Transcription
Hey guys, it's Medical Spur Fictionnal. Today's topic is adult T-cell leukemia or lymphoma. Leukemia or lymphoma, because it's lemon or lemonade; lemon can lead to lemonade and vice versa. [Music]
So, the World Health Organization classifies lymphoid malignancies into three categories: B-cell, T-cell, and Hodgkin's lymphoma. T-cell lymphoma malignancies usually have skin infiltration, meaning a rash. Adult T-cell leukemia, of course, is a subtype of T-cell lymphoid malignancies. Adult T-cell leukemia is associated with human T-cell lymphoma virus type 1, or HTLV-1. It could present as a malignant lymphoma—again, lemon or lemonade. There is activation of a gene called Tax gene, and it will inhibit that p53 suppressor gene. Now, we don't have the suppressor; you are over-activated, which means cancer, cancer, cancer, cancer, cancer. The neoplastic CD4 T lymphocytes undergo proliferation, which is a monoclonal proliferation. Again, any cancer is a monoclonal proliferation process; it's not polyclonal, it's monoclonal.
Oh, where can we find adult T-cell leukemia/lymphoma? In the same places we find human T-cell leukemia virus 1, such as Japan, South America, West Africa, and the Caribbean. By the way, did you know human T-cell leukemia virus 1 is a retrovirus from the Retroviridae family? It's transmitted through IV drug abuse, breastfeeding, maybe sexual intercourse, etc. And this virus can lead to tropical paraparesis, which is a neurological disease. And for all the visual learners, here is Japan, the Land of the Rising Sun; here is South America, they play beautiful soccer, the land of Pelé; and here is Africa, but especially West Africa—not Egypt, like I'm from Egypt, that's why I draw only Egypt here in this map—and the Caribbean islands, a great destination for your vacation. See, medicine can be fun.
Clinically speaking, signs and symptoms: we have a rash, skin infiltration, generalized lymphadenopathy. Also, the lymphoblast, that malignant leukemic cells, will produce osteoclast-activating factor. Osteoclast-activating factor will activate the osteoclasts, and osteoclasts, with the "c," they cut down bone; they lead to these punched-out lytic bone lesions, very similar to what happens in multiple myeloma, but different from beta-thalassemia, because in beta-thalassemia we had a different problem called the "chipmunk faces" and "hair-on-end" appearance. This is different from the punched-out lytic lesion, so please keep that distinction in mind. When you have bone that is being broken down, you end up with hypercalcemia, because there is a lot of calcium in the bone; you break the bone, you release calcium. Also, you can find pulmonary infiltrates in case of adult T-cell leukemia or lymphoma. Again, adult T-cell leukemia can mimic multiple myeloma, why? Both of them can have lytic bone lesions and hypercalcemia. However, there is a difference: in adult T-cell leukemia there is a rash; in multiple myeloma there is no rash. Of course, it's a generalization; there is an exception to every rule.
Let's have some fun and go to the lab. On complete blood count, we see white blood cell count between 10,000 and 50,000—this is a lot—and we'll see lymphoblasts that are CD4 positive but CD8 negative. So, which type of leukemia was CD8 positive? If you know the answer, please let me know in the comment. Red blood cells, you have an anemia, usually normal. Platelets are low, leading to thrombocytopenia. Okay, let's go to the serum antibodies; you will find serum antibodies against the human T-cell leukemia virus 1. On peripheral smear, we find something interesting called "flower cells." These are leukemic cells with indented nucleus. Okay, so pathologists are romantic human beings; they see these cells under the microscope and they call them "flower cells" because they are kind of similar to a flower. What a great imagination.
How to treat adult T-cell leukemia? You can use Idoxuridine, arsenic trioxide. Also, there was a previous disease in oncology we talked about and was treated by this toxin called arsenic trioxide. Do you know the answer? Let me know in the comment. Okay, we can use CHOP regimen. CHOP is an acronym, so you have cyclophosphamide, you have doxorubicin (because the trade name begins with an H), you have vincristine (again, because the trade name starts with an O), and prednisone. So you have CHOP regimen.
So let's summarize: adult T-cell leukemia, again, human T-cell leukemia virus 1, CD4 positive T cells, you have a rash—again, it's common in all T-cell malignancies—lytic bone lesions leading to hypercalcemia. I'm ready to say goodbye. I'll see you in the next video. Don't forget to like me on Facebook; I'm posting a lot of stuff there. And don't forget to subscribe to my YouTube channel and hit the bell to get notified when I post a new video. Thank you so much for watching. It's Médicos Perfectionalis, and as always, be safe, stay happy, and study hard.