Adult T-cell leukemia pathophysiology: Difference between revisions

Jump to navigation Jump to search
No edit summary
(19 intermediate revisions by 5 users not shown)
Line 1: Line 1:
__NOTOC__
__NOTOC__
{{Adult T-cell leukemia}}
{{Adult T-cell leukemia}}
{{CMG}} {{AE}}{{HL}}
{{CMG}} {{AE}}{{HL}}{{AIDA}}  
==Overview==
==Overview==
Adult T‐cell leukemia arises from post‐thymic [[lymphocyte]]s, which are normally involved in the process of [[immune system|cell-mediated immune response]].<ref name="pmid18042693">{{cite journal |vauthors=Matutes E |title=Adult T-cell leukaemia/lymphoma |journal=J. Clin. Pathol. |volume=60 |issue=12 |pages=1373–7 |year=2007 |pmid=18042693 |pmc=2095573 |doi=10.1136/jcp.2007.052456 |url=}}</ref><ref name=wiki>Adult T-cell leukemia/lymphoma. Wikipedia (2015) https://en.wikipedia.org/wiki/Adult_T-cell_leukemia/lymphoma Accessed on November, 3 2015</ref><ref name="wiki1">Human T-lymphotropic virus. Wikipedia (2015) https://en.wikipedia.org/wiki/Human_T-lymphotropic_virus#Transmission Accessed on November, 3 2015</ref><ref name="patho">Lymphoma. Libre Pathology (2015) http://librepathology.org/wiki/index.php/Lymphoma#Adult_T-cell_leukemia.2Flymphoma Accessed on November, 3 2015</ref><ref name="patho2">Adult T-cell Leukemia. PathologyOutlines (2015) http://www.pathologyoutlines.com/topic/lymphomanonBatlv.html Accessed on November, 3 2015</ref> Development of adult T-cell leukemia is the result of multiple [[genetic mutation]]s induced by an [[infection]] with human T‐cell lymphotropic virus ([[HTLV]]). On gross pathology, skin [[nodule]]s, [[maculopapular]] eruption, and [[erythema]] are characteristic skin findings of adult T-cell leukemia. On microscopic histopathological analysis, characteristic findings of adult T-cell leukemia include pleomorphic, medium sized lymphocytes with a polylobated [[nucleus]] and agranular [[cytoplasm]].
Adult T‐cell leukemia arises from post‐thymic [[lymphocyte]]s, which are normally involved in the process of [[immune system|cell-mediated immune response]]. Development of adult T-cell leukemia is the result of multiple [[genetic mutation]]s induced by an [[infection]] with human T‐cell lymphotropic virus ([[HTLV]]). On gross pathology, skin [[nodule]]s, [[maculopapular]] eruption, and [[erythema]] are characteristic skin findings of adult T-cell leukemia. On microscopic histopathological analysis, characteristic findings of adult T-cell leukemia include pleomorphic, medium sized [[lymphocytes]] with a polylobulated [[nucleus]] and agranular [[cytoplasm]].


