Adult T-Cell Leukaemia-Lymphoma Relapsing as Hodgkin Disease Nodular Sclerosis Subtype

Adult T-cell leukaemia-lymphoma (ATLL) is a distinct disease aetiologically associated with HTLV-I. Hypercalcaemia, organomegaly and a pleomorphic blood picture characterized by the presence of convoluted CD4+CD25+ lymphocytes are the main disease features. We report a patient with a well documented ATLL who relapsed after a long-lasting remission induced by deoxycoformycin treatment. At relapse, the blood picture was consistent with ATLL whereas the histological and immunophenotypical features of the lymph node were indistinguishable from those seen in Hodgkin disease (HD) nodular sclerosis subtype. The monoclonal integration of HTLV-I proviral DNA in the lymph node was demonstrated by Southern blot. The unusual evolution of this case emphasizes the difficulties of differential diagnosis between HD and ATLL with atypical histology and adds new support to the concept of a possible viral participation in a subset of HD cases.