CASE REPORT Annals of Nuclear Medicine Vol. 13, No. 3, 181-183, 1999 Indium-111-chloride scintigraphy visualized gastric involvement in a case of adult T-cell leukemia Atsushi TANI and Masayuki NAKAJO Department of Radiology, Faculty of Medicine, Kagoshima University We report a case of adult T-cell leukemia (ATL) with gastric involvement visualized by 111In-chloride scintigraphy. A 55-year-old male patient presented with upper abdominal pain and appetite loss. His barium gastric series showed multiple ulcerating polypoid tumors due to gastric involvement of ATL. These lesions accumulated 111In-chloride and were also avid for 67Ga-citrate. Although the mechanism of 111In-chloride accumulation is unknown 111In-chloride scintigraphy may be useful in evaluating patients with ATL. Key words : 111In-chloride bone marrow scintigraphy, 67Ga-citrate, adult T-cell leukemia INTRODUCTION 111In-chloride has been used frequently as a bone marrow imaging agent.1,2 This agent was also reported as a potential agent for the detection of tumors.3-7 we report a case of adult T-cell leukemia (ATL), caused by human T-lymphotropic virus type I (HTLV-I), with gastric involvement visualized by 111In-chloride scintigraphy. CASE REPORT A 55-year-old male patient presented with upper abdominal pain and appetite loss. In the laboratory findings, pancytopenia (white blood cell count, 1900/mm3 with 7% atypical lymphocytes; red blood cell count, 2.0 x 106/mm3; hemoglobin, 7.5 g/dl; platelet count, 60000/mm3) and a high serum level of lactate dehydrogenase (800 IU/ L: normal range 200-430) were observed. His stool contained occult blood. No superficial lymph nodes were palpable. Bone marrow aspiration obtained from the left iliac crest demonstrated the presence of atypical lymphocyte infiltration (2.0%). His barium gastric series showed multiple ulcerating polypoid tumors (Fig. 1). Biopsy specimens of these lesions were initially diag-nosed as malignant lymphoma. Because anti-HTLV-I-antibodies in his serum were positive and monoclonal proviral DNA integration in tumor cells was demonstrated, a diagnosis of ATL with gastric involvement was made. Barium studies of the small bowel and colon showed no evidence of infiltration of tumor cells. Com-puted tomography of the abdomen showed irregularly thickened gastric walls, but no swollen lymph nodes were found. Bone marrow scintigraphy was performed to evaluate the active bone marrow 48 hr after intravenous injection of 74 MBq of 111In-chloride. It showed a peripheral expansion of bone marrow uptake and abnormal uptake in the upper abdomen and pelvis (Fig. 2). Two of these lesions were consistent with the gastric masses seen in the barium gastric series and were also visualized by 67Ga-citrate scintigraphy, which had been performed 48 hr after intravenous injection of 148 MBq of 67Ga-citrate 10 days before 111In-chloride administration (Fig. 3). The others were regarded as bowel activity. Received November 12, 1998, revision accepted March 2, 1999. For reprint contact: Atsushi Tani, M.D., Department of Radi-ology, Faculty of Medicine, Kagoshima University, 8-35-1 Sakuragaoka, Kagoshima 890-8520, JAPAN. DISCUSSION ATL, which was first described by Takatsuki et al., has many clinical features including lymphadenopathy, hepatomegaly, splenomegaly, skin lesions and hypercal-cemia.8 Cases of infiltration of ATL into the gastrointes-tinal tract have been reported.9-18 Sakata et al, reported that 23 of 76 patients (30.3%) with ATL who underwent an endoscopic examination had gastric involvement.18 Some authors reported that 111In-chloride was a potential agent for the detection of tumors.3-7 Goodwin et al. reported that localization of tumors was possible in seven of ten patients with a variety of head and neck tumors, including squamous cell carcinoma, Hodgkin's disease, lymphosarcoma, reticulum-cell sarcoma, metastatic pro-static carcinoma and carcinoma of the floor of the mouth.3 Although the mechanism of uptake in tumors is unknown, a passive concentration mechanism due to abnormalities in capillary permeability was suggested.3 Wochner et al, reported that about 4% of the dose of indium administered was excreted in feces within 10 days.19 But no bowel activity is known to be seen in 111In-chloride scintigraphy,3 and the bowel activity in our patient was thought to be an abnormal finding. This phenomenon might be due to bleeding from the ulcerative lesions in the stomach, or to inflammatory exudation. The usefulness of 67Ga-citrate scintigraphy is reported in patients with ATL.20,21 Hoshi et al. reported that 17 of 25 patients had positive scans and 10 malignant lesions were detected in 9 of 17 patients by 67Ga-citrate scintigraphy.20 67Ga-citrate was also accumulated in the gastric lesions in this case. Therefore 67Ga-citrate may be useful for the detection of gastric involvement in ATL, but 111In-chloride may play a supplementary role in the evaluation of gastric involvement in ATL, because 67Ga-citrate accumulation in the stomach is also described as a frequent incidental finding.22 Further studies are needed to evaluate the usefulness of 111In-chloride scintigraphy in the detection of ATL lesions. CONCLUSION We report a case of ATL with gastric involvement visualized by 111In-chloride scintigraphy. 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