==Pathogenesis==
==Pathogenesis==
* Adult T‐cell leukemia arises from post‐thymic [[lymphocytes]], which are normally involved in the process of [[immune system|cell-mediated immune response]].<ref name="pmid18042693">{{cite journal |vauthors=Matutes E |title=Adult T-cell leukaemia/lymphoma |journal=J. Clin. Pathol. |volume=60 |issue=12 |pages=1373–7 |year=2007 |pmid=18042693 |pmc=2095573 |doi=10.1136/jcp.2007.052456 |url=}}</ref><ref name=wiki>Adult T-cell leukemia/lymphoma. Wikipedia (2015) https://en.wikipedia.org/wiki/Adult_T-cell_leukemia/lymphoma Accessed on November, 3 2015</ref><ref name="wiki1">Human T-lymphotropic virus. Wikipedia (2015) https://en.wikipedia.org/wiki/Human_T-lymphotropic_virus#Transmission Accessed on November, 3 2015</ref><ref name="patho">Lymphoma. Libre Pathology (2015) http://librepathology.org/wiki/index.php/Lymphoma#Adult_T-cell_leukemia.2Flymphoma Accessed on November, 3 2015</ref><ref name="patho2">Adult T-cell Leukemia. PathologyOutlines (2015) http://www.pathologyoutlines.com/topic/lymphomanonBatlv.html Accessed on November, 3 2015</ref>
The exact mechanism of pathogenesis of the adult T‐cell leukemia is unknown. 
* Adult T‐cell leukemia is mainly caused by an [[infection]] with human T‐cell lymphotropic virus ([[HTLV]]).
* Adult T‐cell leukemia arises from post‐thymic [[lymphocytes]], which are normally involved in the process of [[immune system|cell-mediated immune response]].<ref name="pmid18042693">{{cite journal |vauthors=Matutes E |title=Adult T-cell leukaemia/lymphoma |journal=J. Clin. Pathol. |volume=60 |issue=12 |pages=1373–7 |year=2007 |pmid=18042693 |pmc=2095573 |doi=10.1136/jcp.2007.052456 |url=}}</ref><ref name="wiki">Adult T-cell leukemia/lymphoma. Wikipedia (2015) https://en.wikipedia.org/wiki/Adult_T-cell_leukemia/lymphoma Accessed on November, 3 2015</ref><ref name="wiki1">Human T-lymphotropic virus. Wikipedia (2015) https://en.wikipedia.org/wiki/Human_T-lymphotropic_virus#Transmission Accessed on November, 3 2015</ref><ref name="patho">Lymphoma. Libre Pathology (2015) http://librepathology.org/wiki/index.php/Lymphoma#Adult_T-cell_leukemia.2Flymphoma Accessed on November, 3 2015</ref><ref name="patho2">Adult T-cell Leukemia. PathologyOutlines (2015) http://www.pathologyoutlines.com/topic/lymphomanonBatlv.html Accessed on November, 3 2015</ref>
* [[HTLV]] is usually transmitted via [[breast feeding]] early in life.
* Adult T‐cell leukemia is mainly caused by an [[infection]] with human T‐cell lymphotropic virus ([[HTLV]]) <ref name="pmid279250512">{{cite journal |vauthors=Oliveira PD, Farre L, Bittencourt AL |title=Adult T-cell leukemia/lymphoma |journal=Rev Assoc Med Bras (1992) |volume=62 |issue=7 |pages=691–700 |date=October 2016 |pmid=27925051 |doi=10.1590/1806-9282.62.07.691 |url=}}</ref>.
* Other minor routes of transmission for HTLV may include [[sexual contact]], exposure to [[contamination|contaminated]] [[blood]], or vertical maternal transmission.
* [[HTLV]] is usually transmitted via [[breast feeding]] early in life. Other minor routes of transmission for [[Human T-lymphotropic virus|HTLV]] may include [[sexual contact]], exposure to [[contamination|contaminated]] [[blood]], or vertical maternal transmission <ref name="pmid6261256">{{cite journal |vauthors=Poiesz BJ, Ruscetti FW, Gazdar AF, Bunn PA, Minna JD, Gallo RC |title=Detection and isolation of type C retrovirus particles from fresh and cultured lymphocytes of a patient with cutaneous T-cell lymphoma |journal=Proc. Natl. Acad. Sci. U.S.A. |volume=77 |issue=12 |pages=7415–9 |date=December 1980 |pmid=6261256 |pmc=350514 |doi= |url=}}</ref>.
* There appears to be a long latent period between HTLV-1 infection and the development of adult T‐cell leukemia.
* There appears to be a long latent period between [[Human T-lymphotropic virus|HTLV]]-1 infection and the development of adult T‐cell leukemia.
* The oncogenesis of HTLV infection, which results in the development of adult T-cell leukemia, is due to:
* The oncogenesis of [[Human T-lymphotropic virus|HTLV]] infection, which results in the development of adult T-cell leukemia, is due to:
:* HTLV basic [[leucine zipper]] factor  
:* [[Human T-lymphotropic virus|HTLV]] basic [[leucine zipper]] factor  
:* HTLV p40 tax viral [[protein]]
:* [[Human T-lymphotropic virus|HTLV]] p40 tax viral [[protein]]
:* Activation of [[JAK]]/[[STAT]] signaling pathway by HTLV
:* Activation of [[JAK]]/[[STAT]] signaling pathway by [[Human T-lymphotropic virus|HTLV]]
:* Enhancement of [[CREB]] [[transcription factor]] by HTLV
:* Enhancement of [[CREB]] [[transcription factor]] by [[Human T-lymphotropic virus|HTLV]]
* Adult T‐cell leukemia can manifests as either a [[leukemic]] form (75% of the cases) or a pure [[lymphoma|lymphomatous]] form (25% of the cases).  
* Adult T‐cell leukemia can manifests as either a [[leukemic]] form (75% of the cases) or a pure [[lymphoma|lymphomatous]] form (25% of the cases).  
* Adult T‐cell leukemia is a widely disseminated disease which may involve the peripheral blood cells, [[bone marrow]], [[lymph node]]s, [[liver]], [[spleen]], [[skin]], and [[CNS]].
* Adult T‐cell leukemia is a widely disseminated disease which may involve the peripheral [[Blood cell|blood cells]], [[bone marrow]], [[lymph node]]s, [[liver]], [[spleen]], [[skin]], and [[CNS]].
* Haematopathological features of adult T-cell leukemia are variable, patients may present with:
* Hematopathological features of adult T-cell leukemia are variable, which may include:
:* [[Anemia]]
:* [[Anemia]]
:* [[Thrombocytopenia]]
:* [[Thrombocytopenia]]
:* [[Neutrophilia]]
:* [[Neutrophilia]]
:* [[Eosinophilia]]
:* [[Eosinophilia]]
*  Patchy bone marrow infiltration among adult T-cell leukemia patients may result in:
*  Patchy [[Bone marrow suppression|bone marrow infiltration]] among adult T-cell leukemia patients may result in:
:* Tumor-induced osteolysis due to increased [[osteoclast|osteoclastic activity]]
:* Tumor-induced [[osteolysis]] due to increased [[osteoclast|osteoclastic activity]]
:* Multiple [[lytic]] bone lesions
:* Multiple [[lytic]] bone lesions
:* [[Hypercalcemia]]
:* [[Hypercalcemia]]
* Hypercalcemia among adult T-cell leukemia patients has been associated with elevated serum concentrations of:
* [[Hypercalcemia]] among adult T-cell leukemia patients has been associated with elevated serum concentrations of:
:* [[IL-1]]
:* [[IL-1]]
:* [[TGFβ]]
:* [[TGFβ]]
Line 33: Line 33:
:* MIP-1α
:* MIP-1α
:* [[RANKL]]
:* [[RANKL]]
* Infiltration of malignant leukemic cells results in the expansion of the lymph nodes paracortical region, which may lead to the development of peripheral [[lymphadenopathy]] among adult T-cell leukemia patients.
* Infiltration of malignant leukemic cells results in the expansion of the [[lymph node]]s paracortical region, which may lead to the development of peripheral [[lymphadenopathy]] among adult T-cell leukemia patients.
* Infiltration of the [[liver]] and [[spleen]] may lead to the development of organomegally among adult T-cell leukemia patients.
* Infiltration of the [[liver]] and [[spleen]] may lead to the development of [[organomegaly]] among adult T-cell leukemia patients.
* [[Cutaneous]] manifestations of adult T-cell leukemia is due to the infiltration of leukmeic cells along the [[dermis]] layer of the [[skin]].
* [[Cutaneous]] manifestations of adult T-cell leukemia is due to the infiltration of [[Leukemic|leukemic cells]] along the [[dermis]] layer of the [[skin]].
* Cutaneous [[mycosis|Pautrier's microabcesses]] formation (due to epidermotropism) may also be present among adult T-cell leukemia patients. These cutaneous lesions are indistinguishable from the ones found in [[Sézary syndrome]] and [[mycosis fungoides]].  
* Cutaneous Pautrier's microabscesses formation (due to epidermotropism) may also be present among adult T-cell leukemia patients. These cutaneous lesions are indistinguishable from the ones found in [[Sézary syndrome]] and [[mycosis fungoides]].  
* [[Immune deficiency]] occurs in adult T-cell leukemia due to a defective cell-mediated immunity.
* [[Immune deficiency]] occurs in adult T-cell leukemia due to a defective [[cell-mediated immunity]].


