Adult T cell lymphoma with hypergammaglobulinemia

Five cases of adult T cell lymphoma with hyperglobulinemia were reported. Two patients died of extension of the disease despite intensive chemotherapy. Three others are still under treatment. Histologically, focal proliferation of monotonous pale cells and foci composed of polymorphic large, medium, and small cells were characteristic of all five cases. Infiltration by eosinophilic leukocytes and/or small histiocytic aggregates were also recognized. In addition, proliferation of branching vessels with hyaline deposits, perivascular proliferation of "immunoblasts" and plasma cells, absence of residual follicles, and depletion of small lymphocytes were the findings, which were consistent with immunoblastic lymphoadenopathy (IBL). Varying degrees of polyclonal hypergammaglobulinemia also corresponded with those of IBL. Rosette assay of the lymph node cells revealed a mixed population of E receptor-positive large, medium, and small cells with atypical nuclei. They also had T cell antigens on the surface and revealed no terminal deoxynucleotidyl transferase activity. These findings suggested their peripheral T cell origin. The cellular characteristics of these five cases are discussed in relation to other adult T cell lymphomas and to the helper function of neoplastic T cells.