Skip to main content

Advertisement

SpringerLink
Log in

Three different histological subtypes of Epstein–Barr virus-negative post-transplant lymphoproliferative disorder in a patient with hepatitis C infection

  • Case Report
  • Published:
International Journal of Hematology Aims and scope Submit manuscript

Abstract

We report a rare case in which Epstein–Barr virus (EBV)-negative polymorphic B-cell post-transplant lymphoproliferative disorder (PTLD) and EBV-negative monomorphic T-cell PTLD [anaplastic lymphoma kinase (ALK)-positive anaplastic large cell lymphoma (ALCL)] were observed simultaneously in the same cervical lymph node, 34 months after liver transplantation for hepatitis C liver cirrhosis. Although hepatitis C recurred after 2 months, he had no other complications until PTLD occurred 34 months post-transplantation. The patient underwent reduction of the immunosuppressive drug and rituximab plus cyclophosphamide, doxorubicin, vincristine, and prednisone therapy, and he was considered to have achieved complete remission. However, PTLD recurred, and he died 6 months after the initial diagnosis. Autopsy revealed only EBV-negative monomorphic T-cell PTLD (ALK-negative ALCL) that involved the liver, spleen, bilateral kidneys, stomach, bladder, heart, bone marrow, right ureter, and pons. Thus, recurrent PTLD may show a different histological type from the primary disorder, as PTLD has a multiclonal potentiality that causes various types of lymphomas. Therefore, it may be difficult to predict PTLD-related prognosis from the initial PTLD histological identification.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

References

  1. Swerdlow SH, Campo E, Harris NL, Jaffe ES, Pileri SA, Stein H, editors. WHO classification of tumours of haematopoietic and lymphoid tissues. 4th ed. Lyon: IARC Press; 2008. p. 343–9.

    Google Scholar 

  2. Chen DB, Song QJ, Chen YX, Chen YH, Shen DH. Clinicopathologic spectrum and EBV status of post-transplant lymphoproliferative disorders after allogeneic hematopoietic stem cell transplantation. Int J Hematol. 2013;97:117–24.

    Article  CAS  PubMed  Google Scholar 

  3. Nelson BP, Nalesnik MA, Bahler DW, Locker J, Fung JJ, Swerdlow SH. Epstein–Barr virus-negative post-transplant lymphoproliferative disorders: a distinct entity? Am J Surg Pathol. 2000;24:375–85.

    Article  CAS  PubMed  Google Scholar 

  4. Birkeland SA, Hamilton-Dutoit S. Is posttransplant lymphoproliferative disorder (PTLD) caused by any specific immunosuppressive drug or by the transplantation per se? Transplantation. 2003;76:984–8.

    Article  CAS  PubMed  Google Scholar 

  5. Swerdlow SH. T-cell and NK-cell posttransplantation lymphoproliferative disorders. Am J Clin Pathol. 2007;127:887–95.

    Article  PubMed  Google Scholar 

  6. Morovic A, Jaffe ES, Raffeld M, Schrager JA. Metachronous EBV-associated B-cell and T-cell posttransplant lymphoproliferative disorders in a heart transplant recipient. Am J Surg Pathol. 2009;33:149–54.

    Article  PubMed  Google Scholar 

  7. Yin CC, Medeiros LJ, Abruzzo LV, Jones D, Farhood AI, Thomazy VA. EBV-associated B- and T-cell posttransplant lymphoproliferative disorders following primary EBV infection in a kidney transplant recipient. Am J Clin Pathol. 2005;123:222–8.

    Article  PubMed  Google Scholar 

  8. Chuhjo T, Yachie A, Kanegane H, Kimura H, Shiobara S, Nakao S. Epstein–Barr virus (EBV)-associated post-transplantation lymphoproliferative disorder simultaneously affecting both B and T cells after allogeneic bone marrow transplantation. Am J Hematol. 2003;72:255–8.

    Article  PubMed  Google Scholar 

  9. Nelson BP, Locker J, Nalesnik MA, Fung JJ, Swerdlow SH. Clonal and morphological variation in a posttransplant lymphoproliferative disorder: evolution from clonal T-cell to clonal B-cell predominance. Hum Pathol. 1998;29:416–21.

    Article  CAS  PubMed  Google Scholar 

  10. Hollingsworth HC, Stetler-Stevenson M, Gagneten D, Kingma DW, Raffeld M, Jaffe ES. Immunodeficiency-associated malignant lymphoma. Three cases showing genotypic evidence of both T- and B-cell lineages. Am J Surg Pathol. 1994;18:1092–101.

    Article  CAS  PubMed  Google Scholar 

  11. Euvrard S, Noble CP, Kanitakis J, Ffrench M, Berger F, Delecluse HJ, et al. Brief report: successive occurrence of T-cell and B-cell lymphomas after renal transplantation in a patient with multiple cutaneous squamous-cell carcinomas. N Engl J Med. 1992;327:1924–6.

    Article  CAS  PubMed  Google Scholar 

  12. Frankel AH, Thompson M, Vulliamy T, Williams G, Thomas JA, Crawford DH, et al. A T cell clone in association with an Epstein–Barr virus-related B cell lymphoma. Transplantation. 1991;52:1108–9.

    Article  CAS  PubMed  Google Scholar 

  13. Leon JE, Takahama Junior A, Vassallo J, Soares FA, de Almeida OP, Lopes MA. EBV-associated polymorphic posttransplant lymphoproliferative disorder presenting as gingival ulcers. Int J Surg Pathol. 2011;19:241–6.

    Article  PubMed  Google Scholar 

  14. Mills KC, Sangueza OP, Beaty MW, Raffeld M, Pang CS. Composite B-cell and T-cell lineage post-transplant lymphoproliferative disorder of the lung with unusual cutaneous manifestations of mycosis fungoides. Am J Dermatopathol. 2012;34:220–5.