==Genetic==
==Genetic==
* Development of adult T-cell leukemia is the result of multiple [[genetic mutation]]s.<ref name="pmid18042693">{{cite journal |vauthors=Matutes E |title=Adult T-cell leukaemia/lymphoma |journal=J. Clin. Pathol. |volume=60 |issue=12 |pages=1373–7 |year=2007 |pmid=18042693 |pmc=2095573 |doi=10.1136/jcp.2007.052456 |url=}}</ref><ref name=wiki>Adult T-cell leukemia/lymphoma. Wikipedia (2015) https://en.wikipedia.org/wiki/Adult_T-cell_leukemia/lymphoma Accessed on November, 3 2015</ref><ref name="wiki1">Human T-lymphotropic virus. Wikipedia (2015) https://en.wikipedia.org/wiki/Human_T-lymphotropic_virus#Transmission Accessed on November, 3 2015</ref><ref name="patho">Lymphoma. Libre Pathology (2015) http://librepathology.org/wiki/index.php/Lymphoma#Adult_T-cell_leukemia.2Flymphoma Accessed on November, 3 2015</ref><ref name="patho2">Adult T-cell Leukemia. PathologyOutlines (2015) http://www.pathologyoutlines.com/topic/lymphomanonBatlv.html Accessed on November, 3 2015</ref>
* Development of adult T-cell leukemia is the result of multiple [[genetic mutation]]s.<ref name="pmid18042693">{{cite journal |vauthors=Matutes E |title=Adult T-cell leukaemia/lymphoma |journal=J. Clin. Pathol. |volume=60 |issue=12 |pages=1373–7 |year=2007 |pmid=18042693 |pmc=2095573 |doi=10.1136/jcp.2007.052456 |url=}}</ref><ref name="wiki">Adult T-cell leukemia/lymphoma. Wikipedia (2015) https://en.wikipedia.org/wiki/Adult_T-cell_leukemia/lymphoma Accessed on November, 3 2015</ref><ref name="wiki1">Human T-lymphotropic virus. Wikipedia (2015) https://en.wikipedia.org/wiki/Human_T-lymphotropic_virus#Transmission Accessed on November, 3 2015</ref><ref name="patho">Lymphoma. Libre Pathology (2015) http://librepathology.org/wiki/index.php/Lymphoma#Adult_T-cell_leukemia.2Flymphoma Accessed on November, 3 2015</ref><ref name="patho2">Adult T-cell Leukemia. PathologyOutlines (2015) http://www.pathologyoutlines.com/topic/lymphomanonBatlv.html Accessed on November, 3 2015</ref>
 
