Massive acroosteolysis in adult T-cell leukemia/lymphoma

Human T cell lymphotropic virus type-1 associated lymphoma presenting as an intramuscular mass of the calf

Adult T cell leukemia/lymphoma (ATLL) is a mature T cell neoplasm caused by the human oncogenic retrovirus human T lymphotropic virus type-1 (HTLV-1). While several musculoskeletal manifestations have been described in ATLL, skeletal muscle involvement is unusual, with only four cases reported in the English-language literature. We present a rare case of ATLL manifesting as an intra-muscular calf mass in a 58-year-old man who immigrated to the USA from West Africa. While skeletal muscle involvement by lymphoma is uncommon, it remains important to consider within the differential diagnosis when there are suggestive imaging findings because it entails important technical biopsy considerations as well as treatment implications. This case report also raises awareness of ATLL presenting outside of typical HTLV-1 endemic areas, related to current population migration patterns. ATLL should therefore be considered in patients with appropriate risk factors.

Multiple osteolytic lesions and testicular involvement at first relapse of follicular lymphoma grade 1 in transformation

A 62-year-old man was initially diagnosed with stage IA follicular lymphoma grade 1 of the left tonsil. Shortly after radiotherapy he rapidly developed multiple painful acroosteolytic lesions and testicular involvement. The histological examination revealed a transformed lymphoma in the testis (DLCL) and follicular lymphoma in the acroosteolytic lesions. The clonal identity of lymphoma cells within the primary biopsy as well as in the two sites at relapse was shown by PCR and nucleotide sequence analysis of the lymphoma clone specific B-cell receptor rearrangement. Chemotherapy with six cycles of CHOP followed by high dose chemotherapy and autologous blood stem cell transplantation led to a complete clinical remission with disappearance of all osteolytic lesions.

The radiological features of adult T-cell leukaemia/lymphoma

Adult T-cell leukaemia/lymphoma (ATLL) results from a monoclonal expansion of T-cells infected with the human T-cell lymphotropic virus type 1 (HTLV-1). Six cases of ATLL, three males and three females all from the Caribbean and with a mean age of 55 years, have been reviewed retrospectively, illustrating the wide spectrum of radiological changes. One patient had extensive mediastinal adenopathy, hitherto an unrecorded finding in ATLL.