Epstein-Barr virus in adult T-cell leukemia/lymphoma.

Adult T-cell leukemia/lymphoma (ATLL) is a well-known human T-cell lymphotropic virus type-1-related disease. We studied Epstein-Barr virus (EBV) in the tumor cells of ATLL, to investigate the etiological significance of double infection with these viruses. We used polymerase chain reaction and EBV-encoded small RNA-1 in situ hybridization to investigate the presence of EBV and immunohistochemistry to detect EBV-related oncoproteins, such as EBV-determined nuclear antigen-2 and latent membrane protein. Polymerase chain reaction performed on DNA of frozen specimens from 96 cases of ATLL revealed that the tumor tissue from 21 cases contained EBV DNA. EBV-encoded small RNA-1 in situ hybridization performed on the paraffin sections of the polymerase chain reaction-positive cases indicated EBV in the nuclei of ATLL tumor cells in 16 cases, nine of which were in the pleomorphic nuclei. Latent membrane protein was also detected in the cytoplasm of ATLL tumor cells in 15 cases, and EBV nuclear antigen-2 was observed in the nuclei of ATLL tumor cells in 11 cases. We conclude that EBV was present within tumor cells in about 17% of cases with ATLL and expressed EBV oncoprotein in the tumor cells. It is hypothesized that EBV and human T-cell lymphotropic virus-1 may infect the same T cells in early life and may play a role in the oncogenesis of ATLL.     

Clinical course of retrovirus-associated adult T-cell lymphoma in the United States

We studied the clinical features of 11 patients with adult T-cell lymphoma associated with the human T-cell lymphoma virus. The patients were predominantly young, black, and born in the southeastern United States. They had an aggressive course, with the rapid onset of disseminated skin lesions or symptoms related to hypercalcemia and other metabolic disturbances, or both. Common findings included rapid enlargement of peripheral, hilar, and retroperitoneal lymph nodes, with sparing of the mediastinum; invasion of the central nervous system, lungs, or gastrointestinal tract; and opportunistic infections. A paraneoplastic syndrome characterized by increased bone turnover, abnormal bone scintigraphy, and hypercalcemia was present in all patients. Intensive combination chemotherapy produced prompt complete clinical remissions, which were generally of short duration. Similar features have been described in patients in Japan and the West Indies who had adult T-cell lymphoma, which is also associated with the human T-cell lymphoma virus. This syndrome should be suspected in patients presenting with the acute onset of widespread T-cell lymphoma in association with metabolic bone disease and hypercalcemia. The presence of the syndrome can be confirmed by appropriate serologic and virologic studies.     

Cutaneous manifestations of adult T-cell leukemia/lymphoma

Adult T-cell leukemia/lymphoma (ATLL) is an aggressive peripheral T-cell lymphoma caused by the human T-lymphotropic virus type-1 (HTLV-1). The skin is affected in approximately half of ATLL patients, and it may be the first manifestation of the disease. The skin lesions of ATLL are polymorphous, and depending on the type of skin eruption, it is possible to predict the prognosis of the disease. Besides specific skin lesions, other non-specific lesions and increased risk of cutaneous and systemic infections are observed. In this article, we describe the different skin lesions of ATLL patients (specific, non-specific, and infectious lesions), the different histopathological patterns, and the association of clinicopathological characteristics with prognosis. Recognition of ATLL skin lesions is essential for the correct management and the search for the virus, even in non-endemic regions, where global migration may bring HTLV-1 infected individuals.     

人类白血病病毒Ⅰ型致成人T细胞白血病/淋巴瘤的研究进展

现已证实人类白血病病毒Ⅰ型（human T-cell leukemia virus Type-1,HTLV-Ⅰ）为成人T细胞白血病/淋巴瘤（adult T-cell leukemia/lymphoma,ATLL）的致病病原,在过去的几年中,人们对该肿瘤进行了大量的研究工作并且发现了一些分子遗传学改变,包括结构基因gag,pol,pro和env,调节基因tax和rex以及最近在pX区域的负股发现的hbz基因和Fra-2等。随着人们对成人T细胞白血病/淋巴瘤相关基因功能的不断探索,该肿瘤的发病机制会更加明确,其临床治疗也会得到进一步的改善。本文对HTLV-Ⅰ及成人T细胞白血病/淋巴瘤近年来的分子遗传学研究结果、临床特征、分子机制及遗传倾向的关系作一介绍。     

Immunoelectron-microscopic localization of Tac antigen in adult T-cell leukemia/lymphoma.

