CLINICOPATHOLOGICAL ASPECTS OF HTLV-1 POSITIVE AND NEGATIVE CUTANEOUST-CELL LYMPHOMA

The clinico-pathological and immunohistochemical features of 17 cases of HTLV-1(+) cutaneous T-cell lymphoma (CTCL) are compared with 17 cas es of HTLV-1(-) CTCL. All patients were from the same geographical are a in Northeastern Brazil, an area endemic for HTLV-1(+) infection. In all patients, cutaneous lesions were the first clinical manifestation of disease. In both the HTLV-1(+) and the HTLV-1(-) groups, 12 patient s had pleomorphic lymphoma and 5 had mycosis fungoides (MF). Clinical subtypes in the HTLV-1(+) group included five cases of acute, two case s of chronic, nine cases of smoldering and one case of lymphoma type a dult T-cell leukemia/lymphoma (ATL). A few clinical differences were n oticed between the two groups: a marked predominance of black, mulatto and male subjects, a more aggressive course and a higher frequency of erythroderma and disseminated skin lesions in the HTLV-1(+) patients. However, around 40% of the HTLV-1(+) patients had an indolent course of disease with an evolution of up to 20 years. No specific histopatho logical features that could allow a distinction between HTLV-1(+) and HTLV-1(-) lymphomas were found. No significant differences were observ ed between the two groups concerning the intensity of cellular pleomor phism, cellular size, epidermotropism, frequency and size of Pautrier' s abscesses, fibrosis of the papillary derma, and eosinophilic infiltr ate. In two HTLV-1(+) lymphomas, atypical multinucleated giant cells w ere present. Considering the present knowledge concerning ATL and CTCL , it seems more appropriate to designate CTCL as HTLV-1(+) or HTLV-1(- ) and morphologically as pleomorphic, MF, large cell anaplastic lympho ma or other histological types. The use of the terminology, cutaneous type of ATL, is confusing since there are HTLV-1(+) cutaneous lymphoma s with clinical and histological features distinctly different from AT L.