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Adult T-cell leukemia with a solitary lung mass
1Department of Internal Medicine, Uwajima Social Insurance Hospital, Ehime, Japan.
Insights
This study reports a unique case of Adult T-cell Leukemia/Lymphoma (ATL) presenting as a solitary lung nodule. This finding highlights an atypical presentation of ATL, differing from diffuse infiltration patterns.
Area of Science:
- Oncology
- Hematology
- Infectious Diseases
Background:
- Adult T-cell Leukemia/Lymphoma (ATL) is a lymphoproliferative malignancy associated with Human T-lymphotropic virus type 1 (HTLV-I).
- Pulmonary involvement in ATL can manifest in various ways, including diffuse infiltrates or lymphangitic carcinomatosis.
Observation:
- A 49-year-old woman presented with supraclavicular lymphadenopathy and a distinct 4x4 cm nodular shadow in the right middle lung on chest X-ray.
- Laboratory findings revealed leukocytosis with 44% atypical lymphocytes and strongly positive HTLV-I antibodies.
- Transbronchial biopsy confirmed the presence of ATL cells within the lung nodule.
Findings:
- The patient was diagnosed with ATL based on clinical, laboratory, and histopathological findings.
- Histopathology revealed a large nodular accumulation of ATL cells, a presentation previously undocumented.
- This case represents the first reported instance of ATL manifesting solely as a large nodular lung lesion without diffuse infiltration.
Implications:
- This case expands the spectrum of pulmonary manifestations of ATL.
- It underscores the importance of considering ATL in the differential diagnosis of lung nodules, even in the absence of typical diffuse patterns.
- Further research may elucidate the specific mechanisms leading to this nodular presentation of ATL in the lungs.
Abstract:
A 49-year-old woman was admitted to the hospital with supraclavicular lymph node swelling. On a chest x-ray film, a 4 x 4-cm nodular shadow was observed in the right middle lung field. The white blood cell count was 10,100/cu mm, showing 44 percent abnormal lymphocytes with lobulated nuclei. Since HTLV-I antibodies were markedly positive, she was diagnosed as having ATL. Transbronchial tumor biopsy revealed accumulation of ATL cells. Our patient is the first case with only a large nodular accumulation of ATL cells without diffuse infiltration of the cells in the lung.