Abstracts
PO12
HTLV-1 Positive Peripheral T-Cell Lymphoma, NOS with Extensive Cutaneous, Soft Tissue and Osseous Involvement Complicated by Venous Thromboembolism: A Case Report
Introduction/Background/Significance:
Peripheral T-cell lymphoma, not otherwise specified (PTCL-NOS), is an aggressive mature T-cell neoplasm frequently associated with poor prognosis and advanced-stage disease at diagnosis. We report the case of a 53-year-old woman diagnosed with HTLV-1-positive PTCL-NOS presenting with extensive extranodal involvement.
Materials and Methods/Case Presentation/Objective:
Results/Description/Main Outcome Measure(s):
Conclusion(s).:
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Peripheral T-cell lymphoma, not otherwise specified (PTCL-NOS), is an aggressive mature T-cell neoplasm frequently associated with poor prognosis and advanced-stage disease at diagnosis. We report the case of a 53-year-old woman diagnosed with HTLV-1-positive PTCL-NOS presenting with extensive extranodal involvement.
Materials and Methods/Case Presentation/Objective:
The patient presented with a progressively enlarging right thigh mass evolving over approximately 12 months, followed by multiple painful cutaneous and subcutaneous pseudotumoral lesions involving the gluteal region, abdominal wall, and lower extremities. Imaging studies revealed extensive cutaneous, subcutaneous, muscular, and osseous involvement, including osteolytic iliac lesions. Histopathological examination of the right thigh tumor demonstrated diffuse dermal and hypodermal infiltration by atypical medium-to-large lymphoid cells with a high proliferative index (Ki67 >75%). Immunohistochemistry showed tumor cells positive for CD3, CD5, CD4, CD8, CD25, MUM1, and partially positive for CD30, supporting the diagnosis of PTCL-NOS. HTLV-1 serology was positive, while HIV, HBV, and HCV testing were negative.
The disease was classified as Ann Arbor stage IVA with an International Prognostic Index (IPI) score of 3, corresponding to intermediate-high risk disease. The patient received CHOP chemotherapy, associated with opportunistic infection prophylaxis and subsequent antiretroviral therapy with zidovudine after infectious disease evaluation. During treatment, the clinical course was complicated by extensive venous thromboembolism, including right femoro-popliteal and iliac deep vein thrombosis associated with bilateral minor pulmonary embolism, requiring therapeutic anticoagulation.
Results/Description/Main Outcome Measure(s):
Conclusion(s).:
This case highlights the aggressive clinical behavior of PTCL-NOS associated with HTLV-1 positivity, characterized by extensive extranodal dissemination and thromboembolic complications during treatment. Early recognition of unusual cutaneous and soft-tissue manifestations, comprehensive staging, and multidisciplinary management are essential for these high-risk patients. Hematopoietic stem cell transplantation evaluation was initiated as a consolidation strategy depending on treatment response.
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