* [[Gene]]s involved in the pathogenesis of adult T-cell leukemia include:
:* 14q11 gene mutation
:* [[TCR|TCR‐alpha]] chain gene mutation
:* [[TCR|TCR‐delta]] chain gene mutation


* [[Gene]]s involved in the pathogenesis of adult T-cell leukemia include:
** 14q11 gene mutation
** [[TCR|TCR‐alpha]] chain gene mutation
** [[TCR|TCR‐delta]] chain gene mutation
==Gross Pathology==
==Gross Pathology==
* On gross pathology,  skin nodules, maculopapular eruption, and erythroderma are characteristic skin findings of adult T-cell leukemia.<ref name="patho2">Adult T-cell Leukemia. PathologyOutlines (2015) http://www.pathologyoutlines.com/topic/lymphomanonBatlv.html Accessed on November, 3 2015</ref><ref name="pmid18377598">{{cite journal| author=Pezeshkpoor F, Yazdanpanah MJ, Shirdel A| title=Specific cutaneous manifestations in adult T-cell leukemia/lymphoma. | journal=Int J Dermatol | year= 2008 | volume= 47 | issue= 4 | pages= 359-62 | pmid=18377598 | doi=10.1111/j.1365-4632.2008.03526.x | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=18377598  }} </ref>
* On gross pathology,  [[skin]] nodules, [[maculopapular]] eruption, and [[erythema]] are characteristic findings of adult T-cell leukemia.<ref name="patho2">Adult T-cell Leukemia. PathologyOutlines (2015) http://www.pathologyoutlines.com/topic/lymphomanonBatlv.html Accessed on November, 3 2015</ref><ref name="pmid18377598">{{cite journal| author=Pezeshkpoor F, Yazdanpanah MJ, Shirdel A| title=Specific cutaneous manifestations in adult T-cell leukemia/lymphoma. | journal=Int J Dermatol | year= 2008 | volume= 47 | issue= 4 | pages= 359-62 | pmid=18377598 | doi=10.1111/j.1365-4632.2008.03526.x | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=18377598  }} </ref>


==Mircoscopic Pathology==
==Microscopic Pathology==
* On microscopic histopathological analysis, characteristic findings of adult T-cell leukemia include:
* On microscopic histopathological analysis, characteristic findings of adult T-cell leukemia include:
:* Pleomorphic, medium sized lymphocytes
:* Pleomorphic, medium sized [[lymphocyte]]s
:* Convoluted or polylobated nucleus with condensed chromatin (cloverleaf nuclei)
:* Convoluted or polylobulated [[nucleus]] with condensed [[chromatin]] (cloverleaf nuclei)
:* Nucleoli are not visible
:* [[Nucleoli]] are not visible
:* Agranular cytoplasm  
:* Agranular [[cytoplasm]]
:* “Flower cells”
:* “Flower cells”
:* Reed-Sternberg like cells may also be present
:* [[Reed-Sternberg cells|Reed-Sternberg]]-like cells may also be present
 
