Spontaneous Regression Of Primary Cutaneous Epstein–barr Virus-positive, Cd30-positive Anaplastic Large T-cell Lymphoma In A Heart-transplant Recipient
Chiu, L.S., Choi, P.C.L., Luk, N.M., Chang, M. and Tang, W.Y.M. (2009), spontaneous regression of primary cutaneous Epstein–Barr virus-positive, CD30-positive anaplastic large T-cell lymphoma in a heart-transplant recipient. Clinical and Experimental Dermatology, 34: e21-e24. https://doi.org/10.1111/j.1365-2230.2008.03145.x
View Original Source →Abstract
We presented a rare case of primary cutaneous Epstein-Barr virus-positive, CD30-positive anasplastic large cell lymphoma in a 64-year-old man who had received a heart transplant 11 years previously. The first presenting symptom was the appearance of erythematous skin nodules on the right leg. The lesions subsided with dose reduction of immunosuppressant alone. There was no recurrence 9 months after the first diagnosis. We propose that dose reduction of immunosuppressant alone may be an effective treatment for localized, indolent, post-transplant-related primary cutaneous lymphoma. Our case shows the importance of regular surveillance of skin cancer in patients who have received organ transplant.
Case Details
Disease Location
Erythematous nodules on the right leg (skin)
Personal Characteristics
64 -year-old chinese male heart transplant in 1996
Clinical Characteristics
11 years after the heart transplant, multiple nodules appeared on the right leg , no system symptoms physical exam found multiple erythematous nodules on the right leg with the largest measuring 20 x 15 mm, nodules were firm, nontender and had a smooth surface. Diffuse erythematous induration was noted in the surrounding skin histologic exam of skin biopsy showed dermal infiltrative sheets of medium to large anaplastic cells with prominent nucleoli. Focal necrosis and apoptosis were apparent, stains were positive for CD3, 30, and eber, CD2, and t-cell intracytoplasmic antigen. CD4 and 8 stains showed a decrease in the number of stained cells, but the CD8-positive cells outnumbered the CD4 positive. L26, oct2, tdt, CD56, alk-1, CD31, cd 34, myeloperoxidase and human herpes virus-8 stains were negative full exam didn't find any lymphadenopathy or hepatosplenomegaly. Bone marrow exam were normal. PET and CT scans showed lesions in the colon that were later confirmed to be adenocarcinoma. Clinical and histopathological features were consistent with post-transplant primary cutaneous ebv-positive, CD30-positive, anaplastic large-cell lymphoma (alcl)
Remission Characteristics
When ciclosporin a was reduced, the skin lesions started to regress 3 weeks after dose reduction. Complete resolution was noted 3 months later and no recurrence at 9 months 9 months after hemicolectomy there was no recurrence of colonic adenocarcinoma
Treatment & Mechanisms
Proposed Remission Mechanisms
Dose reduction of immunosuppressants
Clinical Treatment
Azathioprine, ciclosporin a, and prednisolone after heart transplant hemicolectormy for the colonic adenocarcinoma
Non-Clinical Treatment
None reported