A 47-year-old man presents with generalized skin infiltrates, hypercalcemia of 13.5 mg/dL, lytic bone lesions, and a white cell count of 90,000/uL with pleomorphic lymphoid cells showing deeply lobulated nuclei. Serology is positive for human T-cell leukemia virus type 1. What is the diagnosis?

• A Adult T-cell leukemia/lymphoma ✓
• B Sézary syndrome
• C Peripheral T-cell lymphoma, NOS
• D T-cell prolymphocytic leukemia

Explanation

HTLV-1 seropositivity combined with the flower or cloverleaf cells, hypercalcemia from osteoclast-activating cytokines, lytic lesions, and leukemic dissemination is the classic presentation of adult T-cell leukemia/lymphoma, endemic in southwestern Japan and the Caribbean basin. Sézary syndrome features cerebriform nuclei with erythroderma and lacks hypercalcemia, while T-PLL shows prolymphocytes with prominent nucleoli rather than lobulated flower cells.

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.