* On immunohistochemical analysis, characteristic findings of adult T-cell leukemia include:
:* CD2 +ve
:* CD4 +ve
:* CD5 +ve
:* CD8 +ve
:* CD7 -ve
:* CD3 and T‐cell receptor (TCR)‐β may be down‐regulated


* On [[Immunohistochemistry|immunohistochemical]] analysis, characteristic findings of adult T-cell leukemia include <ref name="pmid17951212">{{cite journal |vauthors=Bittencourt AL, da Graças Vieira M, Brites CR, Farre L, Barbosa HS |title=Adult T-cell leukemia/lymphoma in Bahia, Brazil: analysis of prognostic factors in a group of 70 patients |journal=Am. J. Clin. Pathol. |volume=128 |issue=5 |pages=875–82 |date=November 2007 |pmid=17951212 |doi=10.1309/2YGD1P0QCVCWBLDX |url=}}</ref>:
:* [[CD2]] +ve
:* [[CD3 (immunology)|CD3]] +ve
:* [[CD4]] +ve
:* [[CD5]] +ve
:* [[CD8|CD7]] +ve
:* [[CD7|CD8]] -ve
:* [[CD2]]0 +ve
:* [[CD25]] +ve
:* [[CD79a]] +ve
:* CD3 and [[TCR|T‐cell receptor]] (TCR)‐β may be down‐regulated


==References==
==References==
{{reflist|2}}
{{reflist|2}}
 
[[Category:Medicine]]
{{WH}}
[[Category:Hematology]]
{{WS}}
[[Category:Immunology]]
 
[[Category:Infectious disease]]
[[Category:Oncology]]
[[Category:Oncology]]
[[Category:Disease]]
[[Category:Up-To-Date]]
[[Category:Pathology]]
[[Category:Primary care]]
[[Category:Hematology]]

Revision as of 23:12, 12 November 2018

Adult T-cell leukemia Microchapters

Home

Overview

Historical Perspective

Classification

Pathophysiology

Causes

Differentiating Adult T-cell leukemia from other Diseases

Epidemiology and Demographics

Risk Factors

Screening

Natural History, Complications and Prognosis

Diagnosis

Diagnostic study of choice

History and Symptoms

Physical Examination

Laboratory Findings

Electrocardiogram

X-Ray Findings

Echocardiography and Ultrasound

CT scan

MRI Findings

Other Imaging Findings

Other Diagnostic Studies

Treatment

Medical Therapy

Interventions

Surgery

Primary Prevention

Secondary Prevention

Cost-Effectiveness of Therapy

Future or Investigational Therapies

Case Studies

Case #1

Adult T-cell leukemia pathophysiology On the Web

Most recent articles

Most cited articles

Review articles

CME Programs

Powerpoint slides

Images

American Roentgen Ray Society Images of Adult T-cell leukemia pathophysiology

All Images
X-rays
Echo & Ultrasound
CT Images
MRI

Ongoing Trials at Clinical Trials.gov

US National Guidelines Clearinghouse

NICE Guidance

FDA on Adult T-cell leukemia pathophysiology

CDC on Adult T-cell leukemia pathophysiology

Adult T-cell leukemia pathophysiology in the news

Blogs on Adult T-cell leukemia pathophysiology

Directions to Hospitals Treating Adult T-cell leukemia

Risk calculators and risk factors for Adult T-cell leukemia pathophysiology

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Haytham Allaham, M.D. [2]Aida Javanbakht, M.D.

Overview

Adult T‐cell leukemia arises from post‐thymic lymphocytes, which are normally involved in the process of cell-mediated immune response. Development of adult T-cell leukemia is the result of multiple genetic mutations induced by an infection with human T‐cell lymphotropic virus (HTLV). On gross pathology, skin nodules, maculopapular eruption, and erythema are characteristic skin findings of adult T-cell leukemia. On microscopic histopathological analysis, characteristic findings of adult T-cell leukemia include pleomorphic, medium sized lymphocytes with a polylobulated nucleus and agranular cytoplasm.

Pathogenesis

The exact mechanism of pathogenesis of the adult T‐cell leukemia is unknown.

