Plasmocytomes cutanés associés au virus Epstein-Barr chez les transplantés d’organes

A Problem of Classification: 2 Cases of Epstein-Barr Virus + Primary Cutaneous Plasmacytoma Arising in Immunocompetent Elderly Patients

ABSTRACT

Primary extramedullary plasmacytoma is rare monoclonal proliferation of plasma cells, which arise in various nonosseous anatomic locations without detectable underlying systemic disease. Historically, cutaneous infiltrates rich in mature neoplastic plasma cells have fallen into one of the following categories, plasmacytoma, lymphoplasmacytic lymphoma, and marginal zone lymphoma, which included immunocytoma. Since 2005, each of these was subsumed under the marginal zone lymphoma umbrella, largely on the basis of acknowledged diagnostic difficulties in some of these cases. We describe 2 cases in which the cutaneous infiltrates consisted of a pure population of light chain-restricted mature plasma cells in the absence of any other evidence for a marginal zone proliferation, or evidence of extracutaneous involvement, including a paraprotein. We propose that primary cutaneous plasmacytoma is the accurate diagnosis and is consistent with wider nomenclature. The unusual observation of widespread Epstein-Barr virus expression in both tumors is also discussed.

Primary cutaneous Epstein-Barr virus–related lymphoproliferative disorders in 4 immunosuppressed children

Primary cutaneous Epstein-Barr virus-related lymphoproliferative disorders are rare. We describe 4 cases in children: two with acquired immunodeficiencies (HIV infection, heart transplantation) and two with congenital immunodeficiencies (ataxia-telangiectasia and an undetermined disease affecting the T lymphocytes). Two of the lymphoproliferative disorders were T-cell types and two were B-cell types. The two T-cell types were also Epstein-Barr virus positive, which is extremely rare. Three of the patients developed extracutaneous disease with poor outcome, resulting in death.

Dermatologic complications after liver transplantation: a single-center experience

OBJECTIVE

To report our experience with dermatological complications after both deceased donor liver transplantation (DDLT) and living-donor liver transplantation (LDLT).

PATIENTS AND METHODS

Between April 2001 and November 2006, a total of 116 liver transplantation (LT) procedures were performed (73 DDLTs and 43 LDLTs) in 112 patients (4 re-transplants). Posttransplant dermatological problems were recorded.

RESULTS

Among 112 OLT recipients, 14 patients (12.5%) experienced dermatologic problems: epidermolysis bullosa acquisita in one patient, which was self-limiting; graft-versus-host-disease in one patient treated with high-dose steroids; Kaposi sarcoma in one patient treated with surgical excision and conversion to sirolimus-based immunosuppression; drug-induced cutaneous vasculitis with deep thigh ulcer formation treated by drug discontinuation and surgical excision of the ulcer; herpes zoster in one patient treated with intravenous antiviral therapy; herpes simplex in two patients treated with local antiviral cream; cyclosporine-induced gingival hyperplasia treated with conversion to FK506; cyclosporine-induced hypertrichosis treated with conversion to FK506; steroid-induced skin hyperpigmentation in one patient treated with steroid withdrawal; hypomagnesemia-induced hair loss treated with daily oral magnesium supplement; pressure-induced alopecia areata in two patients that was self-limiting; and finally, one patient with a pressure-induced heel ulcer that was treated conservatively. In 8 of 14 patients (57%) who suffered from dermatologic problems, the complication was primarily related to immunosuppressive drugs.

CONCLUSIONS

In our experience, dermatologic complications following LT are not uncommon and usually related to immunosuppressive therapy. Most complications could be prevented by optimizing immunosuppression. The majority of complications were easily managed by simple adjustment of immunosuppression.

Primary Cutaneous Plasmacytoma (Posttransplant Lymphoproliferative Disorder, Plasmacytoma-like) in a Heart Transplant Patient

Extramedullary plasmacytomas in posttransplant patients are rarely encountered. We present the fifth case of a primary cutaneous plasmacytoma (posttransplant lymphoproliferative disorder, plasmacytoma-like) that developed in a heart transplant patient. The tumor presented as a solitary nodule of the skin 10 years after transplantation. It subsequently involved 2 other cutaneous sites and remained confined to the skin for 5 years. The neoplastic cells were Epstein-Barr virus small RNAs (EBER 1,2) positive and EBV-latent membrane protein 1 (LMP 1) negative, corresponding to type I EBV latency. The direct role of EBV in the development of the tumor remains uncertain.