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Subcutaneous panniculitic T-cell lymphoma in a cardiac allograft recipient
Shelli G Bregman1, Gabrielle A Yeaney, Bruce W Greig
1Department of Pathology, Vanderbilt University Medical Cente, Nashville, TN, USA. shelli.bregman@vanderbilt.edu
Insights
This case study highlights an uncommon form of post-transplant lymphoproliferative disorder (PTLD) in a heart transplant recipient, specifically a T-cell lymphoma presenting as skin nodules. This rare PTLD subtype underscores the importance of comprehensive diagnostics in transplant patients.
Area of Science:
- Oncology
- Transplantation Immunology
- Dermatopathology
Background:
- Post-transplant lymphoproliferative disorder (PTLD) is a significant cause of mortality in heart transplant recipients.
- While most PTLD cases involve B-cells, T-cell neoplasms are rare, aggressive, and occur late after solid-organ transplantation.
Observation:
- A 50-year-old male heart transplant recipient presented with subcutaneous nodules on his trunk and extremities.
Findings:
- Microscopic examination revealed subcutaneous panniculitic-like T-cell lymphoma.
- Immunohistochemistry showed CD45RO, TIA-1, and focal CD3 positivity.
- Flow cytometry identified an abnormal CD3+, CD8+, CD56+ T-cell population with T-cell receptor alpha-beta and no CD4 expression.
- Gene rearrangement studies confirmed a clonal T-cell population.
Implications:
- This case represents an unusual T-cell PTLD subtype in a cardiac allograft recipient.
- Highlights the need for thorough investigation of cutaneous lesions in transplant patients.
- Contributes to understanding rare PTLD manifestations and their diagnostic markers.
Background:
Post-transplant lymphoproliferative disorder (PTLD) is the third leading cause of death in heart transplant patients beyond the immediate peri-operative period (Ouseph R, Denny DM, Erbeck KM. J Am Soc Echocardiogr 1998; 11: 758; Armitage JM, Kormos RL, Stuart RS, et al. J Heart Lung Transplant 1991; 10: 877; Swinnen LJ, Mullen M, Carr TJ, et al. Blood 1995; 86: 3333; Ying AJ, Myerowitz D, Marsh WL. Ann Thorac Surg 1997; 64: 1822). The majority of PTLD cases are of B-cell origin whereas T-cell neoplasms have been reported as rare, aggressive, and late complications of solid-organ transplantation (Fatio R, Sutsch G, Mayer K, et al. Transplant Proc 1998; 30: 1118).
Case Report:
A 50-year-old cardiac allograft heart transplant patient presented with subcutaneous nodules involving his trunk and extremities.
Results:
Light microscopy revealed features characteristic of subcutaneous panniculitic-like T-cell lymphoma. Immunohistochemical analysis showed expression for CD45RO, TIA-1, and focal CD3 positivity by tumor cells. Flow cytometry performed on a subsequent subcutaneous nodule demonstrated an abnormal T-cell population with expression of CD3, CD8, CD56, and T-cell receptor alpha-beta, and no expression of CD4. T-cell gene rearrangement studies revealed a clonal population of cells with a bi-allelic gene rearrangement.
Conclusion:
We report a case of an unusual subtype of PTLD in a cardiac allograft recipient.