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Lymphoma - Non B cell neoplasms

Post-transplantation lymphoproliferative disorders - Other


Reviewer: Nat Pernick, M.D. (see Reviewers page)
Revised: 30 October 2011, last major update September 2011
Copyright: (c) 2001-2011, PathologyOutlines.com, Inc.

Post-transplant anaplastic large cell lymphoma

Case reports
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● 14 year old boy with EBV+ anaplastic large T cell lymphoma 14 years after cardiac transplant (Am J Surg Pathol 2004;28:410)
● 68 year old woman with EBV- tumor post-heart/liver transplant (Arch Pathol Lab Med 2003;127:349)

Micro images
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Gastric tumor post-heart/liver transplant


Post-transplant Burkitt lymphoma

Clinical features
=========================================================================

● 5 cases reported (4 men, 1 woman, mean 35 years old, Am J Surg Pathol 2003;27:818)
● Interval averaged 4.5 years
● Presents with high stage disease with generalized lymphadenopathy and bone marrow involvement

Treatment
=========================================================================

● Rituximab or combination chemotherapy led to complete remission

Micro description
=========================================================================

● Burkitt or Burkitt-like morphology with monomorphic intermediate sized tumor cells with a small rim of basophilic cytoplasm, round nuclei and multiple small nuclei, also many tingible-body macrophages giving a typical starry sky pattern
● Touch preparations show deeply basophilic cytoplasm with numerous vacuoles
● Atypical (Burkitt-like) cases have more variability in size and shape

Molecular description
=========================================================================

● C-myc rearrangement, EBV


Post-transplant diffuse large B cell lymphoma

Clinical features
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● Common histologic type of post-transplant monomorphic lymphoma

Case reports
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● 61 year old post liver transplantation (Arch Pathol Lab Med 2003;127:248)

Micro images
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1-CT with multiple liver lesions; 2-diffuse liver involvement by large cells with prominent nucleoli; 3-CD20+; 4-EBV+; pleomorphic atypical lymphoid cells; CD20+


Post-transplant histiocytic sarcoma

Micro images
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Cells with large, irregular nuclei (figure 3)

Positive stains
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● CD68, granzyme B


Post-transplant Hodgkin lymphoma

Clinical features
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● Uncommon type of PTLD
● Most often post renal transplantation
● Almost always EBV+
● CD30+, CD15+ (CD15- cases may exist), CD45-, CD20-
● Rare cases may follow other types of PTLD

Micro description
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● Plasma cells, lymphocytes and eosinophils mixed with Reed-Sternberg or similar appearing cells

Positive stains
=========================================================================

Reed-Sternberg cells - EBV EBER1 by ISH, CD15, CD30, fascin

Negative stains
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● CD45

Molecular description
=========================================================================

● No immunoglobulin gene rearrangements


Post-transplant Hodgkin’s lymphoma-like lymphoproliferative disorder

Description
=========================================================================

● Very rare
● Cases to date involve males, often teenagers
● Similar to Hodgkin lymphoma, but with atypical phenotype
● Nodal or extranodal
● Appears to be a type of B cell post-transplant lymphoproliferative disorder (Arch Pathol Lab Med 2006;130:558)

Treatment
=========================================================================

● Reduce immunosuppression, variable chemotherapy or radiation therapy

Micro description
=========================================================================

● Small to medium lymphoid cells mixed with Reed-Sternberg like cells (large, mono- bi or multinucleated); also histiocytes, plasma cells and rare eosinophils

Micro images
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Reed-Sternberg like-cells are CD30+ (inset), but also CD45+ and CD15- (figure 4)

Positive stains
=========================================================================

● Reed-Sternberg like cells: CD45, CD20, CD79a, EBER; variable CD30; lymphoid cells are B/T cells and often EBER+

Negative expression
=========================================================================

● CD15

Molecular description
=========================================================================

● Immunoglobulin gene rearrangements


Post-transplant MALT-type extranodal marginal zone lymphomas

Clinical features
=========================================================================

● Rare, 5 cases reported at Am J Surg Pathol 2000;24:100
● Mean age 51 years (range, 48-63 years); after heart, liver, kidney transplants; involves stomach (H. pylori+) and parotid gland
● Occurs average 7 years post-transplant
● All tumors reported above were low-grade MALT, EBV negative, non-aggressive


Post-transplant myeloma

Clinical features
=========================================================================

● Rare; 3 cases reported resemble conventional myeloma (Mod Pathol 2004;17:389)

Micro images
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Various images


Post-transplant NK/T cell lymphoproliferative disorders

Clinical features
=========================================================================

● Rare, <100 cases reported; most post-transplant lymphoproliferative disorders are B cell origin
● 20% are associated with Epstein-Barr virus

Case reports of extranodal NK/T cell lymphoma, nasal-type
=========================================================================

● Tumor of hypopharynx in renal transplant recipient (Hum Pathol 2001;32:1264)
● 20 year old woman with EBV+ breast tumor (Mod Pathol 2004;17:125)

Micro description
=========================================================================

● Angiocentric growth of medium to large lymphoid cells with necrosis

Micro images
=========================================================================



Breast tumor after heart transplant


Post-transplant T cell lymphoma of bone marrow

Case reports
=========================================================================

● T-cell large granular lymphocytosis (Am J Clin Pathol 2005;123:196)

Micro description
=========================================================================

● Focal or extensive interstitial involvement of large cells with abundant cytoplasm and prominent nucleoli
● Cellular debris is prominent
● Reduced normal hematopoiesis
● May be difficult to identify without special stains

Positive stains
=========================================================================

● CD2, CD3


End of Lymphoma - Non B cell neoplasms > Post-transplantation lymphoproliferative disorders - Other


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