Adult T cell- leukemia/lymphoma associated with HTLV-1 presenting as giant mass of the face

A 30-year-old Arabic woman of low socio-economic status, without medical history of HIV infection, presented to our department for neglected giant mass of the face evolving for 2 years. She was treated for long time with herbal traditional treatments, which explains the delay of consultation. Physical examination revealed a bulky tumor, of reddish-brown color, occupying the entire face below the franc, more lateralised on the left side. The right eye had restricted movement, while the left eye was fixed (Panel A,B). CT scan showed a nasal cavity tumour with orbital and maxillary sinus invasion, without intra cranial extension or distant metastasis. Laboratory testing was positive for HTLV I/II and she was negative for HIV. Surgical biopsy with histo-pathological study established the diagnosis of HTLV-1 associated adult lymphoma/leukaemia, with strong CD4 and CD25 antibody staining. She received chemotherapy with CHOP (cyclophosphamide, doxorubicin, vincristine, prednisone) regimen, but she died after two cycles.