Valencia Miller, Moreno Luis
Escuela de Medicina Facultad de Salud, Universidad del Valle Cali, Colombia.
Hospital Universitario del Valle "Evaristo Garcia" Cali, Colombia.
Colomb Med (Cali). 2017 Mar 30;48(1):35-38.
Adult T-cell Leukemia/Lymphoma (ATLL) is classified as a peripheral CD4+ T-cell neoplasm caused by the human T-cell lymphotropic virus type 1 (HTLV-1). Typical symptoms are associated with leukemic infiltration; however, atypical and exaggerated manifestations of verrucous carcinoma have also been described.
We present here the case of a patient with multiple skin lesions, ischemic necrosis in the hallux and lymphadenopathies. Biopsies were taken, which showed verrucous epidermal carcinoma and cutaneous lymphoma. Splenomegaly and adenopathy in mesentery, retro peritoneum and lymph node chains in the limbs were observed. Bone marrow examination showed findings compatible with T-cell leukemia/lymphoma; and it was ELISA positive for HTLV-1/2.
The patient had a good initial response to a CHOP scheme (cyclophosphamide, doxorubicin, vincristine and prednisone) with filgrastim. However, the patient had a relapse and died before the second cycle.
Comorbidity could lead to the associated risk factors model. According to this model, secondary immunodeficiency caused by HTLV-1 may induce the development of verrucous carcinomas; alternatively, the disease could be due to a correlation between HTLV-1 and the human papillomavirus (HPV).
成人T细胞白血病/淋巴瘤（ATLL）被归类为由1型人类嗜T细胞病毒（HTLV-1）引起的外周CD4 + T细胞肿瘤。典型症状与白血病浸润有关；然而，也有疣状癌的非典型和夸张表现的描述。
我们在此报告一例有多处皮肤病变、拇趾缺血性坏死和淋巴结病的患者。进行了活检，结果显示为疣状表皮癌和皮肤淋巴瘤。观察到脾肿大以及肠系膜、腹膜后和四肢淋巴结链的腺病。骨髓检查结果与T细胞白血病/淋巴瘤相符；HTLV-1/2的酶联免疫吸附测定（ELISA）呈阳性。
患者对含非格司亭的CHOP方案（环磷酰胺、阿霉素、长春新碱和泼尼松）有良好的初始反应。然而，患者复发并在第二个疗程前死亡。
合并症可能导致相关的危险因素模型。根据该模型，HTLV-1引起的继发性免疫缺陷可能诱发疣状癌的发展；或者，该疾病可能是由于HTLV-1与人类乳头瘤病毒（HPV）之间的相关性。
