Craddock Ashley P, Gru Alejandro A, Mannschreck Diana, Wilson Barbara B, Raghavan Shyam S
Departments of Pathology, and.
Dermatology, University of Virginia, Charlottesville, VA.
Am J Dermatopathol. 2021 Dec 1;43(12):e234-e236. doi: 10.1097/DAD.0000000000001950.
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.
移植后淋巴组织增生性疾病（PTLD）是一个用于描述实体器官移植后发生的一系列淋巴组织增生性疾病的术语。尽管临床表现各异，但原发性皮肤PTLD通常表现为孤立性结节，呈基于真皮的增生。我们报告一例70岁女性肾移植患者，其右小腿出现无症状性红斑斑块2个月，临床怀疑为原位鳞状细胞癌。组织形态学显示真皮内有非典型浆细胞增生，染色质致密，核仁大小不一，核边界不规则。通过原位杂交检测，非典型浆细胞的爱泼斯坦-巴尔病毒呈阳性，通过RNAscope原位杂交检测显示明显的κ链限制。最终诊断为皮肤单形性PTLD，浆细胞肿瘤变体，这在皮肤中是一种罕见的诊断。PTLD的治疗通常包括减少免疫抑制，尽管我们的患者在进行了这种干预后病情仍进展并出现了新的病变。在本研究中，我们报告了皮肤PTLD浆细胞肿瘤变体的一种非典型表现，表现为原位鳞状细胞癌。
