Clinical Features of Gastrointestinal Involvement in Patients with Adult T-cell Leukemia Shin-ichiro Aozaki 1 1Division of Internal Medicine, Saiseikai Sendai Hospital Keyword: 成人T細胞白血病(ATL) , 消化管病変 , 腫瘍細胞の浸潤・発育進展様式 , 糞線虫症 , Isospora belli感染症 pp.857-872
Published Date 1999/6/25
DOI https://doi.org/10.11477/mf.1403103080
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 In 22 adult T-cell leukemia (ATL) patients with gastrointestinal involvement, and who were treated at our institution, tumor cell infiltrative lesions of the gastrointestinal tract were investigated. Radiographic and endoscopic findings were examined with respect to manner of tumor cell infiltration and its growth/expansion, which are factors closely reflected in the images. Further, macroscopic features were classified by the manner of tumor cell infiltration and growth/expansion and these characteristics were described referring to the cases. Tumor cell infiltration was detected in the stomach in 18 of 22 patients, in the small intestine in nine of 17 patients and in the large intestine in nine of 16 patients who were examined. ATL had highly infiltrated a wide area in the gastrointestinal tract and infiltrative lesions tended to be multiple or diffuse. Based on findings on the imaging, the manner of tumor cell infiltration and growth/expansion and the macroscopic features were classified into the following three types ; 1) diffusely infiltrating type (superficial type) : tumor cells diffusely infiltrate the continuous wall of the gastrointestinal tract without forming a mass. The lesions appear flat without noticeable irregular mucosa on macroscopic observation,2) multiple nodular type : tumor cells infiltrate lymphoid follicles and form tumors, showing multiple protruded lesions like multiple lymphomatous polyposis (MLP) as a macroscopic feature, and 3) multiple and diffusely infiltrating type : tumor cells infiltrate a number of lymphoid follicles and form innumerable small elevated lesions. As a macroscopic feature, small protruded lesions resembling erosive gastritis are extensively observed.

 Highly leukemic cases mainly showed the type of infiltration and growth/expansion described in 1) and macroscopic features reflected this type of infiltration and growth/expansion. Other cases mainly showed the features described in 2 ) or 3 ) . Infiltrative lesions in the gastrointestinal tract in ATL may be closely associated with types of tumor cell infiltration of the gastrointestinal tract and growth/expansion as well as with the degree of infiltration, both of which are reflected in various macroscopic features. Further, the possibility of primary ATL in the gastrointestinal tract was described as shown by a case treated at our institution. Furthermore,ATL cases with opportunistic infection with Strongyloides stercoralis or Isospora belli were presented.

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