Lymphoma resembling hodgkin disease after posttransplant lymphoproliferative disorder in a liver transplant recipient

Abstract

Background. Posttransplant Epstein‐Barr virus (EBV)‐associated lymphoproliferative disorders (PTLD) are B‐cell derived tumors of polymorphic to monomorphic histologic type. Hodgkin disease (HD) is not considered part of this spectrum and rarely occurs in the posttransplant population. A liver allograft recipient is reported who had a PTLD develop that resolved after a reduction of immunosuppression. Several years later, the patient had a separate lymphoid tumor develop that resembled HD. The relationship between the two proliferations is analyzed. Methods. Specimens were analyzed for T‐ and B‐cell rearrangements and EBV status by Southern blot hybridization. Immunoperoxidase studies were performed to determine the phenotypic status of the lesions. In situ hybridization for EBV early RNA (EBER) was done to determine the distribution of virus‐positive cells in tissue sections. Results. Unique clonal rearrangements of immunoglobulin genes and EBV were seen in each instance. No evidence of T‐cell receptor rearrangement was observed. EBER positivity was widespread in the PTLD and largely, but not exclusively, limited to the anaplastic cell in the HD‐like tumor. The phenotype of these anaplastic cells was similar to that described for Reed‐Sternberg (RS) cells. Conclusion. The two tumors are unique B‐cell growths associated with separate clones of lymphocytes carrying episomal EBV. Patients with PTLD may be at risk for the continued development of EBV‐associated disorders. Lymphomas resembling HD represent one possible manifestation of this risk.

Hodgkin's disease and B cell lymphoproliferation in rheumatoid arthritis patients treated with methotrexate: A kinetic study of lymph node changes

“…The case of patient 2 illustrates the possible transformation of a monoclonal B cell lymphoproliferation into a monoclonal NHL. This pattern has already been described in a patient treated with cyclosporin A (15). The kinetic studies reported here stress the need for a cautious followup of such patients.…”

Treatment and outcomes of post‐transplant lymphoproliferative disease: A single institution study

“…Although this study included most of the pathologic subtypes of PTLD previously described by Nalesnik et al [22][23][24], Frizzera et al [25], Knowles et al [26] and summarized by Swerdlow [27], including EBV negative forms [18], the small number of cases did not permit an analysis of the relationship between histology and prognosis. Other factors that have shown prognostic significance in immune competent or compromised patients with lymphoma include age, sex, stage, serum LDH, the presence of extranodal disease or presentation with B symptoms.…”

Management of the pediatric liver transplant patient

“…Late-presenting PTLD tends to behave much like a true lymphoma, is frequently difficult to control, and has greater mortality. Hodgkin's lymphoma, T-cell lymphoma, Burkitt's lymphoma, and non-Hodgkin's lymphoma have been described 91 and, in many instances, are associated with the EBV virus.…”