  • Adult T‐cell leukemia arises from post‐thymic lymphocytes, which are normally involved in the process of cell-mediated immune response.[1][2][3][4][5]
  • Adult T‐cell leukemia is mainly caused by an infection with human T‐cell lymphotropic virus (HTLV) [6].
  • HTLV is usually transmitted via breast feeding early in life. Other minor routes of transmission for HTLV may include sexual contact, exposure to contaminated blood, or vertical maternal transmission [7].
  • There appears to be a long latent period between HTLV-1 infection and the development of adult T‐cell leukemia.
  • The oncogenesis of HTLV infection, which results in the development of adult T-cell leukemia, is due to:
  • Adult T‐cell leukemia can manifests as either a leukemic form (75% of the cases) or a pure lymphomatous form (25% of the cases).
  • Adult T‐cell leukemia is a widely disseminated disease which may involve the peripheral blood cells, bone marrow, lymph nodes, liver, spleen, skin, and CNS.
  • Hematopathological features of adult T-cell leukemia are variable, which may include:
  • Hypercalcemia among adult T-cell leukemia patients has been associated with elevated serum concentrations of:
  • Infiltration of malignant leukemic cells results in the expansion of the lymph nodes paracortical region, which may lead to the development of peripheral lymphadenopathy among adult T-cell leukemia patients.
  • Infiltration of the liver and spleen may lead to the development of organomegaly among adult T-cell leukemia patients.
  • Cutaneous manifestations of adult T-cell leukemia is due to the infiltration of leukemic cells along the dermis layer of the skin.
  • Cutaneous Pautrier's microabscesses formation (due to epidermotropism) may also be present among adult T-cell leukemia patients. These cutaneous lesions are indistinguishable from the ones found in Sézary syndrome and mycosis fungoides.
  • Immune deficiency occurs in adult T-cell leukemia due to a defective cell-mediated immunity.

Genetic

  • Genes involved in the pathogenesis of adult T-cell leukemia include:

Gross Pathology

Microscopic Pathology

  • On microscopic histopathological analysis, characteristic findings of adult T-cell leukemia include:

References

  1. 1.0 1.1 Matutes E (2007). "Adult T-cell leukaemia/lymphoma". J. Clin. Pathol. 60 (12): 1373–7. doi:10.1136/jcp.2007.052456. PMC 2095573. PMID 18042693.
  2. 2.0 2.1 Adult T-cell leukemia/lymphoma. Wikipedia (2015) https://en.wikipedia.org/wiki/Adult_T-cell_leukemia/lymphoma Accessed on November, 3 2015
  3. 3.0 3.1 Human T-lymphotropic virus. Wikipedia (2015) https://en.wikipedia.org/wiki/Human_T-lymphotropic_virus#Transmission Accessed on November, 3 2015
  4. 4.0 4.1 Lymphoma. Libre Pathology (2015) http://librepathology.org/wiki/index.php/Lymphoma#Adult_T-cell_leukemia.2Flymphoma Accessed on November, 3 2015
  5. 5.0 5.1 5.2 Adult T-cell Leukemia. PathologyOutlines (2015) http://www.pathologyoutlines.com/topic/lymphomanonBatlv.html Accessed on November, 3 2015
  6. Oliveira PD, Farre L, Bittencourt AL (October 2016). "Adult T-cell leukemia/lymphoma". Rev Assoc Med Bras (1992). 62 (7): 691–700. doi:10.1590/1806-9282.62.07.691. PMID 27925051.
  7. Poiesz BJ, Ruscetti FW, Gazdar AF, Bunn PA, Minna JD, Gallo RC (December 1980). "Detection and isolation of type C retrovirus particles from fresh and cultured lymphocytes of a patient with cutaneous T-cell lymphoma". Proc. Natl. Acad. Sci. U.S.A. 77 (12): 7415–9. PMC 350514. PMID 6261256.
  8. Pezeshkpoor F, Yazdanpanah MJ, Shirdel A (2008). "Specific cutaneous manifestations in adult T-cell leukemia/lymphoma". Int J Dermatol. 47 (4): 359–62. doi:10.1111/j.1365-4632.2008.03526.x. PMID 18377598.
  9. Bittencourt AL, da Graças Vieira M, Brites CR, Farre L, Barbosa HS (November 2007). "Adult T-cell leukemia/lymphoma in Bahia, Brazil: analysis of prognostic factors in a group of 70 patients". Am. J. Clin. Pathol. 128 (5): 875–82. doi:10.1309/2YGD1P0QCVCWBLDX. PMID 17951212.