Abstract
A 58-year-old female was admitted to our hospital on February 18, 1991 because of punched out lesions. No abnormal cells were revealed in the peripheral blood and bone marrow. Serum levels of BUN (93.1mg/dl), creatinine (2.7mg/dl) and calcium (14.5mg/dl) were elevated. M-component in her serum was not detected. X-ray of the skeleton revealed prominent punched out lesions in the skull and long tubular bones. On March 11, peripheral blood suddenly showed marked leukocytosis and hypercalcemia (21.0mg/dl). The flower cells appeared. Serum anti-HTLV-I antibodies was positive and HTLV-I proviral DNA was demonstrated in the peripheral lymphocytes. She was diagnosed as adult T-cell leukemia (ATL). Serum PTHrP level (319.0pmol/l) was also elevated. She was treated with CHOP regimen, but the patient died of disturbances of respiratory function due to brain metastasis. This might be a fairly rare case of ATL with punched out lesion.
