smoldering) were overwhelmingly of Caribbean origin (94%). They had longer median symptom duration (11.9 vs 1.9 months, P<.001) and overall survival (26.7 vs 10.0 months, P<.001) compared with skin-second/skin-uninvolved patients. Cutaneous lesion morphology at diagnosis included nodulotumoral (35%), multipapular (24%), plaques (24%), patches (12%), and erythroderma (6%). After initial skin biopsy, 14 of 17 received a non-ATLL diagnosis, most commonly mycosis fungoides (47%). Notable histopathologic findings from 43 biopsy specimens included greater than or equal to 20:1 CD4:CD8 ratio (79%), angiocentrism (78%), CD25+ (71%), large cell morphology (70%), CD30+ (68%), epidermal infiltration of atypical lymphocytes (67%) forming large Pautrier-like microabscesses (55%), and folliculotropism (65%). Limitations: This was a retrospective, single-center, tertiary referral center study with small sample size. Conclusion: Skin-first patients with ATLL in the United States are diagnostically challenging. Familiarity with clinicopathologic features may aid in diagnosis.
Keywords: adult; human tissue; middle aged; major clinical study; overall survival; united states; cell structure; skin biopsy; retrospective study; enzyme linked immunosorbent assay; immunophenotyping; t cell leukemia; mycosis fungoides; human t cell leukemia virus 1; adult t-cell leukemia/lymphoma; cd4 cd8 ratio; human; male; female; priority journal; article; tertiary care center; cd25 expression; cd30 expression; human t-cell lymphotropic virus type-1; large cell morphology; pautrier-like microabscesses; skin manifestations
Journal Title: Journal of the American Academy of Dermatology
Volume: 72
Issue: 2
ISSN: 0190-9622
Publisher: Mosby Elsevier  
Date Published: 2015-02-01
Start Page: 293
End Page: 301.e2
Language: English
DOI: 10.1016/j.jaad.2014.10.006
PROVIDER: scopus
PUBMED: 25455841
Notes: Export Date: 2 March 2015 -- Source: Scopus
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MSK Authors
  1. Melissa P Pulitzer
    132 Pulitzer
  2. Matthew Alexander Lunning
    26 Lunning
  3. Stephen Dusza
    167 Dusza
  4. Steven M Horwitz
    369 Horwitz
  5. Alison Moskowitz
    151 Moskowitz
  6. Patricia Myskowski
    139 Myskowski