A 45-year-old man from southern Japan presents with skin lesions, hypercalcemia, lytic bone lesions, and lymphadenopathy. Peripheral smear shows large atypical lymphoid cells with deeply lobulated nuclei resembling cloverleaves. Serology is positive for antibodies against a retrovirus. The diagnosis is:

• A Mycosis fungoides
• B Peripheral T-cell lymphoma, NOS
• C Adult T-cell leukemia/lymphoma ✓
• D Angioimmunoblastic T-cell lymphoma

Explanation

Adult T-cell leukemia/lymphoma is caused by HTLV-1, endemic in southwestern Japan, the Caribbean basin, and parts of Africa. It presents with skin lesions, generalized lymphadenopathy, hepatosplenomegaly, and hypercalcemia from osteoclast activation. The flower cells, pleomorphic lymphoid cells with multilobated nuclei, are characteristic on blood film. Mycosis fungoides shows cerebriform Sézary cells and stays largely cutaneous, while the other two entities lack the viral association and hypercalcemia pattern.

Reference: Robbins and Cotran Pathologic Basis of Disease, 10th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.