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Hooper MJ, Lee WJ, LeWitt TM, Nguyen C, Griffin T, Chung C, Zhou XA, Guitart J. Epstein-Barr Virus-Associated Lymphomatoid Papules: A Sign of Immunosuppression Resembling Lymphomatoid Papulosis. Am J Dermatopathol 2023; 45:789-800. [PMID: 37982462 PMCID: PMC10662656 DOI: 10.1097/dad.0000000000002479] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2023]
Abstract
ABSTRACT Epstein-Barr virus (EBV)-positive lymphoproliferative disorders associated with immunodeficiency constitute a spectrum of lymphoid and plasma cell proliferations that vary in cytomorphology, immunophenotype, and clinical behavior. CD30-positive cutaneous lymphocytic infiltrates with EBV expression and lymphomatoid papulosis-like presentations have been rarely reported. This retrospective study assessed the clinical and histopathological characteristics of EBV-positive cases with papulonodular morphologies and CD30 positivity seen by Northwestern Medicine Dermatopathology. Twelve patients (7M:5F, mean age 69 years) were presented with papular cutaneous lesions without antecedent patch/plaque disease. Nine cases were associated with known immunosuppression in the setting of transplant-related therapies (n = 4), hematopoietic malignancy (n = 2), post-transplant hematopoietic malignancy (n = 1), and autoimmune disease treatment (n = 2). Two patients had age-related immunosenescence. Four patients demonstrated EBV viremia; for 2 patients, this finding comprised the first sign of immunosuppression. Workup was negative for systemic lymphoma in all patients. Various treatment strategies were used, including observation (n = 3), discontinuation/reduction of immunosuppression (n = 3), rituximab (n = 4), and steroids (n = 4). At mean 30-month follow-up, 4 patients (33.3%) were alive, 3 with and 1 without disease. Eight patients (67.6%) had died, 3 after lesional resolution and 5 with recurrent disease. Biopsies revealed mixed lymphoid infiltrates composed of atypical CD30-positive T cells (n = 5) or B cells (n = 7) with variable EBV-encoded small RNA expression. These cases suggest clinicopathologic presentations resembling lymphomatoid papulosis with atypical, large CD30-positive, EBV-positive cells could comprise first sign of potentially serious immunodeficiency and should prompt evaluation for EBV viremia. These cases also broaden the current picture of immunodeficiency-associated lymphoproliferative disorders to include lymphomatoid papulosis-like clinical presentations.
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Affiliation(s)
- Madeline J Hooper
- Resident Physician, Department of Dermatology, Northwestern University, Chicago, IL
| | - Woo Jin Lee
- Assistant Professor, Department of Dermatology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Tessa M LeWitt
- Resident Physician, Department of Dermatology, Northwestern University, Chicago, IL
| | - Cuong Nguyen
- Assistant Professor, Department of Dermatology, Northwestern University, Chicago, IL
| | - Teresa Griffin
- Visiting Predoctoral Research Fellow, Department of Dermatology, Northwestern University, Chicago, IL; and
| | - Christopher Chung
- Resident Physician, Department of Dermatology, Northwestern University, Chicago, IL
| | - Xiaolong A Zhou
- Assistant Professor, Department of Dermatology, Northwestern University, Chicago, IL
| | - Joan Guitart
- Professor, Department of Dermatology, Northwestern University, Chicago, IL
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Matsumura M, Miyagi S, Tokodai K, Kashiwadate T, Fujio A, Miyazawa K, Sasaki K, Saito Y, Kanai N, Unno M, Kamei T. Probable posttransplant lymphoproliferative disorder after pediatric living donor liver transplantation: Is a biopsy still needed? Clin Case Rep 2022; 10:e6454. [DOI: 10.1002/ccr3.6454] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2022] [Revised: 07/22/2022] [Accepted: 08/25/2022] [Indexed: 11/06/2022] Open
Affiliation(s)
- Muneyuki Matsumura
- Department of Surgery Tohoku University Graduate School of Medicine Sendai Japan
| | - Shigehito Miyagi
- Department of Surgery Tohoku University Graduate School of Medicine Sendai Japan
| | - Kazuaki Tokodai
- Department of Surgery Tohoku University Graduate School of Medicine Sendai Japan
| | - Toshiaki Kashiwadate
