咽頭痛，嗄声を主訴とした成人T細胞リンパ腫—白血病（ATL-L）の1例

A Case of Adult T Cell Lymphoma-Leukemia with Sore Throat and Hoarseness as Initial Symptoms

I．はじめに

　近年の免疫学の発達は目覚ましく，とくに細胞融合法の発展によりB細胞，T細胞亜群に特異的に反応する単クローン抗体が開発されるとともに，悪性リンパ腫の表面マーカーの検索に応用され，その病態生理の解明に重要な情報を提供している。

　先に筆者らは頭頸部悪性リンパ腫における表面マーカーおよび病理組織像と予後との関連を検索し，これらの解析の重要性^1〜3），さらに鼻性T細胞リンパ腫の存在を示唆した^4〜6）。

　A case of adult T cell lymphoma-leukemia (ATL-L), probably arised in Waldeyer's ring, was reported.

　The histological, immunological and ultrastructural features were analyzed, and anti-adult T cell leukemia antigen (ATLA) antibody of this patient's family was investigated. The patient complained of sore throat and hoarseness as the initial symptoms. Tumorous swelling of Waldeyer's ring, systemic lymphadenopathy, hepatosplenomegaly, and skin infiltration of tumor cells were observed on admission. Hypercalcemia and renal failure were complicated during hospitalization. Histopathological features showed "diffuse pleomorphic type (LSG's classification)", and ultrastructurally, most tumor cells were characterized by strikingly convoluted nuclei. Analyzing tumor surface markers, most tumor cells showed E-rosette formation, but no EAC-rosette formation, and stained with Leu-1 and Leu-3a antibodies, but not Leu-2a antibody. These findings suggested that the phenotype of tumor cells were determined as a helper/inducer T cell subset. Both the patient and his wife, both of them were born in Hokkaido, showed positive ATLA antibody. This result suggested that adult T cell leukemia virus (ATLV) was possibly transmitted horizontally from the husband to his wife.