A 42-year-old man from southern Japan presents with generalized lymphadenopathy, hypercalcemia (13.2 mg/dL), and skin lesions. Peripheral blood shows characteristic flower cells (CD4+ T cells with convoluted nuclei). HTLV-1 serology is positive. What is the most likely diagnosis?
- A Adult T-cell leukemia/lymphoma (ATLL), acute type ✓
- B Mycosis fungoides
- C Angioimmunoblastic T-cell lymphoma
- D T-cell prolymphocytic leukemia
Correct answer: A. Adult T-cell leukemia/lymphoma (ATLL), acute type
Explanation
Adult T-cell leukemia/lymphoma is caused by HTLV-1 and is endemic in southern Japan and the Caribbean. The acute type presents with lymphadenopathy, hypercalcemia (mediated by PTHrP), skin lesions, and flower cells on smear. Mycosis fungoides has cerebriform cells and patches/plasmacytoid plaques but no hypercalcemia. Angioimmunoblastic T-cell lymphoma is HTLV-1 negative. T-cell PLL presents with marked leukocytosis without hypercalcemia.
Reference: Robbins and Cotran Pathologic Basis of Disease, 10th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
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