Primary cutaneous Hodgkin‐like polymorphic post‐transplant lymphoproliferative disorder

Dunn, Carly; Nguyen, Harrison P.; Patel, Viraat; Barker, Heather; Diwan, A. Hafeez; Yared, Marwan; Elghetany, Tarek; Restrepo, Alejandro; Dao, Harry

doi:10.1111/cup.13427

Cited by 7 publications

(17 citation statements)

References 10 publications

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“…Aberrant co‐expression of CD20 has also been described 34 . In some instances of PTCL‐NOS occurring as PTLDs, histopathologic evaluation may reveal a granulomatous inflammatory infiltrate, similar to our case, which could initially be misinterpreted as an infectious process 24 . Infectious workup of the biopsy specimen with appropriate stains should be completed to rule out potential infectious etiology.…”

Section: Discussionsupporting

confidence: 68%

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Post‐transplant primary cutaneous peripheral T‐cell lymphoma not otherwise specified in a pediatric patient

et al. 2021

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Solid organ and hematopoietic stem cell transplantation may be complicated by the development of post‐transplant lymphoproliferative disorders (PTLDs). The World Health Organization categorizes PTLDs into four entities including non‐destructive, monomorphic, polymorphic, and classical Hodgkin lymphoma types. The most common PTLDs are B‐cell lymphomas, with T‐cell lymphomas accounting for only a few cases. Cutaneous T‐cell lymphomas are rarer still in post‐transplant patients with primary cutaneous peripheral T‐cell lymphoma being an extraordinarily rare subtype in this population. PTLDs may be aggressive and are often associated with high morbidity and mortality. Advances in medicine have led to increased awareness of PTLDs and improved diagnostic tools which assist in the diagnosis of these conditions. However, the clinical and histopathologic heterogeneity of PTLDs may make diagnosis a challenge. In the transplant patient population, the cutaneous manifestations of the lymphoproliferative disease may mimic other conditions, such as eczematous dermatitis and graft‐vs‐host disease. Herein, we report a case of post‐transplant primary cutaneous peripheral T‐cell lymphoma not otherwise specified (PTCL‐NOS) in a pediatric heart transplant patient and describe the clinical presentation and diagnostic histopathologic features.

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Section: Discussionsupporting

confidence: 68%

“…Tissue biopsy, immunophenotyping by flow cytometry or immunohistochemistry, ISH for EBER, and peripheral blood EBV PCR all aid in the diagnosis of PTLDs 23 . Analysis of architecture, cytologic pattern, and immunohistochemical profile should be completed to characterize the lymphoproliferative disorder 24 …”

Section: Discussionmentioning

confidence: 99%

Post‐transplant primary cutaneous peripheral T‐cell lymphoma not otherwise specified in a pediatric patient

et al. 2021

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“…First‐line treatment for PT‐CTCL is the reduction of immunosuppression 16,24 . A reduction in calcineurin inhibitor dose by 50% and discontinuation of antimetabolite agents has been recommended 24 .…”

Section: Discussionmentioning

confidence: 99%

Characterization of primary cutaneous T‐cell lymphoma following solid organ transplantation

et al. 2022

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Background Immunosuppression following solid organ transplantation is a known risk factor for the development of posttransplant lymphoproliferative disorders (PTLD). Primary cutaneous T‐cell lymphoma (CTCL) occurring in the posttransplant setting is rare, which has made comprehensive understanding of this disease challenging. This study aims to further characterize the spectrum of clinicopathologic features of CTCL in solid organ transplant recipients (SOTR). Methods A retrospective chart review was performed for SOTR who were diagnosed with CTCL at a multi‐site academic medical center from January 1, 1998, to December 31, 2013. Eight patients fulfilled the inclusion criteria and were included in this study. Data collected included patient demographics, transplanted organ, the time between transplant and CTCL diagnosis, clinical presentation and rash morphology, a histological subtype of CTCL, immunosuppression regimens, and patient status. Twelve diagnostic skin biopsies for five patients were examined and reviewed by a board‐certified dermatopathologist. Results Six (75%) out of the eight patients were men, two (25%) were women, and the median age was 53 years. The median time from the date of transplant to the diagnosis of CTCL was 8.2 years. Transplanted organs included the liver (4), kidney (3), and heart (1). Clinical presentation varied from papulonodules, comedone‐like lesions, intense pruritis, and scaly erythematous eruptions. The most common histologic presentation was folliculotropic mycosis fungoides (FMF) (7/12). Epstein–Barr virus‐in situ hybridization (EBV‐ISH) was negative in all specimens. Conclusions We emphasize the rarity of CTCL among SOTR. Although rare in the general population, the FMF subtype appears to be disproportionately seen in SOTR compared with other CTCL.

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“…About 5% of cases of PTLD involve the skin 7 . Table 1 summarizes reported cases of cutaneous PTLD, including our four cases 15‐25 . Most reported cases with only skin involvement evolved with disease remission, as described by Murad et al, 15 Snavely et al, 8 Traboulsi et al, 17 Capaldi et al 24 and Dabbs et al 21 Treatment in these cases was quite variable, with the majority including reduction of immunosuppression.…”

Section: Discussionmentioning

confidence: 71%

Post‐transplant lymphoproliferative disorder with cutaneous involvement: A series of four cases

Ferreira

Seque

Enokihara

et al. 2020

Clinical Transplantation

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Background Post‐transplant lymphoproliferative disorders (PTLD) are lymphoid proliferations associated with post‐transplant immunosuppression. Most originate from B cells and are associated with Epstein‐Barr virus (EBV) infection. Although extranodal involvement is common, cutaneous presentation is rare. Objective To report and characterize cutaneous manifestations of PTLD from clinical, histopathologic, and immunohistochemistry standpoints. Methods Patients' information was obtained retrospectively by reviewing medical records. Skin biopsies were submitted to histological and immunohistochemistry analysis, and EBV detection was performed by in situ hybridization and polymerase chain reaction (PCR) analysis. Staging examinations were included. A literature review of reported cutaneous PTLD cases was performed. Results We describe two cases of primary cutaneous and 2 cases of systemic PTLD with secondary cutaneous manifestations. All had late onset disease, which presented at least 6 years after transplantation. Histopathologic findings were compatible with monomorphic PTLD in three cases and plasmacytic hyperplasia in one case. EBV was detected in two patients. Both patients with systemic disease had fatal outcome, and those with primary cutaneous involvement responded to treatment. Limitations Due to the rare incidence of cutaneous manifestation of PTLD, the analysis of a large number of cases was not possible. Conclusion Although rare, PTLD should be considered in the differential diagnosis of late onset cutaneous complications post‐renal transplant.

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Primary cutaneous Hodgkin‐like polymorphic post‐transplant lymphoproliferative disorder

Cited by 7 publications

References 10 publications

Post‐transplant primary cutaneous peripheral T‐cell lymphoma not otherwise specified in a pediatric patient

Post‐transplant primary cutaneous peripheral T‐cell lymphoma not otherwise specified in a pediatric patient

Characterization of primary cutaneous T‐cell lymphoma following solid organ transplantation

Post‐transplant lymphoproliferative disorder with cutaneous involvement: A series of four cases

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