Cutaneous manifestations of adult T cell leukemia/lymphoma. Report of three different forms

The clinical and pathologic features of cutaneous lesions observed in three adult T cell leukemia/lymphoma (ATL) patients identified in Taiwan are described. They represent one classical case of ATL and two "smoldering" variants. The classical ATL patient when first seen had numerous erythematous or purpuric papules, nodules, and plaques with or without ulceration. The two "smoldering" cases developed encrusted purpuric plaques with subcutaneous erythematous nodules in one patient and pompholyx-like vesicular eruptions with tumor masses in another patient. The pompholyx-like eruptions have not been described before. Pruritus was the major complaint in two patients. Histopathologic studies revealed pleomorphic infiltration in the classical case and monomorphic infiltration with medium-sized cells in the two "smoldering" variants. Therefore, the cutaneous lesions of ATL are diverse and not pathognomonic. The diagnosis requires a high index of suspicion, detection of circulating characteristic multilobated lymphoid cells with T helper/inducer cell marker, and demonstration of serum antibody against the adult T cell leukemia virus-associated antigen.