CUTANEOUS SQUAMOPROLIFERATIVE LESIONS IN RENAL-TRANSPLANT RECIPIENTS - DIFFERENTIATION FROM LESIONS IN IMMUNOCOMPETENT PATIENTS

Of 291 immunosuppressed renal transplant recipients (RTRs) with surviv ing allografts attending the Royal London Hospital, 171 patients (59%) were found to have warty keratoses. On histological analysis, the les ions in 50 patients (17%) showed partial-thickness dysplasia, and 34 ( 12%) had one or more invasive squamous cell carcinoma (SCC) and/or one or more in situ SCC or full-thickness dysplasia. We examined the clai m that squamoproliferative lesions in RTRs possess distinctive histopa thological features that differ from those of similar lesions occurrin g sporadically in the nonimmunosuppressed population. We compared 40 s quamoproliferative lesions from RTRs with 40 matched squamoproliferati ve lesions from nonimmunosuppressed patients; lesions were coded and t heir source was unknown to the assessors. Two dermatopathologists inde pendently assessed the cases and gave scores for 11 histological featu res that have been reported to be characteristic of such lesions in th e immunosuppressed population. These included a warty architecture, ko ilocytes, and multinucleate giant cells. Using these criteria, it was not possible to distinguish lesions of immunosuppressed patients from those of immunocompetent people.