#00063578

A 55-year old female from Trinidad with a history of hypertension, hyperlipidemia, and glaucoma presented with abdominal pain, mental confusion, and subacute progressive ascending weakness and numbness. A magnetic resonance imaging study of the head revealed abnormal leptomeningeal enhancement. Microscopic evaluation of the cerebrospinal fluid revealed large atypical lymphoid cells with multilobated nuclei and basophilic cytoplasm (see arrows in the microphotographs). Flow cytometry of the cerebrospinal fluid showed a population of atypical CD4+ CD7- CD25+ CD30- T-cells. A complete blood count revealed normal values. Serum calcium was 11.8mg/dl (reference range 8.9- 10.3 mg/dL). Testing for HTLV-I/II done on peripheral blood was positive. Integration of the patient’s history and the clinical, microscopic, immunophenotypic, and serologic findings helped establish the diagnosis of adult T-cell leukemia/lymphoma (ATLL). Bone marrow studies revealed concurrent involvement by ATLL. The patient received only palliative treatment and died one month after the diagnosis.