- Department of Surgery Tohoku University Graduate School of Medicine Sendai Japan
| | - Atsushi Fujio
- Department of Surgery Tohoku University Graduate School of Medicine Sendai Japan
| | - Koji Miyazawa
- Department of Surgery Tohoku University Graduate School of Medicine Sendai Japan
| | - Kengo Sasaki
- Department of Surgery Tohoku University Graduate School of Medicine Sendai Japan
| | - Yoshikatsu Saito
- Department of Surgery Tohoku University Graduate School of Medicine Sendai Japan
| | - Norifumi Kanai
- Department of Surgery Tohoku University Graduate School of Medicine Sendai Japan
| | - Michiaki Unno
- Department of Surgery Tohoku University Graduate School of Medicine Sendai Japan
| | - Takashi Kamei
- Department of Surgery Tohoku University Graduate School of Medicine Sendai Japan
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Natural Killer Cells in Post-Transplant Lymphoproliferative Disorders. Cancers (Basel) 2021; 13:cancers13081836. [PMID: 33921413 PMCID: PMC8068932 DOI: 10.3390/cancers13081836] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Revised: 04/06/2021] [Accepted: 04/07/2021] [Indexed: 12/19/2022] Open
Abstract
Post-transplant lymphoproliferative disorders (PTLDs) are life-threatening complications arising after solid organ or hematopoietic stem cell transplantations. Although the majority of these lymphoproliferations are of B cell origin, and are frequently associated with primary Epstein-Barr virus (EBV) infection or reactivation in the post-transplant period, rare cases of T cell and natural killer (NK) cell-originated PTLDs have also been described. A general assumption is that PTLDs result from the impairment of anti-viral and anti-tumoral immunosurveillance due to the long-term use of immunosuppressants in transplant recipients. T cell impairment is known to play a critical role in the immune-pathogenesis of post-transplant EBV-linked complications, while the role of NK cells has been less investigated, and is probably different between EBV-positive and EBV-negative PTLDs. As a part of the innate immune response, NK cells are critical for protecting hosts during the early response to virus-induced tumors. The complexity of their function is modulated by a myriad of activating and inhibitory receptors expressed on cell surfaces. This review outlines our current understanding of NK cells in the pathogenesis of PTLD, and discusses their potential implications for current PTLD therapies and novel NK cell-based therapies for the containment of these disorders.
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Immunodeficiency-associated lymphoproliferative disorders: time for reappraisal? Blood 2018; 132:1871-1878. [PMID: 30082493 DOI: 10.1182/blood-2018-04-842559] [Citation(s) in RCA: 69] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2018] [Accepted: 07/27/2018] [Indexed: 12/14/2022] Open
Abstract
Immunodeficiency-associated lymphoproliferative disorders (IA-LPDs) are pathologically and clinically heterogeneous. In many instances, similar features are shared by a spectrum of IA-LPDs in clinically diverse settings. However, the World Health Organization (WHO) classifies IA-LPDs by their immunodeficiency setting largely according to the paradigm of posttransplant lymphoproliferative disorders but with inconsistent terminology and disease definitions. The field currently lacks standardization and would greatly benefit from thinking across immunodeficiency categories by adopting a common working vocabulary to better understand these disorders and guide clinical management. We propose a 3-part unifying nomenclature that includes the name of the lesion, associated virus, and the specific immunodeficiency setting for all IA-LPDs. B-cell lymphoproliferative disorders (LPDs) are usually Epstein-Barr virus (EBV)+ and show a spectrum of lesions, including hyperplasias, polymorphic LPDs, aggressive lymphomas, and, rarely, indolent lymphomas. Human herpes virus 8-associated LPDs also include polyclonal and monoclonal proliferations. EBV- B-cell LPDs and T- and NK-cell LPDs are rare and less well characterized. Recognition of any immunodeficiency is important because it impacts the choice of treatment options. There is an urgent need for reappraisal of IA-LPDs because a common framework will facilitate meaningful biological insights and pave the way for future work in the field.
