J Korean Soc Transplant.  2018 Jun;32(2):26-30. 10.4285/jkstn.2018.32.2.26.

Bilateral Conjunctival Mucosa-Associated Lymphoid Tissue Type Lymphoma in a Kidney Transplant Recipient

• Ji EY
• Chang JY
• Yang CW
• Cho SG
• Chung BH

• KMID: 2414445
• DOI: http://doi.org/10.4285/jkstn.2018.32.2.26

Abstract

Lymphoproliferative disorder in a posttransplant setting has emerged as a difficult problem in kidney transplantation (KT). Lymphoma involving adnexa of the eye has rarely been reported due to scarcity of lymphoreticular tissue in the ocular area. This report presents a case of a 37-year-old KT recipient who was diagnosed with conjunctival mucosa-associated lymphoid tissue lymphoma with a chief complaint of seeing black spots. Unlike other post-transplant lymphoproliferative diseases associated with the Epstein-Barr virus (EBV) reactivation via immunosuppression, the lesion was not related to the virus. The patient received radiotherapy with concomitant conversion from the tacrolimus to the sirolimus. Overall, the results presented herein indicate lymphoma may be an important differential diagnosis when KT recipients complain of ocular discomfort.

Keyword

Kidney transplantation; Marginal zone B-cell lymphoma; Lymphoproliferative disorders

MeSH Terms

Adult
Diagnosis, Differential
Herpesvirus 4, Human
Humans
Immunosuppression
Kidney Transplantation
Kidney*
Lymphoid Tissue*
Lymphoma*
Lymphoma, B-Cell, Marginal Zone
Lymphoproliferative Disorders
Radiotherapy
Sirolimus
Tacrolimus
Transplant Recipients*
Sirolimus
Tacrolimus

Figure

• 

  Fig. 1. Clinical appearance (A) and Immunohistochemical staining properties (B-D). (A) Slit-lamp examination showed a salmon color appearance of conjunctival mucosa-associated lymphoid tissue lymphoma. (B) Monotonous atypical cells infiltrated of mucosa by small lymphocytes (HE stain, ×400). (C) The specimen was negative to Epstein-Barr virus encoded RNA (in situ hybridization, ×400). (D) Immunohistochemistry was diffusely positive for CD20 (×400). (E) Microscopic finding revealed lymphoepithelial lesions (Pancytokeratin, ×400).

• 

  Fig. 2. (A) Orbit magnetic resonance imaging showed no definite enhancement or mass in both orbit conjunctivae. (B) Coronal positron emission tomography computer tomography image showed intense fludeoxyglucose uptake in bilateral conjunctivae (white arrows) and both palatine tonsils.

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