Primary Cutaneous Monomorphic Post-transplant Lymphoproliferative Disorder Mimicking Squamous Cell Carcinoma In Situ

Abstract

Post-transplant lymphoproliferative disorder (PTLD) is a term used to describe a range of lymphoproliferative disorders that occur after solid organ transplant. Although the clinical presentation is variable, primary cutaneous PTLD typically presents as isolated nodules that appear as dermal-based proliferations. We present a case of a 70-year-old woman with a history of a kidney transplant who presented with a 2-month history of an asymptomatic, erythematous plaque on the right shin, clinically suspected to be squamous cell carcinoma in situ. Histomorphology demonstrated a dermal proliferation of atypical plasma cells with dense chromatin, variable nucleoli, and irregular nuclear borders. The atypical plasma cells were positive for Epstein-Barr virus by in situ hybridization and markedly kappa-restricted by RNAscope in situ hybridization. A diagnosis of cutaneous monomorphic PTLD, plasma cell neoplasm variant, was rendered, a rare diagnosis in the skin. Treatment for PTLD typically involves reduction of immunosuppression, although our patient progressed and developed new lesions despite this intervention. In this study, we present an atypical presentation of cutaneous PTLD, plasma cell neoplasm variant, presenting as squamous cell carcinoma in situ.

Dermoscopic features of cutaneous post-transplant lymphoproliferative disorder in a renal transplant recipient

“…As such, a comparative analysis could not be done to determine the significance of our dermoscopic findings. The only other case report identified describes dermoscopy findings of cutaneous PTLD of the B-cell plasma cell neoplasm subtype, 7 and this shared some similarities with our findings in the form of dotted vessels. With more cases reported in the future, we may then be able to further qualify our findings as significant.…”

“… 6 In addition, dotted vessels were also seen in other case reports of cutaneous PTLD. 7 Thus, unfocused dotted vessels are a potentially significant vascular feature for B-cell PTLD.…”

Post-Transplant Lymphoproliferative Disorder, Monomorphic Type, in a Kidney Transplant Patient After Administration of Anti-Influenza Vaccine

“…Cutaneous involvement occurs in only 5% of PTLD cases, with most cases being monomorphic (more frequently B-cell than T-cell). 14,[23][24][25][26][27][28][29][30][31][32][33][34][35][36][37][38] Although the onset with cutaneous involvement is considered a favorable factor, the prognosis of these cases is reserved, with a significant percentage of them ending in death.…”