1993 Volume 35 Issue 4 Pages 755-762_1
We report two cases of adult T cell leukemia (ATL) invading the stomach wall. Case 1: A 52-year-old man born in Okayama prefecture was hospitalized because of epigastralgia. Endoscopic examination revealed erosions with erythema on the anterior wall of the fornix. The biopsy specimen showed diffuse infiltration of the abnormal lymphocytes with convoluted or lobulated nuclei to the mucosa. Immunohistochemical studies showed that they had T cell surface markers. HTLV-1 antibody titer was elevated to 1: 4, 096 and he was diagnosed as having ATL. Fifteen days later, a second endoscopic examination was performed. It revealed new fine granular lesions on the greater curvature of the stomach. Histological examination of the biopsy specimen of these lesions showed the same cellular infiltration. The erosions on the anterior wall got worse with marked erythema and petechiae. He was treated by VEPA chemotherapy, and improvement of the gastric lesions with ATL cells infiltration was observed on the subsequent endoscopic examinations. Case 2 : A 44-year-old man born Kagoshima prefecture attended our hospital because of generalized skin eruptions wihout itching. A hemogram showed that the white blood cell count was 5, 700/mm3 with 10% abnormal lymphocytes. He was admitted and diagnosed as having ATL because HTLV-1 proviral DNA was detected from biopsy specimens of the skin eruptions by Southern blot analysis. Endoscopic examination was performed to investigate dysphagia. It revealed verrucous lesions in the antrum, a huge mass with a giant ulcer in the lower body, and giant folds with erosions in the upper body of the stomach. Histologically, infiltration of ATL cells was found in all of these lesions. This is a rare case where a variety of forms of infiltration of ATL cells were observed at the same time.