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Kim YJ, Choi JW, Won CH, Chang SE, Lee MW, Choi JH, Lee WJ. Post-transplant lymphoproliferative disease with features of cutaneous natural killer/T-cell lymphoma. Australas J Dermatol 2018; 59:334-336. [PMID: 29380362 DOI: 10.1111/ajd.12788] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Young Jae Kim
- Department of Dermatology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Jae Won Choi
- Department of Dermatology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Chong Hyun Won
- Department of Dermatology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Sung Eun Chang
- Department of Dermatology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Mi Woo Lee
- Department of Dermatology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Jee Ho Choi
- Department of Dermatology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Woo Jin Lee
- Department of Dermatology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
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Ishimura E, Okute Y, Nakatani S, Ichii M, Tsuda A, Inaba M. Focal accumulation of 67 gallium in the kidney in a patient with anti-glomerular basement membrane glomerulonephritis. Nephrology (Carlton) 2017; 22:728-729. [PMID: 28792126 DOI: 10.1111/nep.12918] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2016] [Revised: 08/27/2016] [Accepted: 08/29/2016] [Indexed: 11/30/2022]
Affiliation(s)
- Eiji Ishimura
- Osaka City University, Graduate School of Medicine, Osaka, Japan
| | - Yujiro Okute
- Osaka City University, Graduate School of Medicine, Osaka, Japan
| | - Shinya Nakatani
- Osaka City University, Graduate School of Medicine, Osaka, Japan
| | - Mitsuru Ichii
- Osaka City University, Graduate School of Medicine, Osaka, Japan
| | - Akihiro Tsuda
- Osaka City University, Graduate School of Medicine, Osaka, Japan
| | - Masaaki Inaba
- Osaka City University, Graduate School of Medicine, Osaka, Japan
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Roman M, Parmar J, Goddard M, Solli P. Native lung pneumonectomy for post-transplantation lymphoproliferative disorder refractory to rituximab following contralateral lung transplantation. Interact Cardiovasc Thorac Surg 2016; 23:841-843. [PMID: 27422972 DOI: 10.1093/icvts/ivw235] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2016] [Revised: 06/08/2016] [Accepted: 06/15/2016] [Indexed: 11/13/2022] Open
Abstract
Post-transplantation lymphoproliferative disorder (PTLD) is a life-threatening complication following lung transplantation. We report a PTLD case of high-grade, B-cell lymphoma following contralateral single-lung transplantation. The disease involved the liver, right kidney and right native lung. While the PTLD affecting the abdominal organs regressed with rituximab chemotherapy, the native lung disease progressed and was treated surgically (right pneumonectomy). Some aspects are unique in this case: (i) different response to medical treatment between lung and abdominal organs; (ii) absolute absence of involvement of the native lung and (iii) surgical treatment with a pneumonectomy, still very rarely described in the literature. We hypothesized that a different morphotype of the disease involved the abdominal organs or the penetrance of rituximab, and chemotherapy could have been impaired by the presence of pulmonary fibrosis.
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Affiliation(s)
- Marius Roman
- Department of Thoracic Surgery, Papworth Hospital, Cambridge, UK
| | - Jasvir Parmar
- Department of Cardiothoracic Transplantation, Papworth Hospital, Cambridge, UK
| | - Martin Goddard
- Department of Histopathology, Papworth Hospital, Cambridge, UK
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Acosta AM, Alagiozian-Angelova V, Kovarik P, Sekosan M. Post-transplant extranodal NK/T-cell lymphoma, nasal type with cutaneous and pulmonary involvement. Pathology 2016; 48:380-3. [PMID: 27130835 DOI: 10.1016/j.pathol.2016.03.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2016] [Revised: 03/08/2016] [Accepted: 03/14/2016] [Indexed: 11/19/2022]
Affiliation(s)
- Andres M Acosta
- Department of Pathology, University of Illinois at Chicago Hospital and Health Sciences System, Chicago, IL, United States.
| | | | - Paula Kovarik
- Department of Pathology, John H. Stroger Jr Hospital of Cook County (CCHS), Chicago, IL, United States
| | - Marin Sekosan
- Department of Pathology, John H. Stroger Jr Hospital of Cook County (CCHS), Chicago, IL, United States
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