Clinical Features

An acute, a chronic, a lymphomatous and a smoldering subtype can be differentiated. Skin involvement occurs in about 50% of the cases during the course of the disease, presenting as purpuric papules, nodules or tumors, or as erythroderma. ATLL may simulate MF in nonendemic areas (6) (Fig. 1). Peripheral blood smears show atypical lymphoid cells with convoluted nuclei (so called flower cells) (Fig. 2) and leukocytosis, sometimes in conjunction with anemia. Additional findings are hypoalbuminemia, hypergammaglobulinemia, and hypercalcemia. Bone marrow involvement, lymphadenopathy, hepatosplenomegaly, and pulmonary infiltrates are frequently found only in patients with acute ATLL.

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