T-cell lymphoma of the vulva in a renal allograft recipient with associated hemophagocytosis.
The risk of B-cell lymphoma is greatly increased in transplant patients, whereas T-cell lymphomas have only rarely been reported in these patients. Although T-cell lymphomas in nonimmunosuppressed patients may be associated with either human T-cell lymphotropic virus type I (HTLV-I) or Epstein-Barr virus (EBV), these viruses have not been reported in association with post-transplant T-cell lymphoma. We report a case of T-cell lymphoma of the vulva arising in a renal allograft recipient receiving azathioprine and prednisone. The unusual clinical presentation led to difficulty in diagnosis because of a resemblance to either an infectious process or squamous cell carcinoma. The large cell lymphoma involved the dermis and subcutaneous fat of the vulva and was associated with hemophagocytosis in lymph nodes and bone marrow. The tumor had a mature, aberrant T-cell immunophenotype (CD3+ CD4+ CD7+ CD2- CD5- CD30+). Rearrangement of the T-cell receptor beta and gamma chain genes was found, but there was no evidence of either EBV or HTLV-I genomes. This case adds to the clinical and morphologic spectrum of T-cell lymphomas reported in allograft recipients and suggests that known lymphotropic viruses do not commonly have a role in post-transplant T-cell lymphoma.
Department of Pathology, Massachusetts General Hospital, Boston 02114.
M A
MA
Kaplan
J O
JO
Jacobson
J A
JA
Ferry
N L
NL
Harris
D015703:Antigens, CD / Q000032:analysis; D000951:Antigens, Neoplasm / Q000032:analysis; D004273:DNA, Neoplasm / Q000235:genetics; D004279:DNA, Viral / Q000032:analysis / Q000235:genetics; D003937:Diagnosis, Differential; D005260:Female; D015333:Gene Rearrangement, beta-Chain T-Cell Antigen Receptor / Q000235:genetics; D015334:Gene Rearrangement, gamma-Chain T-Cell Antigen Receptor / Q000235:genetics; D005838:Genotype; D004854:Herpesvirus 4, Human / Q000235:genetics; D015616:Histiocytosis, Non-Langerhans-Cell / Q000150:complications* / Q000235:genetics / Q000473:pathology; D015368:Human T-lymphotropic virus 1 / Q000235:genetics; D006801:Humans; D015151:Immunoblotting; D016130:Immunophenotyping; D017730:Ki-1 Antigen; D016030:Kidney Transplantation; D016399:Lymphoma, T-Cell / Q000150:complications* / Q000235:genetics / Q000473:pathology; D008875:Middle Aged; D014184:Transplantation, Homologous; D014846:Vulvar Neoplasms / Q000150:complications* / Q000235:genetics / Q000473:pathology
D015703:Antigens, CD; D000951:Antigens, Neoplasm; D004273:DNA, Neoplasm; D004279:DNA, Viral; D017730:Ki-1 Antigen