High prevalence of pulmonary findings in computed tomographies of HTLV-1-infected patients with and without adult-T cell leukemia/lymphoma - implications for staging

Abstract

Lung involvement has been reported in HTLV-1 carriers and in patients with ATLL. Whether there are differences in the pattern of lung involvement between ATLL and HTLV carriers in North American patients is unknown. We aimed to compare CT pulmonary findings among patients with HTLV-1 infection with and without ATLL. Among 140 patients with HTLV-1 diagnosis, 97 had CT chest available. Of these, 72 (74.2%) had ATLL and 25 (25.8%) did not have ATLL. CT chest abnormalities were present in 90 (92.8%) participants (94.4% in ATLL; 88% in non-ATLL). Higher rates of lymphadenopathy (69.4% versus 24%, p < .01) and lower rates of bronchiectasis (25% versus 48%, p = .04) were seen in ATLL compared to non-ATLL. Our study supports that staging of lung involvement in ATLL should consider HTLV-associated pulmonary findings as not all CT chest abnormalities necessarily represent malignant infiltration.

Keywords: ATLL; HTLV-1; T-cell lymphoma.

Figure 1.

Pulmonary findings in patient with HTLV-1 with and without ATLL. (A–C) Right lower lobe nodules (arrowheads) and bilateral mediastinal lymphadenopathy (arrows) in a 42-year-old male admitted with relapsed ATLL, acute form. (D) Extensive, mediastinal lymph nodes (arrows) compressing adjacent airways and vessels in an 82 year-old female with ATLL. (E) Pleural effusion (arrowhead) and pleural thickening (arrows) in a 57-year old female with ATLL. Pleural fluid immunophenotype compatible with ATLL. (F) Bronchiectasis in distal, subsegmental bilateral lower lobe bronchi in a patient with ATLL (arrows). ATLL: adult T-cell lymphoma/leukemia.