Subcutaneous panniculitic T-cell lymphoma in a cardiac allograft recipient.
BACKGROUND
Post-transplant lymphoproliferative disorder (PTLD) is the third leading cause of death in heart transplant patients beyond the immediate peri-operative period (Ouseph R, Denny DM, Erbeck KM. J Am Soc Echocardiogr 1998; 11: 758; Armitage JM, Kormos RL, Stuart RS, et al. J Heart Lung Transplant 1991; 10: 877; Swinnen LJ, Mullen M, Carr TJ, et al. Blood 1995; 86: 3333; Ying AJ, Myerowitz D, Marsh WL. Ann Thorac Surg 1997; 64: 1822). The majority of PTLD cases are of B-cell origin whereas T-cell neoplasms have been reported as rare, aggressive, and late complications of solid-organ transplantation (Fatio R, Sutsch G, Mayer K, et al. Transplant Proc 1998; 30: 1118).


METHODS
A 50-year-old cardiac allograft heart transplant patient presented with subcutaneous nodules involving his trunk and extremities.


RESULTS
Light microscopy revealed features characteristic of subcutaneous panniculitic-like T-cell lymphoma. Immunohistochemical analysis showed expression for CD45RO, TIA-1, and focal CD3 positivity by tumor cells. Flow cytometry performed on a subsequent subcutaneous nodule demonstrated an abnormal T-cell population with expression of CD3, CD8, CD56, and T-cell receptor alpha-beta, and no expression of CD4. T-cell gene rearrangement studies revealed a clonal population of cells with a bi-allelic gene rearrangement.


CONCLUSIONS
We report a case of an unusual subtype of PTLD in a cardiac allograft recipient.
Bregman
Shelli G
SG
Department of Pathology, Vanderbilt University Medical Cente, Nashville, TN, USA. shelli.bregman@vanderbilt.edu
Yeaney
Gabrielle A
GA
Greig
Bruce W
BW
Vnencak-Jones
Cindy L
CL
Hamilton
Katherine S
KS
D000483:Alleles; D015703:Antigens, CD / Q000378:metabolism; D017809:Fatal Outcome; D005434:Flow Cytometry; D015329:Gene Rearrangement, T-Lymphocyte; D016027:Heart Transplantation; D006801:Humans; D016399:Lymphoma, T-Cell / Q000235:genetics / Q000378:metabolism / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D015434:Panniculitis / Q000473:pathology*; D016693:Receptors, Antigen, T-Cell, alpha-beta / Q000378:metabolism; D040521:Subcutaneous Tissue / Q000473:pathology*; D013601:T-Lymphocytes / Q000378:metabolism / Q000473:pathology; D014184:Transplantation, Homologous
D015703:Antigens, CD; D016693:Receptors, Antigen, T-Cell, alpha-beta