The localization of Tac antigen in adult T-cell leukemia-associated antigen (ATLA)-positive lymphomas was studied ultrastructurally with the use of the immunoperoxidase technique. The antigen was observed on the plasma membranes of a portion of the characteristic cells with convoluted nuclei and a majority of the cells with less irregular nuclei, which were larger than the former. In addition, the cisternae of the rough endoplasmic reticulum, perinuclear cisternae, and Golgi cisternae of the latter cells were also positively stained with anti-Tac antibody. It is thought that the positive reaction of the plasma membranes may correspond to interleukin 2 (IL 2) receptors, the cytoplasmic and perinuclear reaction sites may well correspond to the precursor of IL 2 receptors, and Tac antigen may be produced in the cytoplasm of the ATLA-positive lymphoma cells.     

NF-kappaB in pathogenesis and treatment of adult T-cell leukemia/lymphoma

Human T-cell leukemia/lymphoma virus type 1 (HTLV-1) induces aberrant nuclear factor-kappaB (NF-kappaB) activation. Although Tax is thought to play major roles in NF-kappaB activation, cells expressing Tax become a target of cytotoxic T cells. Accordingly, HTLV-1-infected cells lose Tax expression and acquire Tax-independent NF-kappaB activation. Blocking NF-kappaB not only induces apoptosis in adult T-cell leukemia/lymphoma (ATL) cells but also reduces the number of HTLV-1-infected cells in virus carriers. Therefore, because constitutively activated NF-kappaB appears to be the common biological basis shared between HTLV-1-infected untransformed cells and ATL cells, blocking NF-kappaB might be a potential strategy for treating and preventing ATL.     

Massive cardiac involvement of adult T-cell leukemia/lymphoma. An autopsy case

We describe an unusual autopsy case of adult T-cell leukemia/lymphoma with massive cardiac involvement. The patient was admitted to the hospital with symptoms of fever and cervical lymph node enlargement, which improved following treatment with vincristine sulfate, cyclophosphamide (Endoxan), prednisolone sodium succinate, and doxorubicin hydrochloride (Adriamycin). He was then followed up in the outpatient clinic, but was readmitted to the hospital with palpitations and dyspnea. Cardiomegaly developed rapidly, and the patient died of congestive heart failure 3 months after readmission. The heart was massively enlarged at autopsy. The heart, including adhered surrounding tissue, weighed 1600 g. The myocardium was found to be replaced by massive infiltration of atypical lymphoid cells. Cardiac involvement by adult T-cell leukemia/lymphoma may result from extension or retrograde flow through cardiac lymphatics from the destroyed mediastinal lymphatic system.     

Clonal evolution of T-cell prolymphocytic leukemia to a T-large-cell lymphoma. A morphologic and immunologic study

We describe a patient with T-cell prolymphocytic leukemia who developed a large-cell lymphoma of the T-cell type. The neoplastic cells of the large-cell lymphoma demonstrated the same immunologic phenotype (ER+, Leu-3+, Leu-2-, and HLA ABC+) as the cells of the prolymphocytic leukemia, which indicated a clonal evolution of a T-cell prolymphocytic leukemia into a large-cell lymphoma of the T-cell phenotype.     

Hypercalcemia associated with adult T-cell leukemia/lymphoma (ATL).

Hypercalcemia is a frequent manifestation of human T-cell lymphotrophic virus type I (HTLV-I)-associated adult T-cell leukemia/lymphoma (ATL). Human T-cell lymphotrophic virus type I infection is endemic in the Caribbean, Japan, Melanesia, and Africa. This article presents two cases of ATL to increase awareness of the disease by primary care physicians. The management of hypercalcemia is discussed.     

Potential for molecular targeted therapy for adult T-cell leukemia/lymphoma

Adult T-cell leukemia/lymphoma is an aggressive lymphoproliferative disorder of CD4+ T lymphocytes associated with human T-cell leukemia virus type 1 (HTLV-I) infection. Approximately 5% of infected people will develop an aggressive form of ATL, characterized by high circulating cell count, skin and organ infiltration and expression of cytokine, chemokine and survival genes. The available therapies for ATL have minimal efficacy, with few responders and poor survival. Recent advances have led to the identification of key molecules and cellular pathways involved in HTLV-1 mediated cellular transformation and tumor progression. We describe within a few key elements that contribute to neoplastic development of ATL, in addition to interesting molecular drug targets that may lead to more effective therapeutic strategies.     

The relationship of FOXP3 expression and clinicopathological characteristics in adult T-cell leukemia/lymphoma.

