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

Eun-Young Ji; Ji-Yeun Chang; Chul Woo Yang; Seok-Goo Cho; Byung Ha Chung

doi:10.4285/jkstn.2018.32.2.26

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Ji, Chang, Yang, Cho, and Chung: Bilateral Conjunctival Mucosa-Associated Lymphoid Tissue Type Lymphoma in a Kidney Transplant Recipient

Case Report

J Korean Soc Transplant 2018;32(2):26-30.

Published online: 19 January 2018

DOI: https://doi.org/10.4285/jkstn.2018.32.2.26

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

Eun-Young Ji, M.D.¹, Ji-Yeun Chang, M.D.¹, Chul Woo Yang, M.D.¹, Seok-Goo Cho, M.D.², Byung Ha Chung, M.D.^1,

¹Division of Nephrology, Hematology, Department of Internal Medicine, Seoul St. Mary's Hospital College of Medicine, The Catholic University of Korea, Seoul, Korea

²Division of Nephrology, Hematology, Department of Internal Medicine, Seoul St. Mary's Hospital College of Medicine, The Catholic University of Korea, Seoul, Korea

Corresponding author: Byung Ha Chung Division of Nephrology, Department of Internal Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, 222 Banpo-daero, Seocho-gu, Seoul 06591, Korea Tel: 82-2-2258-6066, Fax: 82-2-536-0323 E-mail: chungbh@catholic.ac.kr

Received 21 February 2018 Revised 31 March 2018 Accepted 23 April 2018

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

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.

Keywords: Kidney transplantation, Marginal zone B-cell lymphoma, Lymphoproliferative disorders

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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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