    Article  PubMed  Google Scholar 

  15. Wu TT, Swerdlow SH, Locker J, Bahler D, Randhawa P, Yunis EJ, et al. Recurrent Epstein–Barr virus-associated lesions in organ transplant recipients. Hum Pathol. 1996;27:157–64.

    Article  CAS  PubMed  Google Scholar 

  16. Nalesnik MA, Jaffe R, Starzl TE, Demetris AJ, Porter K, Burnham JA, et al. The pathology of posttransplant lymphoproliferative disorders occurring in the setting of cyclosporine A-prednisone immunosuppression. Am J Pathol. 1988;133:173–92.

    CAS  PubMed Central  PubMed  Google Scholar 

  17. Cleary ML, Nalesnik MA, Shearer WT, Sklar J. Clonal analysis of transplant-associated lymphoproliferations based on the structure of the genomic termini of the Epstein–Barr virus. Blood. 1988;72:349–52.

    CAS  PubMed  Google Scholar 

  18. Chadburn A, Cesarman E, Liu YF, Addonizio L, Hsu D, Michler RE, et al. Molecular genetic analysis demonstrates that multiple posttransplantation lymphoproliferative disorders occurring in one anatomic site in a single patient represent distinct primary lymphoid neoplasms. Cancer. 1995;75:2747–56.

    Article  CAS  PubMed  Google Scholar 

  19. Dotti G, Fiocchi R, Motta T, Facchinetti B, Chiodini B, Borleri GM, et al. Primary effusion lymphoma after heart transplantation: a new entity associated with human herpesvirus-8. Leukemia. 1999;13:664–70.

    Article  CAS  PubMed  Google Scholar 

  20. Kapelushnik J, Ariad S, Benharroch D, Landau D, Moser A, Delsol G, et al. Post renal transplantation human herpesvirus 8-associated lymphoproliferative disorder and Kaposi’s sarcoma. Br J Haematol. 2001;113:425–8.

    Article  CAS  PubMed  Google Scholar 

  21. Matsushima AY, Strauchen JA, Lee G, Scigliano E, Hale EE, Weisse MT, et al. Posttransplantation plasmacytic proliferations related to Kaposi’s sarcoma-associated herpesvirus. Am J Surg Pathol. 1999;23:1393–400.

    Article  CAS  PubMed  Google Scholar 

  22. Hoshida Y, Li T, Dong Z, Tomita Y, Yamauchi A, Hanai J, et al. Lymphoproliferative disorders in renal transplant patients in Japan. Int J Cancer. 2001;91:869–75.

    Article  CAS  PubMed  Google Scholar 

  23. Aravindan AN, Moger V, Sakhuja V, Kohli HS, Varma N, Jha V. Hepatitis C virus related lymphoproliferative disorder in a renal transplant recipient. Int Urol Nephrol. 2006;38:355–7.

    Article  CAS  PubMed  Google Scholar 

  24. Kinch A, Baecklund E, Backlin C, Ekman T, Molin D, Tufveson G, et al. A population-based study of 135 lymphomas after solid organ transplantation: The role of Epstein–Barr virus, hepatitis C and diffuse large B-cell lymphoma subtype in clinical presentation and survival. Acta Oncol. 2014;53(5):669–79.

    Article  CAS  PubMed  Google Scholar 

  25. Cocco P, Piras G, Monne M, Uras A, Gabbas A, Ennas MG, et al. Risk of malignant lymphoma following viral hepatitis infection. Int J Hematol. 2008;87(5):474–83.

    Article  PubMed  Google Scholar 

  26. Kang J, Cho JH, Suh CW, Lee DH, Oh HB, Sohn YH, et al. High prevalence of hepatitis B and hepatitis C virus infections in Korean patients with hematopoietic malignancies. Ann Hematol. 2011;90:159–64.

    Article  PubMed  Google Scholar 

  27. Costes-Martineau V, Delfour C, Obled S, Lamant L, Pageaux GP, Baldet P, et al. Anaplastic lymphoma kinase (ALK) protein expressing lymphoma after liver transplantation: case report and literature review. J Clin Pathol. 2002;55:868–71.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  28. Lee LY, Harpaz N, Strauchen JA. Posttransplant CD30+ (Ki-1) anaplastic large cell lymphoma: a case report and review of the literature. Arch Pathol Lab Med. 2003;127:349–51.

    PubMed  Google Scholar 

Download references

Conflict of interest

The authors declare no competing financial interests.

Author information

Authors and Affiliations

  1. Department of Laboratory Medicine, Shinshu University Hospital, Shinshu University School of Medicine, Asahi 3-1-1, Matsumoto, Nagano, 390-8621, Japan

    Mikiko Kobayashi & Takayuki Honda

  2. Department of Clinical Laboratories, Nagoya University Hospital, 65 Tsurumai-cho, Showa-ku, Nagoya, Aichi, 466-8560, Japan

    Naoko Asano

  3. Department of Pathology, Laboratory Medicine, Kanazawa Medical University, 1-1 Daigaku, Uchinada, Kahoku, Ishikawa, 920-0293, Japan

    Mana Fukushima

Authors
  1. Mikiko Kobayashi
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Naoko Asano
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Mana Fukushima
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Takayuki Honda
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Takayuki Honda.

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Kobayashi, M., Asano, N., Fukushima, M. et al. Three different histological subtypes of Epstein–Barr virus-negative post-transplant lymphoproliferative disorder in a patient with hepatitis C infection. Int J Hematol 100, 307–311 (2014). https://doi.org/10.1007/s12185-014-1599-6

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s12185-014-1599-6

Keywords

Search

Navigation