Adult T-cell leukemia-lymphoma with mediastinal involvement and an asymptomatic chronic phase

A black, West Indian woman with adult T-cell leukemia-lymphoma (ATLL), hypercalcemia, peripheral and retroperitoneal lymphadenopathy, and serum antibodies to human T-lymphotropic virus (HTLV) was found to have massive mediastinal adenopathy, a feature not previously reported in patients with ATLL. In addition, she had had asymptomatic leukocytosis with marked lymphocytosis for at least 6 years before presenting with full-blown ATLL. These findings broaden the clinical picture of ATLL. Cell surface-marker studies and close follow-up are recommended for patients with apparent chronic lymphocytic leukemia, especially if they have pleomorphic lymphocytosis, are younger than usual or are from the Caribbean or Japan.