A rare case of primary cutaneous plasmacytoma‐like lymphoproliferative disorder following renal transplantation

Abstract

Post-transplant lymphoproliferative disorder (PTLD) is a lymphoid proliferation that develops as a complication of solid organ or bone marrow transplants. PTLD limited to the skin is very rare. Plasmacytoma-like PTLD is an uncommon variant of monomorphic PTLD. Its presentation in the skin is extraordinary with very few cases reported in the literature. We report a new case of plasmacytoma-like PTLD presenting as multiple skin nodules on the leg of a 74-year-old kidney transplant recipient. Histopathologic and immunohistochemical examination of one nodule revealed atypical plasmacytoid and plasmablastic cells that showed kappa light chain restriction and stained positive for CD138. Staging investigations excluded extracutaneous manifestations of the disease. This case is unusual for several reasons including involvement limited to the skin, plasmacytoid phenotype of the tumor, presentation 18 years following transplantation and Epstein-Barr virus negativity.

Array‐CGH predicts prognosis in plasma cell post‐transplantation lymphoproliferative disorders

“…Most of the cases are associated with Epstein‐Barr virus (EBV). Among monomorphic PTLD, plasma‐cell myeloma (PCM) and plasmacytoma‐like lesion (PLL) are rare (less than 5% of PTLD) with less than 60 cases reported in the literature (Melato and Paladini, ; Schemankewitz et al, ; Chucrallah et al, ; Joseph et al ; Fischer et al, ; Harris et al, ; Leigh et al, ; Ibe et al, ; Papadaki et al, ; Au et al, ; Pacheco et al, ; Gupta et al, ; Sun et al, ; Syed et al, ; Takahashi et al, ; Komrokji et al, ; Tcheng et al, ; Willoughby et al, ; McFarlane et al, ; Richendollar et al, ; Ninan and Datta, ; Trappe et al, ; Molina‐Ruiz et al, ; Karuturi et al, ; Kuppachi et al, ; Perry et al, ; Plant et al, ), the largest series including 9 patients (Karuturi et al, ). Currently, reduction of immunosuppressive therapy (RIT) is commonly performed when PTLD is diagnosed with, however, a low response rate and a high risk of rejection.…”

Diverse clinical and histopathologic features of cutaneous post‐transplant lymphoproliferative disorders: A presentation of two cases

“…As expected, the reported monomorphic PTLDs are the same cutaneous lymphomas commonly seen in immunocompetent patients, only diagnosed in transplant recipients. These include mycosis fungoides‐type cutaneous lymphoma, anaplastic large cell lymphoma, diffuse large B‐cell lymphoma and plasmacytoma . Less common types of monomorphic PTLD have been reported (Table ).…”

“…Post‐transplant lymphoproliferative disorders (PTLDs) comprise a heterogeneous group of lymphoid or plasmacytic proliferations occurring in solid organ or haematopoietic stem cell allograft recipients. Transplant recipient patients are thought to be susceptible to lymphoproliferative disorders largely due to post‐transplant immune suppressive regimens . Epstein–Barr virus (EBV) is implicated in many of these lymphoproliferative disorders, particularly those arising in the first few years following transplantation.…”

“…The gastrointestinal tract, lymph nodes, liver, kidneys and other internal organs are the most frequently involved sites . Solid organ allografts can also be involved . Less commonly, PTLDs present as cutaneous lesions .…”

FDG PET/CT Findings of the Recurrent Posttransplantation Lymphoproliferative Disorder in a Pediatric Liver Transplant Recipient With Right Leg Pain as the Only Complaint

“…However, PTLD can occur in very rare locations including dental extraction socket 15 and skin. 16 Our case indicated that pain in an appendicular bone can also be a presentation of PTLD and FDG PET/CT can help to reach an early diagnosis which had shown to associate with a better prognosis due to early intervention than those who received therapy late. 12 …”