The cutaneous form of adult T‐cell leukemia/lymphoma in a woman from the ivory coast. Clinical, immunovirologic studies and a review of the African adult T‐cell leukemia/lymphoma cases

A 36‐year‐old woman from Ivory Coast, who has lived in France since 1976, had multiple cutaneous nodules and tumors in 1988. Histopathologic studies showed a massive infiltration of the dermis and hypodermis by a diffuse proliferation of mature activated T‐cells (CD4‐posi‐tive, CD25‐positive, HLA‐DR‐positive) with irregular nuclei. The patient did not present with a leukemic picture and only few lymphoid cells with abnormally shaped nuclei were present in the blood. Human T leukemia/lymphoma virus type I (HTLV‐I) antibodies were present in the serum and specific HTLV‐I pol sequences were detected in the DNA extracted from the tumor nodules and peripheral blood mononuclear cells (PBMC) using the polymerase chain reaction technique. Whereas only a polyclonal integration of HTLV‐I provirus was detectable in the PBMC, a clonal integration of three HTLV‐I proviruses was demonstrated in the tumor nodules DNA, establishing with certainty the diagnosis of HTLV‐I‐in‐duced adult T‐cell leukemia/lymphoma (ATL). This case illustrates the need for molecular studies to differentiate without ambiguity an ATL from any other type of cutaneous lymphoproliferation, even when it occurs in a HTLV‐I‐seropositive individual. The situation of HTLV‐I‐asso‐ciated ATL in Africa is reviewed. Cancer 1992; 69:1362‐1367.