We report here unique endoscopic findings of cytomegalovirus(CMV) gastritis associated with adult T-cell leukemia/lymphoma(ATLL). A 67-year-old Japanese man presented to a hematologistwith a month history of appetite loss. Physical examination showedblurred consciousness (GCS E4V2M5) with labored breathing andhypotension. Blood examination revealed hypercalcemia (adjustedCa: 3.24 mmol/L), anemia (Hb: 70 g/L), and leukocytosis (whiteblood cell count: 21.3 × 109/L) with abnormal lymphocytes (7%).Human T-cell lymphotropic virus type 1 antibody and provirus DNAmonoclonality were positive. A blood transfusion was given, andnoradrenaline and denosumab were administered. Upper gastrointestinal tract endoscopy showed multiple polypoid lesions withredness and erosive surface (upper left; see Figure 1). A gastricbiopsy specimen showed the presence of CD3+CD4+CD8− T cells,compatible with the gastric involvement by ATLL, and CMV gastritispresenting with inclusion bodies positive for anti-CMV antibody byimmunohistochemistry (upper right and lower left; see Figure 1).

A 35-year-old Japanese female (gravida 2, para 2), who was negativefor herpes simplex virus, hepatitis C virus, human immunodeficiencyvirus, and human T-cell Leukemia Virus Type 1, had a 4-month historyof prolapsed haemorrhoids, which began after the birth of her firstchild (Figure 1A). She received two haemorrhoidectomies. The first, onAugust 2017, revealed that tissue in the 6 o’clock direction was nonmalignant; however, a second (conducted in November 2018) revealedthat the tissue in the 12 o’clock direction showed diffuse large B-celllymphoma (DLBCL; Figure 1B–F), which had the following immunophenotype: CD3−, CD5−, CD10−, CD20+, CD79a+, BCL-2−, BCL-6−,MUM1+, and Ki-67 (70% positive), which is consistent with a nongerminal center B-cell type. Unfortunately, no extra tissues were availablefor further karyotype or molecular studies.

Langerhans cell histiocytosis (LCH), a granulomatous tumorous lesionconsisting of CD1a-positive clonal immature dendritic cells in association with various inflammatory cells, develops in tissues includingbone, skin, lungs, and lymph nodes. When bone LCH exhibits osteolyticlesions, the spine is often involved, and each part of the vertebral body,vertebral arch, and vertebral spinous process can be affected. Such vertebral LCH can occur at the onset of disease and in relapse. To confirm pathological sites, a computed tomography (CT) scan is generallyused to characterize lytic lesions of vertebrae, while MRI is suitablefor delineating marrow and soft tissue. Additionally, to identify specificlocations, 18F-fluorodeoxyglucose-positron emission tomography/CT(FDG-PET/CT) is useful. We describe three LCH cases showing characteristic cervical spinal involvement.