title: Cutaneous presentation of post-renal transplant lymphoproliferative disorder: a series of four cases.
abstract: We report detailed histological and molecular characteristics of four post transplant lymphoproliferative disorders (PTLD) presenting in the skin of renal transplant patients, and their clinical outcome. Three had B-cell lymphomas (cases 1-3), and one had a T-cell lymphoma (case 4). All B-cell lymphomas showed Epstein-Barr virus (EBV) by immunohistochemistry (IHC) or in situ hybridization (ISH). Cases 1 and 2 were large cell lymphomas, and case 3 a plasmacytoma. Case 1 showed light chain restriction and heavy chain gene rearrangement by polymerase chain reaction (PCR). The patient was then diagnosed with an abdominal lymphoma and died of sepsis. Case 2 had no recoverable DNA. Case 3 had a plasmacytoma that showed monoclonal light chain restriction on IHC and an oligoclonal heavy chain rearrangement by PCR. In cases 2 and 3, the lesions regressed following reduction of immunosuppression, and died 1.5 and 8 years later from unrelated medical causes. Case 4 was a CD 30+ anaplastic large T-cell lymphoma with no EBV detected by IHC, ISH and PCR, and died of heart failure 2 years later. Cutaneous manifestations of PTLD are rare, show wide array of clinical and pathological features, and generally have a favorable prognosis. EBV appears to be associated only with B-cell cutaneous lymphomas.
authors.affiliation: Department of Pathology and Molecular Medicine, St. Joseph's Hospital, McMaster University, Hamilton, ON, Canada L8N 4A6. ssalama@mcmaster.ca
authors.forename: Samih
authors.initials: S
authors.lastname: Salama
authors.forename: Stanley
authors.initials: S
authors.lastname: Todd
authors.forename: Davide Pietro
authors.initials: DP
authors.lastname: Cina
authors.forename: Peter
authors.initials: P
authors.lastname: Margetts
mesh_terms: D000368:Aged; D005260:Female; D004854:Herpesvirus 4, Human / Q000235:genetics; D006801:Humans; D007150:Immunohistochemistry; D017403:In Situ Hybridization; D016030:Kidney Transplantation / Q000009:adverse effects*; D016393:Lymphoma, B-Cell / Q000209:etiology / Q000473:pathology* / Q000821:virology; D016399:Lymphoma, T-Cell / Q000209:etiology / Q000473:pathology* / Q000821:virology; D008297:Male; D008875:Middle Aged; D020133:Reverse Transcriptase Polymerase Chain Reaction; D012878:Skin Neoplasms / Q000209:etiology / Q000473:pathology* / Q000821:virology