Kirito K, Shindou H, Chiba N, Tobinai K, Shimoyama M, Kinoshita T
Department of Internal Medicine, Yamanashi Central Hospital.
Rinsho Ketsueki. 1993 Dec;34(12):1550-5.
We described a case of adult T cell leukemia (ATL) not associated with human T-cell leukemia virus type I (HTLV-I), a clinical entity that was first reported by Shimoyama et al. A 79-year-old male was admitted with anorexia and fever in October, 1989. Physical examination revealed marked hepatosplenomegaly and superficial lymphadenopathies. Hematological examination revealed marked leukocytosis (136,300/microliters) with abnormal lymphoid cells showing highly lobulated nuclei. Hypercalcemia (11.2 mg/dl) and elevation of lactic dehydrogenase were also recognized. Surface marker analysis showed that the abnormal lymphoid cells in the peripheral blood were positive for CD2 and CD4 but negative for CD8. Southern blot analysis of the DNA from peripheral blood leukemic cells revealed monoclonal rearrangement of T-cell receptor beta-chain gene. The clinical and hematological findings of the patient were compatible with those of acute type ATL, however, serum anti-HTLV-I antibody was negative and HTLV-I proviral DNA was not detected in the leukemic cells by Southern blot analysis. Furthermore, the polymerase chain reaction showed no integration of the HTLV-I proviral DNA in the leukemic cells.
我们描述了一例与I型人类T细胞白血病病毒（HTLV-I）无关的成人T细胞白血病（ATL）病例，这是一种临床实体，最初由Shimoyama等人报道。一名79岁男性于1989年10月因厌食和发热入院。体格检查发现明显的肝脾肿大和浅表淋巴结病。血液学检查显示明显的白细胞增多（136,300/微升），异常淋巴细胞显示高度分叶核。还发现高钙血症（11.2毫克/分升）和乳酸脱氢酶升高。表面标志物分析显示外周血中的异常淋巴细胞CD2和CD4呈阳性，但CD8呈阴性。对外周血白血病细胞的DNA进行Southern印迹分析，发现T细胞受体β链基因发生单克隆重排。患者的临床和血液学表现与急性型ATL相符，然而，血清抗HTLV-I抗体为阴性，Southern印迹分析在白血病细胞中未检测到HTLV-I前病毒DNA。此外，聚合酶链反应显示白血病细胞中没有HTLV-I前病毒DNA的整合。
