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Lymphoma - Non B cell neoplasms

Post-transplantation lymphoproliferative disorders (PTLD)

Early lesions: plasmacytic hyperplasia (PH) & infectious mononucleosis (IM)-like PTLD


Reviewer: Dragos Luca, M.D. (see Reviewers page)
Revised: 24 October 2011, last major update August 2011
Copyright: (c) 2001-2011, PathologyOutlines.com, Inc.

Definition
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● Lymphoid proliferations in an allograft recipient, characterized by architectural preservation of the involved tissue, with preservation of the nodal sinuses or tonsillar crypts, and residual and sometimes floridly reactive follicles, usually forming mass lesions (WHO Classification, 2008)
● Must exclude other lymphoid proliferations or non-specific inflammatory processes

Clinical features
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● Younger age than other PTLD, often in solid organs with no prior EBV infection
● Involves lymph nodes and tonsils/adenoids more often than extranodal sites
● Frequent spontaneous regression or regression after reduction of immunosuppression
● Poly- or mono-PTLD may follow; IM-like cases may be fatal

Micro description
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● Plasmacytic hyperplasia: numerous plasma cells, small lymphocytes, occasional immunoblasts
● IM-like: paracortical expansion, numerous immunoblasts, background of T-cells & plasma cells, normal architecture may be partially destroyed
● Florid follicular hyperplasia may also occur; criteria not well-defined to distinguish from reactive follicular hyperplasia

Micro images
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Plasmacytic hyperplasia (1A&B)


EBER-ISH (4A)


IM-like PTLD (Multiple images, H&E and IHC)

Immunophenotype
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● Polyclonal B-cells, plasma cells and T-cells with no aberrant biomarkers
● EBV-positive (EBV-LMP1): most plasmcytic hyperplasia and florid follicular hyperplasia cases, and virtually all IM-like cases

Genetics and molecular
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● No clonal rearrangements of the Ig genes
● Small mono- or oligoclonal populations may be detected in IM-like lesions

End of Lymphoma - Non B cell neoplasms > Post-transplantation lymphoproliferative disorders > Early lesions: plasmacytic hyperplasia (PH) & infectious mononucleosis (IM)-like PTLD


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