ORAL PRESENTATION OF POSTTRANSPLANTATION LYMPHOPROLIFERATIVE DISORDERS - AN UNUSUAL MANIFESTATION

Cyclosporine, an immunosuppressive agent widely used in organ transpla ntation, has several undesirable side effects, including gingival hype rplasia, which occurs in up to 70% of patients. Another complication a ssociated with use of cyclosporine and other immunosuppressants is an increased incidence of malignancies. Long-term use of cyclosporine als o is associated with a spectrum of hyperproliferative disorders rangin g from reactive lymphoid hyperplasia to aggressive malignant lymphomas . While cyclosporine-related lymphoproliferative disorders have been w idely reported, they have not been described in the oral cavity as the first manifestation of this disease. We report on two cardiac transpl antation patients with a history of cyclosporine use who presented ini tially with oral symptoms of lymphoproliferative disorder. Both had er ythematous to cyanotic and hyperplastic gingiva. On gingivectomy, the fixed tissue was soft, glistening and tan colored, in contrast to the usual firm, white, cyclosporine-associated, benign gingival fibrous hy perplasia. Histologically, a dense, diffuse infiltrate of lymphoplasma cytoid cells with vesicular nuclei, prominent nucleoli, a moderate amo unt of cytoplasm, and high mitotic activity was observed. Immunocytoch emical studies confirmed that the cells were monoclonal for lambda lig ht chains in one patient and kappa light chains in the other. The cell s from one patient were positive for CD45, while both patients were ne gative for CD20 and all nonhematopoietic antigens tested. Both tissues were strongly positive for Epstein-Barr virus. Morphology and immunoc ytochemistry findings are consistent with a posttransplant lymphoproli ferative disorder. These are the first two reported cases of cyclospor ine-associated posttransplant lymphoproliferative disorders presenting as gingival hyperplasia.