Metachronous spinal cord involvement B cell and subcutaneous tissue involvement NK/T cell lymphoid proliferations and lymphomas arising in post-transplantation mimicking general NK/T cell lymphoma: a case report and review of the literature

Abstract

Lymphoid proliferations and lymphomas arising in post-transplantation are potentially life-threatening complications after solid organ transplant (SOT) and hematopoietic stem cell transplant (HSCT). The lymphoid proliferations and lymphomas arising in post-transplantation originating from different cell lineages in the same patient are highly unusual. Herein, we delineate a case of isolated spinal cord involvement with B cell lymphoid proliferations and lymphomas arising in post-transplantation at 11 months post-transplantation, which was successfully treated with chemotherapy and intrathecal injection. Six months later, the patient again developed lymphoma arising in post-transplantation, presenting with predominant subcutaneous tissue involvement deriving from EBV-positive NK/T cells, and received four courses of chemotherapy. Ultimately, she achieved complete remission (CR). The report further contributes to our new insights into the unusual clinical presentations of lymphoid proliferations and lymphomas arising in post-transplantation.

Keywords: Nk/T cell lymphoma; lymphoid proliferations and lymphomas associated with immune deficiency/dysregulation; spinal cord; subcutaneous; transplantation.

Figure 1

(A)-T2 weighted sagittal images revealed diffuse swelling and increased spinal cord signal intensity from cervical 2 to thoracic 3 before treatment (the red arrow). (B)- T2 weighted sagittal images showed that spinal cord swelling and abnormal strengthening signals from cervical 2 to thoracic 3 were significantly remitted after treatment (the red arrow). (C)- T2 weighted axial images revealed hyper-intense signal in the spinal cord more in the white matter region before treatment (the red arrow). (D)- T2 weighted axial images revealed hyper-intense signal in the white matter of the spinal cord return to normal (the red arrow).

Figure 2

(A, B)-neoplastic NK/T-cells-positive reaction for CD20; biopsy of mass on the left upper extremity and the right upper extremity respectively; (C, D)–neoplastic NK/T-cells-positive reaction for CD3; biopsy of mass on the left upper extremity and the right upper extremity respectively; (E, F)–neoplastic NK/T-cells-positive reaction for CD4; biopsy of mass on the left upper extremity and the right upper extremity respectively; (G, H)–neoplastic NK/T-cells-positive reaction for CD8; biopsy of mass on the left upper extremity and the right upper extremity respectively; (I, J)–neoplastic NK/T-cells-positive reaction for CD56; biopsy of mass on the left upper extremity and the right upper extremity respectively; (K, L)– neoplastic NK/T-cells; high proliferative index – almost all cells showed expression of Ki67; biopsy of mass on the left upper extremity and the right upper extremity respectively; (M, N)–neoplastic NK/T-cells-positive reaction for EBER; biopsy of mass on the left upper extremity and the right upper extremity respectively; (O, P)–neoplastic NK/T-cells-positive reaction for Granzyme B; biopsy of mass on the left upper extremity and the right upper extremity respectively; (Q, R)–neoplastic NK/T-cells-positive reaction for TIA-1; biopsy of mass on the left upper extremity and the right upper extremity respectively; (S, T)–neoplastic NK/T-cells-positive reaction for EBNA2; biopsy of mass on the left upper extremity and the right upper extremity respectively.