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Primary Cutaneous Monomorphic Post-transplant Lymphoproliferative Disorder Mimicking Squamous Cell Carcinoma In Situ
Ashley P Craddock1, Alejandro A Gru1, Diana Mannschreck2
1Departments of Pathology, and.
The American Journal of Dermatopathology
|April 26, 2021
Summary
Post-transplant lymphoproliferative disorder (PTLD) can manifest unusually in the skin. This case highlights a rare plasma cell neoplasm variant of PTLD mimicking squamous cell carcinoma.
Area of Science:
- Oncology
- Transplant Immunology
- Dermatopathology
Background:
- Post-transplant lymphoproliferative disorder (PTLD) encompasses lymphoproliferative conditions arising after solid organ transplantation.
- Primary cutaneous PTLD often presents as dermal nodules, but presentations can be variable.
Observation:
- A 70-year-old kidney transplant recipient developed an asymptomatic erythematous plaque on her shin, initially suspected as squamous cell carcinoma in situ.
- Histopathology revealed a dermal proliferation of atypical plasma cells with specific morphological features.
Findings:
- The atypical plasma cells were positive for Epstein-Barr virus (EBV) via in situ hybridization.
- RNAscope in situ hybridization confirmed marked kappa restriction, indicating a clonal plasma cell population.
- A diagnosis of cutaneous monomorphic PTLD, plasma cell neoplasm variant, was established.
Implications:
- This case represents a rare cutaneous manifestation of PTLD, specifically the plasma cell neoplasm variant.
- The presentation mimicked squamous cell carcinoma in situ, underscoring the importance of differential diagnosis in post-transplant patients.
- The patient progressed despite reduction of immunosuppression, suggesting alternative therapeutic strategies may be necessary for this rare variant.
