A case of cutaneous nodular adult T-cell leukemia/lymphoma treated with biweekly CHOP chemotherapy and local electron beam irradation

A 69-year-old Japanese woman presented multiple cutaneous nudules on her left upper arm, left thigh and left ankle, but demonstrated no palpable surface lymphadenopathy. We could not detect any extra-cutaneous lesions based on the findings of abdominal echography, chest and abdominal computed tomography and Ga-scintigraphy. The leukocyte count in the peripheral blood was 4800/mm³ with 3% circulating atypical lymphoid cells. Anti-HTLV-1 antibody was positive in her sera. Histologically, the nodule was diagnosed to be malignant lymphoma, diffuse pleomorphic type. A southern blot analysis showed the monoclonal integration of HTLV-1 proviral DNA into the atypical cells of a cutaneous nodule. Based on these clinical and laboratory findings, the patient was diagnosed to have adult T-cell leukemia/lymphoma, cutaneous nodular type. She was treated with one cycle of CHOP and 5 cycles of THP-COP chemotherapy associated with 30 Gy of local electron beam irradiation.