Kwon Eun Ji, Katz Kenneth A, Draft Karla S, Seykora John T, Rook Alain H, Wasik Mariusz A, Junkins-Hopkins Jacqueline M
University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania 19104, USA.
J Am Acad Dermatol. 2006 Apr;54(4):657-63. doi: 10.1016/j.jaad.2005.11.1066.
A 58-year-old lung transplant patient developed worsening shortness of breath and indurated erythematous plaques on the lower left leg. A skin biopsy specimen revealed a dense angiocentric and angioinvasive infiltrate in the mid to reticular dermis and panniculus containing large, atypical lymphocytes with convoluted nuclei and prominent nucleoli. Immunohistochemical stains showed that the atypical cells were of B-cell origin, and that Epstein-Barr virus was present. Molecular studies demonstrated B-cell clonality. The patient was successfully treated with rituximab. The clinical and pathologic features in this case represent posttransplantation lymphoproliferative disease with features of lymphomatoid granulomatosis. The case also highlights the importance of clinical and pathologic examination of cutaneous lesions in the evaluation of lymphoproliferative disorders for patients undergoing transplantation.
一名58岁的肺移植患者出现呼吸急促加重，左小腿下部出现硬结性红斑斑块。皮肤活检标本显示，在真皮中层至网状层以及皮下组织中有密集的血管中心性和血管浸润性浸润，其中含有大的、非典型淋巴细胞，核呈卷曲状，核仁突出。免疫组化染色显示非典型细胞起源于B细胞，且存在EB病毒。分子研究证实为B细胞克隆性。该患者接受利妥昔单抗治疗成功。本例的临床和病理特征代表具有淋巴瘤样肉芽肿特征的移植后淋巴细胞增生性疾病。该病例还强调了在评估移植患者的淋巴细胞增生性疾病时，对皮肤病变进行临床和病理检查的重要性。
