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Liver and intrahepatic bile ducts-nontumor

Transplantation

Post liver transplant lymphoproliferative disorder


Reviewers: Komal Arora, M.D. (see Reviewers page)
Revised: 27 May 2012, last major update May 2012
Copyright: (c) 2004-2012, PathologyOutlines.com, Inc.

General
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● Due to immunosuppressive drugs for solid organ transplantation (including liver), particularly cyclosporine
● Usually presents at 6-17 months post-transplant as systemic illness; only 2-3% of liver grafts are involved
● Tumors usually of host origin
● Strongly associated with EBV
● Also associated with acute rejection in 80% of biopsies, which can be treated even if EBV present (Am J Surg Pathol 2001;25:324, Am J Surg Pathol 2006;30:1604)

Treatment
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● Reduction in dose of tacrolimus or cyclosporine (Leuk Lymphoma 2010;51:1494)

Case reports
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● 61 year old man with hiccups due to post-transplant diffuse large B cell lymphoma (Arch Pathol Lab Med 2003;127:248)
● B cell lymphomas and anaplastic plasmacytoma (Am J Surg Pathol 2000;24:733)
● Distinct EBV+ diffuse large B cell lymphomas in abdomen and brain (Hum Pathol 1999;30:1262)

Micro description
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Early lesions: formerly called plasmacytic hyperplasia; infectious mononucleosis like, composed of small lymphocytes, plasma cells, scattered immunoblasts
Polymorphic lesions: medium sized lymphocytes with mitotic activity, plasma cells, immunoblasts
Monomorphic lesions: resemble high grade lymphoma; most cells are large and plantlike

Micro images
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H&E, CD20, EBV

Additional references
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Hepatol Int. 2011;5:759


Pediatric cases

General
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● All cases related to EBV
● Often involves Waldeyer’s ring
● Favorable prognosis for early lesions and nonmalignant lesions (polymorphous subtype)
● Malignant lesions often diffuse large B cell lymphoma
Poor prognostic factors: 3+ sites of involvement, allograft involvement

Micro images
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Infectious mononucleosis-like lesion


Polymorphous subtype with monotypic light chain expression,
EBV+, diffuse large B cell lymphoma-like lesion


Additional references
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Arch Pathol Lab Med 2001;125:337

End of Liver and intrahepatic bile ducts-nontumor > Transplantation > Post liver transplant lymphoproliferative disorder


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