Cutaneous Plasmacytoma in a Hemodialysis Patient

Abstract

Background Extramedullary plasma cell dyscrasias are rare. Case report We report a case of a 56-year-old male Caucasian hemodialysis patient with cutaneous plasmacytoma. The diagnosis was made a few months after surgical removal of his renal graft due to chronic rejection. Investigations for the presence of an associated myeloma were negative. He underwent local radiotherapy with complete resolution of the skin lesion. Conclusions Nephrologists should be aware that the frequency of post-transplant lymphoproliferative disorders is increasing in the dialysis population, especially in those previously or currently treated with immunosuppressive drugs.

Primary Cutaneous Giant Cell Plasmacytoma in an Organ Transplant Recipient: A Rare Presentation of a Posttransplant Lymphoproliferative Disorder

“…We have done a search for PTLD in the pathology file of Duke (Table 2). [8][9][10][11][12][13][14][15][16][17][18][19][22][23][24][25][26][27][28][29][30][31][32][33][34][35][36][37][38] Of these, about two-thirds of the cases occurred in male patients and one-third in female patients. The median age was 56 years with a range of 17-76 years, which seems to be significantly older than most reported age ranges for PTLD in general.…”

“…43,44 Interestingly, the median interval from transplantation to diagnosis of PTLD in the cases of primary cutaneous B-cell PTLD was 8 years with a range of 0.4-30 years. When divided by EBV status, the median interval to presentation was 8 years (range of 0.4-30 years) and the mean was 7.34 6 4.12 years for the EBV-positive group, whereas for the EBV-negative group, the median was 6 years (range of [3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19] and the mean was 8.5 6 3.25 years.…”

“…As in other types of PTLD, plasmacytoma-like lesions present less frequently in skin as a primary site of involvement. Nonetheless, 18 cases of this type of PTLD have been reported in the literature (Table 2), [8][9][10][11][12][13][14][15][16][17][18][19] constituting almost 40% of the cases of primary cutaneous Bcell PTLD, although a selection bias cannot be excluded. Of the 19 cases (including the present case), 9 (47.4%) are heart transplant recipients, 5 (26.3%) are kidney transplant recipients, and 5 (26.3%) are other organ transplant recipients.…”

“…As with other cutaneous monomorphic B-cell PTLDs, most reported cases of plasmacytoma-like PTLD were managed with reduction of immunosuppression and/or treated locally with radiotherapy. [8][9][10][11]15,17 Five cases received systemic treatment with either Rituximab alone or chemotherapy with or without Rituximab. A favorable outcome was achieved in the majority of these reported cases with an 80% response rate and 60% survival rate, with a 1-year median follow-up.…”

“…7 Primary cutaneous involvement by PTLD is infrequent, and the plasmacytoma-like variant of PTLD with primary involvement of the skin is extremely rare, with only 18 cases reported in the literature. [8][9][10][11][12][13][14][15][16][17][18][19] Here we present a case of primary cutaneous EBV-positive PTLD with morphologic and immunophenotypic features consistent with a giant cell plasmacytoma. Although giant cell myeloma or plasmacytoma has been previously described, 20,21 the giant cell morphologic variant of plasmacytoma primarily involving skin in the setting of postorgan transplantation has never been reported in the English literature to the best of our knowledge.…”