Book contents
- Frontmatter
- Contents
- List of Contributors
- Foreword by Daniel R. Salomon
- Foreword by Robin Marks
- Foreword by Kathy Schwab
- Preface
- Acknowledgments
- SECTION ONE TRANSPLANT DERMATOLOGY: AN EVOLVING DYNAMIC FIELD
- Section Two Transplant Medicine and Dermatology
- Section Three Pathogenic Factors in Transplant Dermatology
- Section Four Cutaneous Effects of Immunosuppressive Medications
- Section Five Infectious Diseases of the Skin in Transplant Dermatology
- Section Six Benign and Inflammatory Skin Diseases in Transplant Dermatology
- Section Seven Cutaneous Oncology in Transplant Dermatology
- 20 The Pathogenesis of Skin Cancer in Organ Transplant Recipients
- 21 The Epidemiology of Skin Cancer in Organ Transplant Recipients
- 22 The Clinical Presentation and Diagnosis of Skin Cancer in Organ Transplant Recipients
- 23 Actinic Keratosis in Organ Transplant Recipients
- 24 Basal Cell Carcinoma in Organ Transplant Recipients
- 25 Squamous Cell Carcinoma in Organ Transplant Recipients
- 26 Malignant Melanoma in Organ Transplant Recipients
- 27 Merkel Cell Carcinoma in Organ Transplant Recipients
- 28 Kaposi's Sarcoma in Organ Transplant Recipients
- 29 Posttransplant Lymphoproliferative Disorder/Lymphoma in Organ Transplant Recipients
- 30 Rare Cutaneous Neoplasms in Organ Transplant Recipients
- 31 Histopathologic Features of Skin Cancer in Organ Transplant Recipients
- Section Eight Special Scenarios in Transplant Cutaneous Oncology
- Section Nine Educational, Organizational, and Research Efforts in Transplant Dermatology
- Index
29 - Posttransplant Lymphoproliferative Disorder/Lymphoma in Organ Transplant Recipients
from Section Seven - Cutaneous Oncology in Transplant Dermatology
Published online by Cambridge University Press: 18 January 2010
- Frontmatter
- Contents
- List of Contributors
- Foreword by Daniel R. Salomon
- Foreword by Robin Marks
- Foreword by Kathy Schwab
- Preface
- Acknowledgments
- SECTION ONE TRANSPLANT DERMATOLOGY: AN EVOLVING DYNAMIC FIELD
- Section Two Transplant Medicine and Dermatology
- Section Three Pathogenic Factors in Transplant Dermatology
- Section Four Cutaneous Effects of Immunosuppressive Medications
- Section Five Infectious Diseases of the Skin in Transplant Dermatology
- Section Six Benign and Inflammatory Skin Diseases in Transplant Dermatology
- Section Seven Cutaneous Oncology in Transplant Dermatology
- 20 The Pathogenesis of Skin Cancer in Organ Transplant Recipients
- 21 The Epidemiology of Skin Cancer in Organ Transplant Recipients
- 22 The Clinical Presentation and Diagnosis of Skin Cancer in Organ Transplant Recipients
- 23 Actinic Keratosis in Organ Transplant Recipients
- 24 Basal Cell Carcinoma in Organ Transplant Recipients
- 25 Squamous Cell Carcinoma in Organ Transplant Recipients
- 26 Malignant Melanoma in Organ Transplant Recipients
- 27 Merkel Cell Carcinoma in Organ Transplant Recipients
- 28 Kaposi's Sarcoma in Organ Transplant Recipients
- 29 Posttransplant Lymphoproliferative Disorder/Lymphoma in Organ Transplant Recipients
- 30 Rare Cutaneous Neoplasms in Organ Transplant Recipients
- 31 Histopathologic Features of Skin Cancer in Organ Transplant Recipients
- Section Eight Special Scenarios in Transplant Cutaneous Oncology
- Section Nine Educational, Organizational, and Research Efforts in Transplant Dermatology
- Index
Summary
INTRODUCTION
Posttransplant lymphoproliferative disorder (PTLD) is a wellknown, serious complication of solid organ transplant recipients (OTRs) or bone marrow (hematopoietic stem cell) transplant recipients. The clinicopathological spectrum ranges from a mononucleosis-like illness or benign lymphoid hyperplasia to an aggressive malignant lymphoma. Although the skin may be involved as a component of disease dissemination, primary localized cutaneous disease is rare.
PATHOGENESIS
The etiology of PTLD is multifactorial. More than 95% of the world's population is infected by Epstein-Barr Virus (EBV). With primary infection, EBV establishes latency in memory B-cells. Immunocompetent individuals mount a humoral immune response producing antibodies that bind to viral membrane proteins and neutralize viral infectivity. A cellular immune response, composed of cytotoxic T-lymphocytes (CTL), is necessary to control primary and latent EBV-infected cells. In the latent state, viral proteins, Epstein-Barr nuclear antigen (EBNA) and latent membrane proteins (LMP), are produced and protect the B-cell from apoptosis while allowing for continued viral replication.
In the setting of immunosuppression, the normal CTL response to EBV antigens is impaired, allowing viral replication to continue unabated and leading to cell cycle dysregulation in B-cells and an uncontrolled lymphoproliferative response. When unregulated replication proceeds, the virus can infect adjacent host cells. Viral proliferation leads to expression of EBV-derived oncogenes including synthesis of EBNA and LMP. Persistent immunosuppression and additional mutations may result in transformation from an EBV-mediated polyclonal lymphoproliferative disorder to a true, potentially aggressive, monoclonal lymphoma.
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- Information
- Skin Disease in Organ Transplantation , pp. 199 - 202Publisher: Cambridge University PressPrint publication year: 2008