Adult T-cell leukemia/lymphoma is an aggressive malignant disease associated with regulatory T cells as discussed in some recent reports. We analyzed the expression of FOXP3, a key molecule of regulatory T cells, in adult T-cell leukemia/lymphoma and its association with clinicopathological features. Of 169 adult T-cell leukemia/lymphoma cases examined, 60 (36%) showed FOXP3 expression in lymphoma cells. Morphologically, 22 cases were classified as anaplastic large cell variant and 147 as pleomorphic cell variant. Only 1 (5%) of the anaplastic large cell variant cases and 59/147 (40%) of the pleomorphic cell variant cases expressed FOXP3. Epstein-Barr virus-infected cells were significantly more frequently found in FOXP3(+) cases (23/60; 38%) than in FOXP3(-) cases (12/109; 11%) (P<0.0001). Cytogenetic analysis showed that FOXP3(+) cases had simpler chromosomal abnormalities than FOXP3(-) cases. Clinically, FOXP3(+) and FOXP3(-) cases did not differ significantly in age distribution, clinical stage, lactate dehydrogenase and calcium in serum and overall survival. However, 8 of 34 FOXP3(+) cases suffered a severe infectious state, an indication of immunosuppression, while only 2 of 62 FOXP3(-) cases did so (P<0.005). FOXP3 expression in adult T-cell leukemia/lymphoma thus reflects morphological features and is clinically and pathologically associated with an immunosuppressive state.     

Human T-cell lymphotropic virus type I-associated adult T-cell leukemia/lymphoma in an atypical host

Human T-cell lymphotropic virus type I (HTLV-I) is a unique retrovirus associated with specific malignancies of T cells in humans. The virus is endemic to Japan, the Caribbean, Africa, and the southeastern United States. We report here the first case of HTLV-I-associated lymphoma in an atypical host. The incidence of antibodies in this individual with a T-cell malignancy strongly suggests HTLV-I virus as the causative agent. Direct identification of viral DNA using an HTLV-I-specific probe provides definitive evidence of infection.     

A case of adult T-cell leukemia/lymphoma, histologically presenting CD30-positive large cell lymphoma.

A 48-year-old Japanese woman with adult T-cell leukemia/lymphoma (ATLL), histologically presenting CD30-positive large cell lymphoma is reported. The patient, who was from an ATLL endemic area in Japan, had cutaneous nodules in the head, trunk, and extremities, and cervical lymph node swelling; these had been found three months before her admission to our hospital. A biopsy specimen of a skin lesion showed diffuse large cell lymphoma; the lymphoma cells were positively stained with CD30 (Ki-1/Ber H-2), CD4 (helper-T), and CD25 (interleukin-2 receptor) antibodies. Anti HTLV-1 antibody (ATLA) was detected in the serum, and molecular cytogenetic studies of lymphoma cells showed both positive T-cell receptor rearrangement and HTLV-1 specific DNA sequences.     

Adult T-cell lymphoma/leukemia in a Caribbean patient: cytogenetic, immunologic, and ultrastructural findings

Cytogenetic findings on immunologically and morphologically characterized leukemic cells from a Caribbean patient with adult T-cell lymphoma/leukemia (ATLL) (HTLV+) are reported. Marker studies on peripheral blood lymphoid cells showed a mature postthymic phenotype: TdT-, OKT3+, OKT4+, OKT6-, OKT8-, 3A1-, anti-HLA-DR-. Light and electron microscopic analysis revealed a great cellular pleomorphism with respect to nuclear features. Three main types of leukemic cell were observed: typical multilobed ATLL lymphocytes, Sézary's syndrome (SS) cells, and cells intermediate between those two. Chromosome studies on PHA-stimulated cultures revealed three clones. The predominant clone was hyperdiploid; significant abnormalities were 1q+, 14q+, and 6q- (breakpoint q21), which are known to occur in lymphoid malignancies, together with trisomy 7q and i(17q), which have been reported previously in Japanese ATLL and the small variant of SS, respectively. The 14q+ marker was t(11;14)(q13;q22-24). The incidence of 6q-, trisomy 7q, and i(17q) varied within the main clone, and it is speculated that these chromosome abnormalities might be related to the variation observed in the cell types of this patient. Two minor clones had 6q- (breakpoint q25) and 13q+ markers, respectively. It was not possible to unequivocally establish the relationship between these three clones. The chromosomal, morphologic, and immunologic findings in this case support a close relationship between ATLL in Japan and in the Caribbean basin, as well as between the proliferating cells of ATLL and SS.     

Adult T-cell leukemia: clinical and immunologic characterization of a nonendemic case

A 56-year-old black man with nonendemic adult T-cell leukemia is reported, who presented with severe hypercalcemia and leukemic leptomeningeal infiltration but had no evidence of bone marrow involvement. His malignant cells were characterized by light and transmission electron microscopy, cytogenetics, and flow cytometry. The cells demonstrated the deeply indented or convoluted nuclei characteristic of endemic human T-cell lymphoma virus-associated cases. Surface phenotyping indicated the cells' origin to be from the mature, helper/inducer subset of T-lymphocytes. However, there was no clinical or laboratory evidence that the malignant cells retained immunoregulatory function. The clinical and immunologic features of this and other nonendemic cases are compared with those of patients from the endemic regions of Japan, the Caribbean islands, and the southeastern United States.