Clinicopathological studies of a patient with adult T-cell leukemia and pseudogynecomasty

We present a rare case of adult T cell leukemia/lymphoma (ATL) in which leu kemic T cells expressed CD4 and CD25 surface antigens and infiltrated mamma ry glands during clinical course of the disease. A 40-year-old male was adm itted with long-standing skin lesions and leukocytosis. Peripheral blood ly mphocytes were highly pleomorphic and presented CD2, CD4, CD25, CD38 membra ne surface antigens. The patient proved to be seropositive for human T-cell lymphotropic virus type I (HTLV-I) antibodies. Monoclonal expansion of lym phoid cells integrated with HTLV-I genome was observed, and the diagnosis o f AIL chronic type was made. He underwent a chemotherapy regimen, and skin lesions and leukocytosis improved markedly. He progressed with an indolent clinical course of ATL, when he was admitted with bilateral hyperplasia of breast, recurrent skin lesions, and leukocytosis. Breast biopsy revealed bi lateral gynecomasty, extensive leukemic infiltration of typical ATL cells i n the mammary glands, and the presence of mammary epithelial cells producti vely infected with HTLV-I. This is the first report describing invasion of the mammary tissue with HTLV-l-transformed T-cells and HTLV-l-associated br east disease. (C) 2000 Wiley-Liss, Inc.