Fine Needle Aspiration Biopsy of a Posttransplant Lymphoproliferative Disorder with Pronounced Plasmacytic Differentiation Presenting in the Face

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Abstract
Posttransplant lymphoproliferative disorders (PTLDs) occur in fewer than 2% of transplant patients. However, as a group, 54% of PTLD patients die of these diseases. Presentation as only skin/superficial soft tissue nodules is rare, with this the second such reported case, and this is the only fine needle aspiration biopsy (FNAB) of such a case as well as the only FNAB of a plasmacytoid monomorphous/monoclonal PTLD. A 48-year-old, white male, seven years status post kidney transplantation, presented with a 2.5-cm mass in the skin/soft tissue anterior to the right maxillary sinus. FNAB showed a moderately cellular smear composed of discohesive cells, many with the morphology of plasma cells and some with the morphology of large lymphocytes. Flow cytometry showed these cells to be a monoclonal B-cell population, and a diagnosis of monomorphous/monoclonal PTLD was made. The diagnosis was subsequently confirmed by histology. The patient ultimately died. The clinical course of the present patient was grave as compared with the course of the other reported patient.

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