Abstract:

Immunosuppression following solid organ transplantation is a known risk factor for the development of post-transplant lymphoproliferative disorders (PTLD), particularly B?cell lymphomas. Primary cutaneous T?cell lymphomas (CTCL) are considered rare. Although folliculotropic mycosis fungoides (FMF) accounts for only 4% of the CTCLs, it may be more common in post?transplant patients compared to the general population. There is limited data describing the spectrum of clinical and histopathological features of CTCL in solid organ transplant recipients (SOTR). We performed a retrospective review of 8 patients seen at a multi-site academic institution who developed post-transplant CTCL from January 1, 1998 to December 31, 2013. 6 patients (75%) were male and 2 patients (25%) were female. The average age was 58.3 years. The average time from date of transplant to diagnosis of CTCL was 10.2 years. Organs that were transplanted included heart (1), liver (4), and kidney (3). Clinical presentation varied from ulcerated papulonodules, comedone-like lesions, intense pruritus, and scaly erythematous eruptions. 12 biopsies were available for review in 5 patients. The most common histologic presentation was FMF (7/12). Other histologic presentations included patch (2/12) and plaque stage (3/12) mycosis fungoides. EBV-ISH (Epstein-Barr virus-in situ hybridization) performed on all specimens were negative confirming that unlike B-cell PTLDs, EBV infection does not play a role in T-cell PTLDs. We emphasize the rarity of CTCL development following solid organ transplantation. Although rare in the general population, the FMF subtype appears to be disproportionately seen in the SOTR population compared to other CTCLs.

Financial Disclosure:
No current or relevant financial relationships exist.

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Christina Dai, MD